Minnesota Administrative Rules

7700.0040 RESPONSIBILITIES OF CONSUMER ASSISTANCE PARTNERS; CONSUMER ASSISTANCE SERVICES.

Subpart 1.

Duties and responsibilities.

As required in Code of Federal Regulations, title 45, section 155.210 (e), consumer assistance partners, at a minimum, must perform the following activities:

A.

maintain expertise in eligibility, enrollment, and program specifications and conduct public education activities;

B.

provide information and services in a fair, accurate, and impartial manner, and this information must acknowledge other health programs;

C.

facilitate enrollment in qualified health plans offered in MNsure;

D.

provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies for any enrollee with a grievance, complaint, or question regarding an enrollee's health plan, coverage, or a determination under such plan or coverage;

E.

provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by MNsure including individuals with limited English proficiency; and ensure accessibility and usability of tools and functions for individuals with disabilities according to the Americans with Disabilities Act and section 504 of the Rehabilitation Act; and

F.

comply with Title VI of the Civil Rights Act of 1964, section 1557 of the Americans with Disabilities Act, and other applicable federal law and regulation.

Subp. 2.

Consumer assistance services.

Consumer assistance partners and insurance producers certified by MNsure shall guide consumers through the application and enrollment process and facilitate access to the range of health coverage options available through MNsure by providing the following services, including but not limited to:

A.

informing consumers of health insurance options and the value of coverage, in addition to reviewing insurance options available through MNsure;

B.

informing individuals of application processes, required documentation, mandated requirements, and any exemption criteria;

C.

providing information and referrals to small employers on enrollment in the Small Business Health Options Program (SHOP) and any tax provisions, including credits and penalties, potentially affecting small employers;

D.

gauging eligibility through MNsure and providing referrals to appropriate support services or programs for further assistance, such as free health clinics;

E.

providing nonmedical referrals, to the extent possible, according to MNsure referral guidance;

F.

explaining program eligibility rules and providing application assistance for Medicaid/CHIP, premium tax credits, and cost-sharing reductions;

G.

assisting with the entry of information into enrollment tools and resources, including final submission of information;

H.

advising American Indians and Alaskan Natives on benefits specified by the Affordable Care Act, such as cost-sharing reductions, income exclusions, special open enrollment periods, and exemption from minimum health care coverage mandate;

I.

addressing questions regarding the submission of eligibility and enrollment verification documentation;

J.

facilitating referrals to insurance producers for individuals and families enrolling in qualified health plans through MNsure and requesting plan enrollment assistance beyond the scope of consumer assistance partners;

K.

facilitating referrals to community organizations, counties, or other appropriate nonprofit or public entities when individuals and families require technical expertise and assistance beyond the scope of the consumer assistance partner or insurance producer;

L.

explaining, discussing, and interpreting coverage and policies with consumers to facilitate plan selection; and

M.

assisting with plan comparison based upon individual priorities, including but not limited to metal tier levels, quality ranges, providers including, but not limited to, specialty care, pharmaceutical, dental and eye care, and total cost estimation including utilization and health status.

Regardless of services listed in this subpart, no consumer assistance partner may provide a service that requires licensure under Minnesota Statutes, chapter 60K, unless the consumer assistance partner has the appropriate licensure under Minnesota Statutes, chapter 60K.

Statutory Authority:

MS s 62V.05; L 2013 c 9 s 14

History:

37 SR 1579

Published Electronically:

July 11, 2013