Aug 27, 2021 — This bulletin provides guidance on the training, certification, and recertification requirements and procedures for assisters in the FFEs. In
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1 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information & Insurance Oversight 200 Independence Avenue SW Washington, DC 20201 Date: August 27, 2021 From: Leslie Wagstaffe, Director, Consumer Support Group Title: CMS Enrollment Assister Bulletin: 2021 -011 Subject: Guidance Regarding Training, Certification, and Recertification for Navigators and Certified Application Counselors in the Federally -facilitated Exchanges I. Purpose In preparation for the Open Enrollment Period beginning November 1, 202 12 for the 2022 pla n year in the individual market, the Centers for Medicare & Medicaid Services (CMS) has updated the annual training curriculum for Navigators and certified application counselors (CACs) in the Federally -facilitated Exchanges (FFEs). This bulletin provides guidance on the training, certification, and recertification requirements and procedures for assisters in the FFEs. In this bulletin, we refer to this training curriculum as the fi 2022 trainingfl and refer collectively to Navigators, CACs, and CAC designated organizations (CDOs) as fiassisters.fl The 2022 training will be delivered through the Marketplace Learning Management System (MLMS), with optional, supplemental training s provided through the Assister Readiness Webinar Series and Marketplace Assister Micro learning modules 3. 1 This communication was printed, published, or produced and disseminated at U.S. taxpayer expense. 2 See 45 C.F.R. § 155.410(e)(3) . Note that for PY 2022 and beyond, CMS has proposed to amend 45 C.F.R. § 155.410(e) to lengthen the annual open enrollment p eriod for coverage through all Exchanges to November 1 through January 15. See, Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyon d; Proposed Rule; (July 1, 2021), 86 FR 35156 at 35167 -68, available at: https://www.govinfo.gov/content/pkg/FR -2021-07-01/pdf/2021 -13993.pdf . 3 You will receive informati on on how to access the Assister Readiness Webinar Series and the Marketplace Assister Microlearning modules through an email from the CMS Assister Listserv. To sign up to receive information on these optional, supplemental training opportunities, as well as the assister newsletters and
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2 II. Certification and Recertification Requirements for Navigators in the FFEs Before carrying out any required or authorized Navigator functions, Navigators in the FFEs must, among other things : 1) Complete training that has been approved by CMS, 4 2) Ach ieve a passing score on all approved certification examinations, 5 3) Obta in continuing education and be certified and/or recertified on at least an annual basis, 6 and 4) Meet any licensing, certification, or other standards prescribed by the State or Exchange , if applicable, so long as such standards do not prevent the application of the provisions of title I of the Affordable Care Act (ACA). 7 Tr aining. All new FFE Navigators must successfully complete all of the required 2022 Navigator training courses in order to be certified by the FFE. Depending on specific factors, as explained below, many returning FFE Navigators may be eligible to complete the abbreviated 2022 Navigator recertification training to be recertified by th e FFE. Returning FFE Navigators are eligible to complete the abbreviated 2022 Navigator recertification training if all of the following criteria are met: 1) They were certified as an FFE Navigator during the 20 20-2021 budget period under an award for the 2 019-2021 CMS Navigator grant period of performance, 2) They remained certified ( were not decertified ) during the entire 2020 -2021 budget period, 3) They are still affiliated with the same CMS Navigator grantee organization with which they were affiliated when they were certified during the 2020 -2021 budget period , and 4) The same CMS Navigator grantee organization received another CMS Navigator grant award for the 2021 -2024 period of performance or wa s approved for a No Cost Extension (NCE) of the period of performance under its 2019 -2021 CMS Navigator grant. webinar call -in information, please send an email to the assister inbox at ASSISTERLISTSERV@cms.hhs.gov . If you are already receiving information through the listserv, then no further action is required. 4 45 CFR 155.21 5(b)(1)(ii). 5 45 CFR 155.21 5(b)(1)(iii). 6 45 CFR 155.21 5(b)(1)(iv). 7 45 CFR 155.210(c)(1)(iii).
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3 FFE Navigators who are eligible to complete the abbreviated 2022 Navigator recertification training will still have access to the full suite of 2022 Navigator training courses and may choose to complete additional training courses if desired. Period of Performance and Navigator Certification . The 2019 -2021 Navigator grant period of performance ends on August 29, 2021 . On that date, the certification for all individual FFE Navigators who were certified du ring the 2020 -2021 budget period will expire unless the CMS Navigator grantee organization with which they were affiliated when they were certified during the 2020 -2021 budget period is selected to receive a new CMS Navigator grant award for the 2021 -2024 period of performance , or is approved for a NCE of the period of performance under its 2019 -2021 CMS Navigator grant . Assisters with an active Plan Year 2021 certification status will expire on October 31, 2021. Returning FFE Navigators must successfully complete either the entire required 2022 Navigator training , or the abbreviated 202 2 Navigator recertification training, and be certified or recertified by the FFE in order to continue performing any Navigator functions after October 31, 202 1. All new an d returning FFE Navigators who successfully complete either the full or abbreviated 202 2 Navigator training will receive a Navigator certificate with an expiration date of October 31, 202 2. This will once again help ensure that all Navigators successfully complete training and are certified/ recertified prior to the individual market Open Enro llment Period for plan year 202 3. Please note, the 202 2 certification of any Navigator working for a CMS Navigator grantee organization that has received a NCE of the period of performance under its 2019-2021 CMS Navigator grant, but has not received a CMS Navigator grant for the 2021-202 4 period of performance, will expire on the same date the organization™s NCE ends. Use of Navigator ID. When registering for the 2022 Navigator training on the MLMS training platform, all individual FFE Navigators should e nsure that they register for and complete the 2022 Navigator certification or recertification training using the unique Navigator ID number assigned to them by the CMS Navigator grantee organization with which they are affiliated. Navigators should use the unique Navigator ID number assigned to them to ensure that the Navigator certificate issued to them reflects their current ID number and their current affiliation with a CMS Navigator grantee organization. Who Can Claim to Be a n FFE-certified Navigator. We remind all CMS Navigator grantees that individual Navigators must not hold themselves out as FFE -certified Navigators, and
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4 must not carry out any Navigator functions (including outreach and education activities), until they have been trained and are ce rtified by the FFE. 8 Additionally, individuals may not hold themselves out as Navigators, or perform Navigator functions in an FFE, unless they are affiliated with a current CMS Navigator grantee and have a current certification that accurately reflects t hat affiliation (or are themselves a current CMS Navigator grantee). III. Certification and Recertification Requirements for Certified Application Counselors (CACs) in the FFEs CMS regulations require that, prior to functioning as a CAC, all CACs in the FFEs m ust , among other things : 1) Successfully complete FFE -approved training, 2) Achieve a passing score on all FFE -approved certification examinations, 3) Obtain a certification from their CDO after successfully completing FFE -approved CAC training, and 4) Meet any licens ing, certification, or other standards prescribed by the State or Exchange , if applicable, so long as such standards do not prevent the application of the provisions of title I of the ACA. 9 The FFEs do not certify individual CACs. CDOs are responsible fo r certifying individual CACs who are associated with the CDO (as specified in the agreements between CMS and CDOs in the FFEs). CACs must enter into an agreement with the CDO that meets the requirements specified at 45 CFR 155.225(d)(6). CACs in the FFEs m ust be recertified by their CDO on at least an annual basis, after successfully completing recertification training. 10 Please note, the 2021 certification of any FFE CAC working for a CDO in a state that will be transitioning from a FFE to a State -b ased Exchange on the Federal Platform (SBE -FP) for the 2022 plan year in the individual market will expire once the state officially 8 See 45 CFR 155.215(b)(1)(i). As noted i n the preamble to the 2017 Payment Notice , finothing in the Exchange regulations prohibits individuals who are not trained and certified as Exchange -approved Navigators–or certified application counselors from conducting outreach about Exchanges and providing application and enrollment assistance. These individuals may of course conduct outreach and education about Exchanges as long as they do not represent themselves as Exchange -approved Navigators–or certified application counselors.fl 81 Fed. Reg. 12204, 12257 (Mar. 8, 2016). 9 We encourage CACs and CDO s to review the standards applicable to CDOs and individual CACs under 45 CFR 155.225(d), including 155.225(d)(1), (d)(7), and (d)(8). 10 45 CFR 155.225(d) (7).
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5 transitions from an FFE to a SBE -FP. SBE -FP CACs will need to complete training and certification requirements as outlined by their state. CAC Roster . Beginning with plan year 2021, all FFE CDOs must create and maintain a roster of their active CACs using the CDO Organizational Maintenance Web Form during their 2 -year certification period with CMS .11 In addition to being a required component of the CDO ™s record with CMS , maintaining an up -to-date roster is necessary for CACs in the FFEs to be able to access the annual certification training on the MLMS. The CDO ™s contact(s), typically the CAC Project Director, must add and maintain a roster of its CACs, which includes the CACs ™ full name s, email address es, and CAC ID s. Once created, CDO s can use their roster to monitor their CACs™ annual assister certification training completion dates from the MLMS. 12 To ensure that the CAC certification requirement is satisfied, CDOs in the FFEs should: 1) Assign each CAC a unique 13 -digit alphanumeric CAC ID number, 2) Maintain a roster of the organization™s CACs using the CDO Organizational Maintenance Web Form , 3) Confirm that the individual who wishes to become a CAC has successfully completed certification training and continues to meet all other certification requirements, and 4) Recertify returning CACs within one year of the date the organization issued the CAC™s current certification. Training . To help establish an annual training and certification cycle that is consistent with the individual market Open Enrollment Period , all CACs who successfully completed the 2021 CAC training received a CAC certificate of training completion with an expiration date of October 31, 2021 . We en courage CDOs in the FFEs to confirm that each of their CACs completes the 2022 CAC training prior to the start of the Open Enrollment Period for the 2022 plan year in the individual market, which begins on November 1, 2021 ,13 even if the CAC is not due for recertification. This will ensure that CACs have received the most up -to-date training to be prepared to provide application 11 CMS typically designates CDOs in the FFEs for a 2 -year period. CDOs in the FFEs are res ponsible for renewing their certification with CMS within a timeframe determined and communicated by CMS, typically every 2 years to remain active and continue providing enrollment assistance services. More information on the CDO renewal process can be fou nd on the technical assistance page of Marketplace.CMS.gov . 12 Additional instructions on how to create and maintain a CAC roster, as well as assign CAC IDs, are available on the technical assistance page of Marketplace.CMS.gov . 13 See supra note 2.
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6 and enrollment assistance during Open Enrollment and assist enrollees through the FFE redetermination and renewal process. NEW F OR 2022 : For the first time, returning FFE CACs are now eligible to complete an abbreviated CAC recertification training. Returning FFE CACs are eligible to complete the 2022 CAC recertification training if all of the following criteria are met: 1) They successfully completed the 2021 FFE CAC training in the MLMS using their unique 13 -digit alphanumeric CAC ID number; 2) They were certified as a CAC by their CDO for the 2021 plan year (active certification status documented on the CDOs roster of CACs), receive d a MLMS training Certificate of Completion from their CDO, and were not decertified during plan year 2021; and 3) They remain affiliated with the same CDO with which they were certified by for plan year 2021. FFE CACs who are eligible to complete the abbrevi ated 2022 recertification training will still have access to the full suite of 2022 CAC training courses and may choose to complete additional training courses if desired. Use of CAC ID Number. CACs must use their unique 13 -digit alphanumeric CAC ID number to access annual certification training on the MLMS. When registering for the 2022 CAC training on the MLMS training platform, all individual CACs should ensure that they register for and complete the 2022 CAC certificatio n or recertification training using the unique CAC ID number assigned to them by the CDO with whom they are affiliated. CACs should use the unique CAC ID number assigned to them to ensure that the CAC certificate issued to them reflects their current ID nu mber and their current CDO affiliation. Prior to registering for the 2022 CAC training, returning CACs should ensure they are using their current CAC ID number. CACs should not register for the 2022 CAC training until they have confirmed with their organization that they are using their current CAC ID. 14 New organizations that apply to become CDOs during CMS™s 2021 Open Season 15 and are approved to operate as CDOs during plan year 2022 should instruct their CACs to 14 Current CAC ID N umbers issued for plan year 2019 or later are formatted as follows: state abbreviation, followed by CDO and a unique number (i.e., MICDO00000000). If an ID contains CAC , it is invalid and the CAC should contact their organizatio n for a new ID number immediately. 15 CMS™s 2021 Open Season began June 1, 202 1 and ends on August 31, 202 1. Organizations interested in providing CAC enrollment assistance to consumers for plan year 2022 must be CDOs and enter into an agreement
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8 approved for a n NCE of the period of performance under its 2019 -2021 CMS Navigator grant. 3. Will a shorter recert ification course offering be available this year for returning FFE CACs ? Yes. For the first time, returning FFE CACs are now eligible to complete an abbreviated CAC recertification training. Returning FFE CACs are eligible to complete the 2022 CAC recertification training if all of the following criteria are met: 1) They successfully completed the 2021 FFE CAC training in the MLMS using their unique 13 -digit alphanumeric CAC ID number; 2) They were certified as a CAC by their CDO for the 2021 plan year (active certification status documented on the CDOs roster of CACs), received a MLMS training Certificate of Completion from their CDO, and were not decertified during plan year 2021; and 3) They remain affiliated with the same CDO with which they were certified by for plan year 2021. 4. What are the FFE Navigator and CAC traini ng courses for 2022 ? How many hours will be needed to complete the training? The 2022 FFE training for Navigators and CACs includes the following courses: Course Title New FFE Navigators and CACs Returning FFE Navigators and CACs 001 Training Overview R R 002 Health Coverage Basics R O 003 Patient Protection and Affordable Care Act Basics R O 004 Privacy, Security, and Fraud Prevention Standards R R 005 Marketplace Assister Essentials R R 006 Serving Vulnerable and Underserved Populations R R 007 Cultural Competence and Language Assistance R R 008 Working with Consumers with Disabilities R R 009 Customer Service Standards and Community Outreach O O
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9 Course Title New FFE Navigators and CACs Returning FFE Navigators and CA Cs 010 Coverage to Care Assistance O O 011 Assister Standard Operating Procedures O O 012 Advanced Marketplace Issues and Technical Support R O 013 Assister Feedback O O R= Required O= Optional FFE Navigators and CACs must successfully complete all of the required courses to become certified. The amount of time it takes to complete the training will vary from person to person. CMS estimates it will take approximately 4 -5 hours for returning FFE Navigators and CACs, and 6 -7 hours for new FFE Navigators and CACs to complete the required web -based training. 5.As an existing CDO in an FFE, do I need to complete and return a new CMS -CDO Agreement each year? No. CDOs are certified for a timeframe determined by CMS, typically a two (2) -year period .16 CDOs that bec ame certified in 201 9 will be due for CDO Renewal in 2021 . Prior to the end of a CDO™s 2 -year certification period , the CMS -CDO Agreement should be renewed if the CDO wishes to continue its CDO functions. CMS will email your CDO contacts when it™s time to renew. In preparation for renewal, ensure your organization contacts and information is up -to-date in the CDO Organizational Maintenance Web Form. 6.As an existing CDO in an FFE, do I need to enter into a new agreement with our organization™s CACs as part of their recertification? No. CMS regulations do not require CDOs to enter into a new agreement with their individual CACs as part of the recertification process. Howe ver, each CDO must ensure that its agreements with individual CACs are consistent with 45 CFR 155.225(d)(6) and the organization™s agreement with CMS. If desired, a CDO may choose to enter into a new agreement with its CACs as part of their 16 The exceptions to the model CMS -CDO Agreement™s typical two -year term are when (1) in the sole and absolute discretion of CMS, thirty days (30) Days™ advance written notice of nonrenewal is provided by CMS to CDO, or the Agreement is terminated pursuant t o Section V of the CMS -CDO Agreement; (2) either CMS or the CDO terminates the CMS -CDO Agreement without cause and for its convenience upon at least thirty (30) days ™ prior written notice to the other Party, where practicable; (3) CMS terminates the CMS -CDO Agreement for cause pursuant to Section V.2 of the CMS -CDO Agreement; or (4) when the CDO rejects an Amendment to the CMS -CDO Agreement pursuant to Section VII. 8 of the CMS -CDO Agreement.
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10 recertificati on in accordance with the organization™s own internal policies and procedures for overseeing the individual CACs it certifies. In addition, a CDO in an FFE should ensure that any agreement it has with its CACs is in effect and has not expired. If the CDO™ s agreement with its CAC has expired, the individual CAC is no longer authorized to serve as a CAC, and the organization must enter into a new agreement in order for the individual to serve as a CAC again, as required by federal regulations at 45 CFR 155.2 25(d)(6). 7. As an individual CAC in an FFE, what do I need to do to get certified by the FFE? The FFEs do not certify or recertify individual CACs. Certification and recertification of individual CACs in the FFEs is the responsibility of the FFE CDOs. Each F FE CDO must assign CAC ID numbers, maintain a CAC roster using the CDO Organizational Maintenance web form, and ensure that all CACs it certifies or recertifies have completed the necessary training requirements, consistent with the CDO™s agreement with CM S. Individual CACs should use their CAC ID to access certification training and check with the CDO they are affiliated with to learn how to report successful completion of required training. Please remember that the official CAC certification is not issue d by the FFEs or by the MLMS training website; it is issued only by the CDO with which the CAC is affiliated. CDOs should use the MLMS training completion date noted on the CAC roster confirm to successful completion of required training. 8. What steps shoul d CDOs in an FFE take to certify or recertify their CACs? FFE CDOs should do all of the following: 1) Have a process in place for identifying individuals who want to be certified or recertified as CACs and evaluating their compliance with: Federal rules gover ning the CAC program, as set forth in 45 CFR 155.225, The terms and conditions of the CAC™s agreement with the organization (for CACs seeking recertification), The organization™s policies and procedures for its CAC activities, and Any applicable state req uirements that do not prevent the application of the provisions of title I of ACA. 2) Ask each person who is fully compliant with these criteria whether he or she is seeking to become certified/recertified.
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11 3) For individuals who would like to be certified/recer tified: Require that the individual disclose to the organization any relationships the individual has with qualified health plans or insurance affordability programs (e.g., Medicaid, CHIP), or other potential conflicts of interest, in accordance with 45 CFR 155.225(d)(2), 17 Assign each CAC a unique 13 -digit alphanumeric CAC ID number , Maintain a roster of the organization ™s CACs using the CDO Organizational Maintenance Web Form , Ensure that the individual takes the 2022 CAC training and provides the organ ization with proof of successful completion (e.g., training completion date on CAC Roster and the training certificate), Enter into an agreement (or if necessary, a new agreement) with the individual that is consistent with 45 CFR 155.225(d)(6) (see FAQ # 6 above), and Issue a new official CAC certificate. 4) If a CDO is fulfilling its duty under 45 CFR 155.225(d)(2) to inform consumers of any relationships the organization has with qualified health plans or insurance affordability programs, or other potential conflicts of interest, by providing this information to consumers through its individual CACs, then the CDO should disclose such relationships to its certified CACs. Each year, the organization should re -disclose such relationships to all of its recertifi ed CACs to ensure that this information is current when a CAC provides this information to consumers ( See 45 CFR 155.225(d)(2) for disclosure requirements). Organizations must not issue any CAC certifications or recertifications until all steps required fo r certification or recertification are completed, including ensuring that individuals take the 2022 CAC training and show proof of successful completion. 17 Organizations should be aware that 45 CFR 155.225(g)(2) establi shes that an individual or entity serving as a CAC or CDO must not receive any consideration directly or indirectly from a health insurance or stop loss insurance issuer in connection with the enrollment of any individuals in a qualified health plan ( QHP ) or non -QHP. In an FFE , however, no health care provider shall be in eligible to operate as a CAC or CAC designated organization solely because it receives consideration from a health insurance issuer for health care services provided.
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