The Texas Department of Insurance Imposes Stiff Requirements and Background Checks for Health-care Navigators

Texas legislators are concerned with, “safeguarding privacy and keeping personal information out of the wrong hands.”

The Texas Department of Insurance has just proposed new rules for counselors tasked with helping uninsured Texans navigate their way through the complicated process of buying health insurance. The navigators would have to prove their employment eligibility or citizenship, show evidence of financial responsibility and undergo a background check under the new rules proposed by Julia Rathgeber, Texas Insurance Commissioner, on Tuesday.

Additionally, 40 hours of education on Texas-specific Medicaid and privacy standards must be obtained by the navigators. Once completed the navigators will have to prove they have the proper training to guide Texas consumers to the right health plans. However, they are restricted from recommending any specific health benefit plans or being compensated for their services. Navigators are restricted from providing advice on comparative benefits or substantive benefits of the different health plans, the department proposes.

“In Texas, we are being vigilant about safeguarding privacy and keeping personal information out of the wrong hands,” said Rathgeber in a written statement. “These proposed rules address insufficiencies in federal regulations and make the training and qualifications of navigators in our state more readily apparent to consumers and service providers.”

Texas legislature passed a new law this year that required the Texas Department of Insurance to provide a set of rules if they deemed federal guidelines for navigators insufficient, which they did. Rathgeber’s office compiled 64 pages of rules and restrictions in response to the inadequacies. Her office said Texas-specific Medicaid programs and privacy standards were not address in the federal guidelines. The Texas Register will publish the new rules on Friday, a public hearing will be held on December 20th and the Insurance Department will accept public comments until January 6th. Soon after the public comment period ends, the rules will go into effect.

Joanne Peters, a spokesperson for the federal Department of Health and Human Services said, “This is an attempt to add cumbersome requirements to the navigator program and deter groups from working to enroll Americans in coverage in the Health Insurance Marketplace. The navigator program is similar to Medicare counselors, which have existed for years and never faced this kind of scrutiny from Texas. Despite the state’s efforts, we are confident that navigators will continue to help Texans enroll in quality, affordable health coverage.”


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