Current through Register Vol. 49, No. 13, September 23, 2024
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.
