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Administrative Policy on Navigator Payment

Scope

This policy applies to navigators and certified application counselors (CACs), referred to collectively as assisters in this policy.

Terms and Definitions

Assister Case Association Form:  Form used to associate an assister with a consumer application or enrollment in case evidence in METS.

Assister portal:   Online portal that enables assisters to apply and enroll on behalf of a consumer who has authorized them.

Reference Number:  A unique identification number that allows a consumer to associate with a specific assister through the assister portal. 

METS:  Minnesota Eligibility Technology System 

Policy Details

To ensure navigators and CACs can associate with consumer applications and enrollments.

Assisters are associated with applications and/or enrollments for the following reasons:

  • To comply with federal requirements that assister’s receive authorization prior to obtaining access to an applicant’s personally identifiable information and maintain a record of the authorization in a form and manner as determined by MNsure (45 C.F.R. 155.210(e)(6)(ii).
  • To facilitate the processing of navigator per enrollee payments.
  • To allow processing agencies to release information about the application case to the assister, including the status of the case.

There are four ways an assister can be associated with an application or enrollment:

  1. The assister information is entered on the signature page of the online application.
  2. The consumer associates with an assister through the assister portal. The application and/or enrollment can be completed using the consumer or assister portal.
  3. The assister portion of Appendix C of the Application for Health Coverage and Help Paying Costs (DHS-6696) or Application for Health Coverage (DHS-6741) is completed.  

Procedure for Associating with a Consumer When Submitting an Online Application

  1. In the "MNsure Assister" section of the “Signature” page of the online application, select “Yes” to the question: “Did a MNsure Assister help you with this application?”

  2. Additional fields will pop open. Enter the assister’s nine-digit alpha-numerical Assister ID in the “Assister ID” field and the full name of organization into the “Organization Name” field.

  3. The association information is stored in METS as case evidence:

    Information is viewable to caseworkers (including ARC, MNsure Contact Center, DHS and counties).

    Information is pulled in reports used for processing navigator payments.

Procedure for Associating with a Consumer Through the Assister Portal

  1. Assister provides a consumer their unique Reference Number.

  2. The consumer creates an account or logs into their existing MNsure account.

  3. The consumer clicks on "Manage Assister" on their MNsure.org account's tool bar.

  4. On the Assister Details page, the consumer clicks "Add or change my assister."

  5. On the "Select the Assister Helping You" page, the consumer enters the assister's Reference Number and clicks "Search."

  6. If a valid Reference Number is entered, the "Select the Assister Helping You" page will display the details for the assister in the "Assister Details" section of the page. If the correct assister displays, the consumer clicks "Next." If the consumer does not click "Next," the association will not be processed.

  7. The "Assister Authorization/Agent of Record" screen will display. If the consumer agrees to the terms outlined on the screen, the consumer clicks "Confirm" to associate with the assister.

  8. Once the consumer clicks "Confirm," the assister is now associated with the consumer in METS.

    The association information is pulled in reports used for processing navigator payments.

    The association information is not viewable to caseworkers (including ARC, MNsure Contact Center, DHS and counties).

  9. An application or enrollment can be submitted using either the consumer's account or the assister portal. In either case, there will be an association for purposes of payment.

Procedure for Associating with a Consumer When Submitting a Paper Application

  1. Complete the assister information on Appendix C of the Application for Health Coverage and Help Paying Costs (DHS-6696) or Application for Health Coverage (DHS-6741). The following information should be entered in the section titled: "For certified application counselors, navigators, in-person assisters, agents and brokers only."

    • Application start date

    • Name of applicant

    • Name of assister

    • Assister phone number

    • Organization name (please avoid acronyms)

    • Assister ID Number (nine-digit-alpha-numerical)

  2. When the paper application is entered into METS, the assister information is entered as case evidence:

  3. Information is viewable to caseworkers (including ARC, MNsure Contact Center, DHS and counties).

  4. Information is pulled in report used for processing navigator payments.

Procedure for Associating with a Consumer Using an Assister Case Association Form

  1. This method of association should only be used when none of the previous methods of association were possible. All required fields (*) on the form must be completed or the form will not be processed.

  2. Enter information about the assister in the “From:” section of the Assister Case Association Form.

  3. Enter information about the primary applicant in the “Re:” section of the Assister Case Association Form

    • The name, date of birth and address are all required fields.

    • If a paper application was submitted, the date of application is also a required field.

  4. Enter the name and date of birth for any additional household members applying for coverage or enrolling in a qualified health plan.

  5. Select the reason for using the form (only one reason should be selected):

    • An assister helped a consumer submit a paper Renewal Form for a consumer in a “Need to Renew” status. It is necessary to complete an Assister Case Association Form in these situations because there is no place on the renewal form for an assister to be associated with the renewal.

    • An assister helped a consumer submit a Minnesota Health Care Programs Application for Certain Populations (DHS-3876) paper application. It is necessary to complete an Assister Case Association Form in these situations because there is no place on the DHS-3876 for an assister to be associated with the application.

    • An assister is working with a consumer who submitted an Application for Health Coverage and Help Paying Costs (DHS-6696) or Application for Health Coverage (DHS-6741) and the assister was not listed on Appendix C of the application. Do not submit an Assister Case Association Form if Appendix C of the application was completed (see procedure F).

    • An assister is working with a consumer who submitted an online application through MNsure.org. Do not submit an Assister Case Association Form if the Assister ID and organization was entered on the online application signature page (see procedure D) and/or the assister was associated with the consumer through the assister portal at the time of application (see Procedure E).

    • An assister helped a renewing consumer actively select a qualified health plan (QHP) for the new plan year and there was no association through the assister portal. In most cases, renewing consumers does not need to complete a new application. However, they may need to, or choose to, select a new plan for the new plan year. Do not submit an Assister Case Association Form if the assister was associated with the consumer through the assister portal at the time of application (see Procedure E).

  6. A signature is required from both the assister and the primary applicant. While the Assister Case Association Form is fillable, it will need to be printed to be signed by the assister and the applicant. Electronic signatures are not acceptable.

  7. Submit the form to the ARC by fax or secure email within 30 days. Incomplete forms received by the ARC will not be processed. A new and complete form will need to be submitted to process the association.

References and Related Documents

Assister Case Association Form (PDF)

Navigator Payment policy

Scope

This policy applies to navigators.

Terms and Definitions

Insurance Affordability Program (IAP): Insurance Affordability Programs (IAPs) include Medical Assistance, MinnesotaCare and Advanced Premium Tax Credit (APTC).

Auto Renew: This term applies to those enrolled in an IAP where there was sufficient information available to automatically renew coverage

Need to Renew: This term applies to those enrolled in an IAP where there was not sufficient information to automatically renew coverage. The individual must complete and sign a pre-populated renewal form within 30 days to avoid loss of coverage. 

Passive renewal: This term applies to a consumer who is enrolled in a qualified health plan (QHP) through MNsure for the current plan year and MNsure can automatically renew the consumer into the same QHP for the next plan year. 

Paper application: Unless otherwise specified, paper application refers to the Application for Health Coverage and Help Paying Costs (DHS-6696) and the Application for Health Coverage (DHS-6741).

Policy Details

MNsure will pay navigator organizations for each individual successfully enrolled in an Insurance Affordability Program (IAP) or qualified health plan (QHP) resulting from the submission of an application through MNsure by a certified navigators.

Effective October 1, 2013, the payment rate is:

  • Seventy and 00/100 dollars ($70.00) per successful enrollment in a QHP.
  • Twenty Five and 00/100 dollars ($25.00) per successful enrollment in Medical Assistance (MA).
  • Seventy and 00/100 dollars ($70.00) per successful enrollment in MinnesotaCare.

Payment rates are set by the MNsure board and any changes to the rate must be published in the State Register. Payments are based on the availability of funding.

Navigator organizations are eligible for payments for:

  • An application (online or paper) that results in a QHP determination (with or without assistance).
  • An application (online or paper) that results in a MA enrollment.
  • An application (online or paper) that results in a MinnesotaCare enrollment.
  • A paper Application for Certain Populations (DHS-3876) that results in a MA enrollment.
  • Assisting with the following renewal actions:
    • MA member in a Need to Renew status that results in a successful renewal.
    • MinnesotaCare member in a Need to Renew status that results in a successful renewal.
    • QHP enrollee in a Need to Renew status that results in a successful renewal.
    • QHP enrollee who actively changes plans for the new plan year.

Navigator organization are not eligible for payment for assisting with:

  • MA member that is auto renewed.
  • MinnesotaCare member that is auto renewed.
  • QHP enrollee that passively renews.
  • Reporting life event changes for those enrolled in an IAP.

Procedures

If a certified navigator assists a consumer with submitting an online application through MNsure, the navigator will be associated for the purposes of payment if any one of the following is true:

  • The consumer enters the navigator's Assister ID and organization on the signature page of the online application.
  • The consumer has an active association with the navigator through the assister portal at the time the application is submitted.
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the application submission date.

If a certified navigator assists a consumer with enrolling in a QHP through MNsure (but did not assist with submitting the application, or the consumer was renewing), the navigator will be associated for the purposes of payment if any one of the following is true:

  • The consumer has an active association with the navigator through the assister portal at the time the consumer enrolls in a QHP.
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the consumer enrolling in a QHP.

If a certified navigator assists a consumer with submitting a paper application, including the Application for Certain Populations (DHS-3876), the navigator will be associated for the purposes of payment if any one of the following is true:

  • The navigator completes the assister portion of Appendix C on the paper application (note: this option is not available on the DHS-3876).
  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the application submission date.

If a certified navigator assists a consumer in a Need to Renew status with submitting a renewal form, including the Application for Certain Populations (DHS-3876), the navigator will be associated for the purposes of payment if:

  • The navigator completes an Assister Case Association Form and submits it to the ARC within 30 days of the renewal submission date.

Refer to the Assister Case Association policy for procedures on how to associate with a consumer.

References and Related Documents

Assister Case Association Form (PDF)

Assister Case Association policy

MNsure Grant Services Contract Navigator/In-Person Assister Attachment A (PDF)

MNsure Joint Powers Agreement Navigator/In-Person Assister Attachment A (PDF)

MNsure Grant Services Contract with Tribal Nation Navigator/In-Person Assister Attachment A (PDF)

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