§ 6864. Roles and Responsibilities.
10 CA ADC § 6864Barclays Official California Code of Regulations
10 CCR § 6864
§ 6864. Roles and Responsibilities.
(1) Provide information to individuals and employees about the full range of QHP options and insurance affordability programs for which they are eligible, which includes providing fair, impartial, and accurate information that assists consumers with submitting the eligibility application; clarifying the distinctions among health coverage options, including QHPs; and helping consumers make informed decisions during the health coverage selection process;
(6) Either directly or through an appropriate referral to assist personnel certified pursuant to Article 8 of this Chapter, provide information in a manner that is accessible to individuals with disabilities, as defined by the Americans with Disabilities Act, as amended, 42 U.S.C. Section 12101 et seq. and Section 504 of the Rehabilitation Act, as amended, 29 U.S.C. Section 794;
(9) 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, 42 U.S.C. § 300gg-93, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
(10) Provide referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Exchange application and enrollment process, exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment, and premium tax credit reconciliations.
(h) To ensure that information provided as part of any Consumer Assistance is culturally and linguistically appropriate to the needs of the population being served, including individuals with limited English proficiency as required by 45 C.F.R. §§ 155.205(c)(2) and 155.225, Certified Application Entities and Certified Application Counselors shall:
(3) Provide consumers with information and assistance in the consumer's preferred language, at no cost to the consumer, including the provision of oral interpretation of non-English languages and the translation of written documents in non-English languages when necessary to ensure meaningful access. Use of a consumer's family or friends as oral interpreters can satisfy the requirement to provide linguistically appropriate services only when requested by the consumer as the preferred alternative to an offer of other interpretive services;
(1) Ensure that any consumer education materials, web sites, or other tools utilized for Consumer Assistance purposes are accessible to people with disabilities, including those with sensory impairments, such as visual or hearing impairments, and those with mental illness, addiction, and physical, intellectual, and developmental disabilities;
(2) Provide auxiliary aids and services for individuals with disabilities, at no cost, where necessary for effective communication. Use of a consumer's family or friends as interpreters can satisfy the requirement to provide auxiliary aids and services only when requested by the consumer as the preferred alternative to an offer of other auxiliary aids and services;
(j) To ensure that no consumer is discriminated against, Certified Application Entities and Certified Application Counselors shall provide the same level of service to all individuals regardless of age, disability, culture, sexual orientation, or gender identity, and seek advice or experts when needed.
(5) Provide gifts, including gift cards or cash or provide promotional items that market or promote the products or services of a third party, to any applicant or potential enrollee as an inducement for enrollment. The value of gifts provided to applicants and potential enrollees for purposes other than as an inducement for enrollment must not exceed nominal value, either individually or in the aggregate, when provided to that individual during a single encounter. The nominal value is equal to or less than $15. Gifts of nominal value may not include beer, wine, liquor, cigarettes, tobacco, or lottery tickets. Gifts, gift cards, or cash may be provided for the purpose of providing reimbursement for legitimate expenses incurred by a consumer in an effort to receive Exchange application assistance, such as, but not limited to, travel or postage expenses;
(6) Solicit any consumer for application or enrollment assistance by going door to door or through other unsolicited means of direct contact, including calling a consumer to provide application or enrollment assistance without the consumer initiating the contact, unless the individual has a pre-existing relationship with the individual Certified Application Counselor or designated organization and other applicable state and federal laws are otherwise complied with. Outreach and education activities may be conducted by going door to door or through other unsolicited means of direct contact, including calling a consumer;
(7) Initiate any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Certified Application Counselor or designated organization has a relationship with the consumer and so long as other applicable state and federal laws are otherwise complied with;
(15) Invite, influence, or arrange for an individual whose existing coverage through an eligible employer-sponsored plan is affordable and provides minimum value, as described in 26 U.S.C. § 36B(c)(2)(C) and in 26 C.F.R. § 1.36B-2(c)(3)(v) and (vi) (July 26, 2017), hereby incorporated by reference, to separate from employer-based group health coverage.
(l) Certified Application Counselors shall report to the Exchange any subsequent arrests for which they have been released on bail or personal recognizance, criminal convictions, and administrative actions taken by any other agency within 30 calendar days of the date of the arrest or final administrative action order.
Credits
Note: Authority cited: Section 100504, Government Code. Reference: Section 100502, Government Code; 26 C.F.R. Section 1.36B-2; 42 C.F.R. Section 436.603; and 45 C.F.R. Sections 155.205, 155.215, 155.225 and 155.260.
History
1. New section filed 7-6-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill (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. Refiling of 7-6-2015 order on 9-1-2016, including new subsections (a)(9)-(10) and (b)(3) and subsection renumbering, as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-1-2016 (Register 2016, No. 36). Senate Bill 833 (Stats. 2016, c. 30) modified Government Code section 100504(a)(6) to extend the date upon which a Certificate of Compliance must be transmitted to OAL; a Certificate of Compliance must be transmitted to OAL by 7-6-2020 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
3. Editorial correction of History 2 (Register 2016, No. 40).
4. Refiling of 7-6-2015 order on 9-21-2017, including amendment of subsections (b)(10)-(11) and (k)(5) and amendment of Note, as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-21-2017 (Register 2017, No. 38). A Certificate of Compliance must be transmitted to OAL by 7-6-2020 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 7-6-2015 order, including amendment of section and Note, transmitted to OAL 4-25-2019 and filed 6-7-2019; amendments operative 6-7-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 23).
6. Editorial correction of History 1 (Register 2019, No. 39).
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 10, § 6864, 10 CA ADC § 6864
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