(a) All entities who apply to become a Certified Application Entity shall complete training for the management of Certified Application Entities prior to any affiliated Certified Application Counselors carrying out any Consumer Assistance functions.
(b) All Certified Application Counselors shall complete training in the following subjects prior to carrying out any Consumer Assistance functions under this article:
(1) QHPs (including the metal levels described at 45 C.F.R. § 156.140(b) (April 18, 2017), hereby incorporated by reference) and how they operate, including benefits covered, payment processes, rights and processes for appeals and grievances, and contacting individual plans;
(2) The full range of insurance affordability programs, including Medicaid, the Children's Health Insurance Program, and other public programs;
(3) The tax implications of enrollment decisions;
(4) Eligibility requirements for premium tax credits and cost-sharing reductions, and the impacts of premium tax credits on the cost of premiums;
(5) Contact information for appropriate federal, state, and local agencies for consumers seeking additional information about specific coverage options not offered through the Exchange;
(6) Basic concepts about health insurance and the Exchange and the benefits of having health insurance and enrolling through an Exchange;
(7) Eligibility and enrollment rules and procedures, including how to appeal an eligibility determination;
(8) Providing culturally and linguistically appropriate services;
(9) Ensuring accessibility for people with any disability;
(10) Understanding differences among health plans;
(11) Privacy and security standards applicable under 45 C.F.R. § 155.260 (September 6, 2016), hereby incorporated by reference, for handling and safeguarding consumers' personally identifiable information;
(12) Working effectively with individuals with limited English proficiency, people with disabilities, people of any gender identity, people of any sexual orientation, and vulnerable, rural, and underserved populations;
(13) Customer service standards;
(14) Outreach and education methods and strategies;
(15) Applicable administrative rules, processes, and systems related to Exchanges and QHPs;
(16) Procedures for assisting consumers with voter registration in compliance with Section 6462 of Article 4; and
(17) The individual responsibility to have health insurance.
(c) Training shall be provided by the Exchange through instructor-led training or computer-based training.
(d) In order to maintain certification with the Exchange, Certified Application Counselors shall annually pass an exam administered by the Exchange testing the subjects in subdivision (b) of this section. Certified Application Counselors must complete training within 30 days of enrolling in the recertification course.
Credits
Note: Authority cited: Section 100504, Government Code. Reference: Section 100502, Government Code; and 45 C.F.R. Sections 155.225, 155.260 and 156.140.
History
1. New section filed 7-6-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, c. 18); operative 7-6-2015 (Register 2015, No. 28). A Certificate of Compliance must be transmitted to OAL by 7-6-2018 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
2. Editorial correction of History 1 (Register 2018, No. 37).
3. New section filed 6-7-2019; operative 6-7-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 23).
4. Editorial correction of History 1 (Register 2019, No. 39).
This database is current through 4/26/24 Register 2024, No. 17.
