5.05 Certified application counselors98

In general. AHS certifies staff and volunteers of state-partner organizations to act as application counselors, authorized to provide assistance to individuals with the application process and during renewal of eligibility. Certification Application counselors are certified by AHS to provide assistance at application and renewal with respect to one, some, or all of the permitted assistance activities, and enter into certification agreements with AHS. To be certified, application counselors must: (i) Be authorized and registered by AHS to provide assistance at application and renewal; (ii) Be effectively trained in the eligibility and benefits rules and regulations governing enrollment in a 95 33 VSA § 1805(17). 96 8 VSA § 4022. 97 45 CFR § 155.20. See, also, 45 CFR §§ 155.220 and 155.221. 98 42 CFR § 435.908; 45 CFR § 155.225. General Provisions and Definitions Part 1 – Page 37 (Sec.5.00, Sub.5.05) QHP and all health-benefits programs operated in Vermont; (iii) Have successfully completed the required training and received a passing score on the certification examination; (iv) Disclose to AHS and potential applicants any relationships the certified application counselor or sponsoring agency has with QHPs or insurance affordability programs, or other potential conflicts of interest; (v) Comply with AHS’s privacy and security standards adopted consistent with § 4.08 and applicable authentication and data security standards; (vi) Agree to act in the best interest of the applicants assisted; (vii) Either directly or through an appropriate referral to the VHC call center, 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. § 12101 et seq. and § 504 of the Rehabilitation Act, as amended, 29 USC § 794; and (viii) Be recertified on at least an annual basis after successfully completing recertification training as required by AHS. Withdrawal of certification. AHS will establish procedures to withdraw certification from individual application counselors, or from all application counselors associated with a particular organization, when it finds noncompliance with the terms and conditions of the application counselor agreement. Duties. Certified application counselors are certified to: Provide information to individuals and employees about the full range of QHP options and health-benefits programs for which they are eligible, which includes providing fair, impartial and accurate information that assists individuals with submitting the eligibility application; clarifying the distinctions among health coverage options, including QHPs; and helping individuals make informed decisions during the health coverage selection process; Assist individuals and employees to apply for coverage in a QHP through VHC and for health-benefits programs; and Help to facilitate enrollment of eligible individuals in QHPs and health-benefits programs. Availability of information; authorization. AHS must establish procedures to ensure that: Individuals are informed, prior to receiving assistance, of the functions and responsibilities of certified application counselors, including that certified application counselors are not acting as tax advisers or attorneys when providing assistance as certified application counselors and cannot provide tax or legal advice within their capacity as certified application counselors; Individuals are able to provide authorization in a form and manner as determined by AHS prior to a certified application counselor obtaining access to personally identifiable information about the individual General Provisions and Definitions Part 1 – Page 38 (Sec.5.00, Sub.5.05) related to the individual's application for, or renewal of, health benefits, and that the organization or certified application counselor maintains a record of the authorization in a form and manner as determined by AHS. AHS will establish a reasonable retention period for maintaining these records; AHS does not disclose confidential individual information to an application counselor unless the individual has authorized the application counselor to receive such information; and Individuals may revoke at any time the authorization provided the certified application counselor. No charge for services. Application counselors may not: Impose any charge on individuals for application or other assistance related to VHC; Receive any consideration directly or indirectly from any health insurance issuer or issuer of stop-loss insurance in connection with the enrollment of any individual in a QHP or a non-QHP; Provide to an applicant or potential enrollee gifts of any value as 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. For purposes of this paragraph, the term gifts includes gift items, gift cards, cash cards, cash and promotional items that market or promote the products or services of a third party, but does not include the reimbursement of legitimate expenses incurred by a consumer in an effort to receive application assistance, such as, but not limited to, travel or postage expenses; Solicit any individual for application or enrollment assistance by going door-to-door or through other unsolicited means of direct contact, including calling an individual to provide application or enrollment assistance without the individual 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 an individual; or Initiate any telephone call to an individual 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 individual and so long as other applicable state and federal laws are otherwise complied with. Non-discrimination and organizations receiving federal funds to provide services to defined populations.99 Notwithstanding the non-discrimination provisions of § 5.01(g), an organization that receives federal funds to provide services to a defined population under the terms of federal legal authorities that participates in the certified application counselor program may limit its provision of certified application counselor services to the same defined population, but must comply with § 5.01(g) with respect to the provision of certified application counselor services to that defined population, If the organization limits its provision of certified application counselor services pursuant to this exception, but is approached for certified application counselor services by an individual who is not included in the defined population that the organization serves, the organization must 99 45 CFR § 155.120(c)(2). General Provisions and Definitions Part 1 – Page 39 (Sec.5.00, Sub.5.05) refer the individual to other AHS-approved resources that can provide assistance. If the organization does not limit its provision of certified application counselor services pursuant to this exception, the organization must comply with § 5.01(g).