Navigating the Navigator: Senate Bill 324

By Evie Zois Sweeney
Muchmore Harrington Smalley & Associates
Senior Lobbyist

April 2013 – The newest chapter in Michigan’s journey with the Patient Protection and Affordable Act (ACA) was unveiled on April 17, 2013 when a bill sponsored by Senator Jim Marleau (R), Lake Orion was introduced in the Michigan Senate. Senate Bill 324 defines the role of the “navigator,” prescribes certain powers and authority to the director of the Department of Insurance and Financial Services and establishes a licensing and training program for a prospective navigator. The bill also stipulates what a navigator is prohibited from doing. If passed by the state legislature, it will become a significant piece of legislation for those most interested in the state’s implementation of the ACA.

The ACA describes the navigator role as an entity that has “existing relationships or could readily establish relationships, with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan.” Eligible entities could include trade, industry and professional associations, community and consumer focused nonprofit groups, chambers of commerce and licensed insurance agents and brokers, to name just a few.

Senate Bill 324 requires a navigator to be licensed in order to receive funding from an exchange.

The bill also specifies that a navigator may do all of the following:
A)    Conduct public education activities to raise awareness of the availability of qualified health plans.
B)    Distribute fair and impartial general information concerning enrollment in all qualified health plans offered within the exchange and the availability of the premium tax credit.
C)    Facilitate enrollment in qualified health plans, without suggesting that an individual select a particular plan.
D)    Provide referrals to appropriate state agencies for an enrollee with a grievance, complaint, or question regarding the enrollee’s health plan, coverage or a determination under such plan coverage.
E)    Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the exchange.

In addition to identifying the functions a navigator is prohibited from engaging in (a link to the bill in its entirety is provided below), the legislation also grants the director of the Department of Insurance and Financial Services the ability to refuse, suspend or revoke a navigator license (of a person or business entity) if the director considers it necessary to protect insureds and the public. The legislation also identifies various violations warranting suspension or revocation.

Senate Bill 324 was referred to the Senate Health Policy committee where it awaits a hearing. The bill in its entirety can be viewed at: http://www.legislature.mi.gov/documents/2013-2014/billintroduced/Senate/pdf/2013-SIB-0324.pdf.