CMS official: ‘We really do see the role of the Navigator and agent and broker as different’

Employee Benefit Adviser reports:

“The Centers for Medicare and Medicaid Services is taking a firm stand on the discussion about how the Navigators’ role varies from brokers and agents — they’re different. After testifying before a hearing Thursday of the U.S. Senate Committee on Health, Education, Labor and Pensions, Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight, part of CMS, told EBA that Navigators will be supplying objective information, while brokers will continue in their role of advising.

“They are not making recommendations, they’re not selling,” Cohen said about Navigators. “Some things are the same; they will [both] provide education and inform people about options available to them. But I think you go to an agent because you want to ask the agent sort of the bottom-line question, ‘what do you think I should do?’ And if a Navigator is asked that question they’re going to say ‘I can’t tell you what to do.’”

He continued to say that CMS is “very eager to have agents and brokers play a significant role in this and we’re confident that they will.” He confirmed what CMS spokespeople have said in recent weeks that information is forthcoming on how brokers will be “able to access the system” and conduct training. Cohen said it will be available “soon.”

Sen. Tom Harkin (D – Iowa), chairman of HELP, said during the hearing that while he is supportive of the Navigator program he takes issue with “how you’re paying for that.” He acknowledged that the matter is above Cohen’s “pay grade” but wants to “send a message that’s we’re not going to accept that.” Harkin explained that “robbing the money from the Prevention Fund … to take money out of that to set up a Navigator system is illogical.” A CMS press secretary said after the hearing that the Prevention Fund is more than $10 billion dog-eared in the Patient Protection and Affordable Care Act for disease prevention.

Cohen also noted during the hearing that Navigators will come from “community organizations in every state ­—­­­ church ­groups, advocacy groups … that already have ties to the community and are serving the community.”

The hearing Thursday was called “A new, open marketplace: the effect of guaranteed issue and new rating rules.” In addition to the chairman, ranking member Sen. Lamar Alexander (R – Tenn.) and several other senators from Wisconsin, Minnesota, Kansas, South Carolina and Rhode Island asked questions mostly pertaining to state level issues.”