5.01 Assistance offered through AHS

In general.76 AHS will provide assistance to any individual seeking help with the application or renewal process in person, over the telephone, and online, and in a manner that is accessible to individuals with disabilities and those who are limited English proficient. Eligibility and enrollment assistance that meets the accessibility standards in paragraph (c) of this subsection is provided, and referrals are made to assistance programs in the state when available and appropriate. These functions include assistance provided directly to any individual seeking help with the application or renewal process. Assistance tools Call center.77 A toll-free call center is provided to address the needs of individuals requesting assistance and meets the accessibility requirements outlined in paragraph (c) of this subsection. The call center will provide individuals with access to a live call center representative during the call center’s published hours of operation who may assist the individuals with filing their applications, including providing information to them on their eligibility for APTC and CSR, facilitating a comparison of QHPs, and helping them complete their applications for submission to AHS. Internet website.78 An up-to-date internet website that meets the requirements outlined in paragraph (c) of this subsection is maintained. The website: (i) Supports applicant and enrollee activities, including accessing information on the health-benefit programs available in the state, applying for and renewing coverage and providing assistance to individuals seeking help with the application or renewal process; (ii) Provides standardized comparative information on each available QHP, which may include differential display of standardized options on consumer-facing plan comparison and shopping tools, 75 45 CFR § 155.270(b). 76 42 CFR § 435.908; 45 CFR § 155.205(d). Note: While the consumer-assistance responsibilities of Medicaid agencies and Exchanges may be distinct, “[s]ome aspects of [the Medicaid agency’s] applicant and beneficiary assistance may be integrated with the consumer assistance tools and programs of the Exchange.” See, CMS “Summary of Proposed Provisions and Analysis of and Responses to Public Comments,” 77 Fed. Reg. 17144, 17166 (Mar. 23, 2011). Vermont has opted to operate one health-benefits assistance call center, serving the needs of all applicants and beneficiaries of health benefits. 77 42 CFR § 435.908; 45 CFR § 155.205(a). 78 Social Security Act § 1943 (42 USC § 1396w-3); 42 CFR § 435.1200(f); 45 CFR § 155.205(b). General Provisions and Definitions Part 1 – Page 26 (Sec.5.00, Sub.5.01) including at a minimum: Premium and cost-sharing information; The summary of benefits and coverage established under § 2715 of the PHS Act; Identification of whether the QHP is a bronze, silver, gold, or platinum level plan as defined by § 1302(d) of the ACA, or a catastrophic plan as defined by § 1302(e) of the ACA; The results of the enrollee satisfaction survey, as described in § 1311(c)(4) of the ACA; Beginning 2015, quality ratings assigned in accordance with § 1311(c)(3) of the ACA; Medical loss ratio information as reported to HHS in accordance with 45 CFR part 158; Transparency of coverage measures reported to VHC during certification; and The provider directory made available to VHC. (iii) Publishes the following financial information: The average costs of licensing required by VHC; Any regulatory fees required by VHC; Any payments required by VHC in addition to fees under paragraphs (b)(2)(iii)(A) and (B) of this subsection; Administrative costs of VHC; and Monies lost to waste, fraud, and abuse. (iv) Provides individuals with information about Navigators as described in § 5.03 and other consumer assistance services, including the toll-free telephone number of the call center required in paragraph (b)(1) of this subsection. (v) Allows for an individual to submit a single, streamlined eligibility application to AHS in accordance with § 52.02 and for AHS to make all determinations of eligibility for enrollment in a QHP and insurance affordability programs in accordance with § 58.00, through the operation of a centralized eligibility and enrollment platform. (vi) Allows a qualified individual to select a QHP in accordance with § 71.00, and allows AHS to maintain records of all QHP enrollments through the operation of a centralized eligibility and enrollment platform. (vii) Makes available by electronic means a calculator to facilitate the comparison of available QHPs after the application of any APTC, premium reductions and any federal or state CSR. General Provisions and Definitions Part 1 – Page 27 (Sec.5.00, Sub.5.01) Accessibility79 Information is provided in plain language and in a manner that is accessible and timely. Individuals living with disabilities will be provided with, among other things, accessible websites and auxiliary aids and services at no cost to the individual, in accordance with the Americans with Disabilities Act and § 504 of the Rehabilitation Act. For individuals with limited English proficiency, language services will be provided at no cost to the individual, including: (i) Oral interpretation, including telephonic interpreter services; (ii) Written translations; (iii) Taglines in non-English languages indicating the availability of language services; and (iv) Website translations. Individuals will be informed of the availability of the services described in this paragraph and how they may access such services. Availability of program information80 The following information is furnished in electronic and paper formats, and orally as appropriate, to all individuals who request it: (i) The eligibility requirements; (ii) Available health benefits and services; and (iii) The rights and responsibilities of individuals. Bulletins or pamphlets that explain the rules governing eligibility and appeals in simple and understandable terms will be published in quantity and made available. Such information is provided in a manner that meets the standards in paragraph (c) of this subsection. Outreach and education.81 Outreach and education activities that meet the standards in paragraph (c) of this subsection to educate consumers about VHC and Vermont’s health-benefits programs to encourage participation will be conducted. 79 42 CFR § 435.905(b); 45 CFR § 155.205(c). 80 42 CFR § 435.905; 45 CFR § 155.205. 81 Social Security Act § 1943 (42 USC § 1396w-3); 45 CFR § 155.205(e). General Provisions and Definitions Part 1 – Page 28 (Sec.5.00, Sub.5.02) Americans with Disabilities Act (ADA).82 As required by the Americans with Disabilities Act, reasonable accommodations and modifications will be made to policies, practices, or procedures when necessary, as determined by the appropriate commissioners or their designees, to provide equal access to programs, services and activities, or when necessary to avoid discrimination on the basis of disability. An individual may appeal the commissioner’s determination regarding necessity to the appropriate fair hearings entity or appeals entity in accordance with departmental regulations governing appeals and fair hearings. Non-discrimination.83 AHS assistance programs and activities will: Comply with applicable non-discrimination statutes; and Not discriminate based on race, color, national origin, disability, age, sex, gender identity or sexual orientation.