Bill Text: OR SB356 | 2013 | Regular Session | Introduced

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Bill Title: Relating to navigator qualifications for the Oregon Health Insurance Exchange.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB356 Detail]

Download: Oregon-2013-SB356-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 2459

                         Senate Bill 356

Sponsored by Senator MONROE, Representative TOMEI; Senator
  SHIELDS, Representatives GALLEGOS, HOYLE (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Specifies requirements and code of ethics for navigators for
Oregon Health Insurance Exchange. Requires Oregon Health
Insurance Exchange Corporation to adopt rules to implement
requirements.

                        A BILL FOR AN ACT
Relating to navigator qualifications for the Oregon Health
  Insurance Exchange; creating new provisions; and amending ORS
  741.002.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + (1) As used in this section, 'client' means an
individual, family or employer who is enrolled in or seeking
enrollment in a qualified health plan offered through the Oregon
Health Insurance Exchange.
  (2) The Oregon Health Insurance Exchange Corporation shall
adopt by rule qualifications for the certification of navigators
under ORS 741.002 (1)(j) that includes, but is not limited to,
the following requirements:
  (a) A certified navigator may not receive any financial benefit
or other compensation from any person that employs or contracts
with insurance producers to enroll individuals or groups in the
health insurance exchange.
  (b) A certified navigator shall disclose to every client,
orally and in writing, whether and to what extent any member of
the navigator's immediate family receives a financial benefit or
other compensation from any person that employs or contracts with
an insurance producer.
  (c) Certified navigators shall have:
  (A) Educational backgrounds or training that would demonstrate
their ability to recognize the extent to which the structures and
values of a culture may oppress, marginalize or alienate
individuals or may create or enhance the privilege and power of
individuals;
  (B) The ability to eliminate the influence of personal biases
and values in working with diverse groups;
  (C) The ability to recognize and communicate an understanding
of the importance of diversity in shaping life experiences; and
  (D) The ability to view themselves as learners and to engage
the clients with whom the navigators work.

  (3) The corporation shall adopt by rule a code of ethics for
navigators that includes, but is not limited to, the following
standards:
  (a) A certified navigator may not participate in, condone or be
associated with dishonesty, fraud, deceit or misrepresentation.
  (b) A certified navigator may not misrepresent the navigator's
qualifications, education, experience or affiliations.
  (c) A certified navigator must report to the corporation as
soon as practicable, but not later than 10 days after:
  (A) Being convicted of a misdemeanor or felony;
  (B) Being arrested for a felony crime;
  (C) Receiving notice of a civil lawsuit that names the
navigator as a defendant and makes allegations related to the
navigator's duties as a navigator; or
  (D) Being admitted to a hospital or day treatment facility for
psychiatric treatment.
  (d) If a certified navigator has reasonable cause to believe
that another navigator has engaged in prohibited conduct, the
navigator must report the conduct to the corporation without
undue delay, but in no event later than 10 days after learning of
the conduct.
  (e) A certified navigator may not violate the trust of clients.
  (f) A certified navigator may not work with clients in a manner
that creates a risk of exploiting clients for financial gain.
  (g) A certified navigator may not provide inappropriate or
unnecessary services to clients.
  (h) A certified navigator must provide clients with accurate
and complete information regarding the nature and extent of
services available, including the risks, rights, opportunities
and obligations associated with the provision of services.
  (i) A certified navigator must seek consultation or make a
referral whenever the consultation or referral may improve the
provision of services and is in the best interest of the client.
  (j) A certified navigator may not attempt to provide services
to clients if the services are beyond the navigator's area of
competence, training and qualifications.
  (k) A certified navigator must terminate services to a client
when the services are no longer required or no longer meet the
client's needs or interests.
  (L) A certified navigator must notify a client if the navigator
anticipates the termination or interruption of services and must
provide for transfer, referral or continuation of service in
accordance with the client's needs and preferences.
  (m) A certified navigator must respect the privacy of clients
and hold in confidence information obtained in the course of
contact between a client and the navigator.
  (n) A certified navigator must inform clients fully about the
limits of confidentiality. + }
  SECTION 2. ORS 741.002, as amended by section 1, chapter 38,
Oregon Laws 2012, and section 88, chapter 107, Oregon Laws 2012,
is amended to read:
  741.002. (1) The duties of the Oregon Health Insurance Exchange
Corporation are to:
  (a) Administer a health insurance exchange in accordance with
federal law to make qualified health plans available to
individuals and groups throughout this state.
  (b) Provide information in writing, through an Internet-based
clearinghouse and through a toll-free telephone line that will
assist individuals and small businesses in making informed health
insurance decisions, including:
  (A) The grade of each health plan as determined by the
corporation and the grading criteria that were used;
  (B) Quality and enrollee satisfaction ratings; and
  (C) The comparative costs, benefits, provider networks of
health plans and other useful information.

  (c) Establish and make available an electronic calculator that
allows individuals and employers to determine the cost of
coverage after deducting any applicable tax credits or
cost-sharing reduction.
  (d) Using procedures approved by the corporation's board of
directors and adopted by rule by the corporation under ORS
741.310, screen, certify and recertify health plans as qualified
health plans according to federal and state standards and ensure
that qualified health plans provide choices of coverage.
  (e) Decertify or suspend, in accordance with ORS chapter 183,
the certification of health plans that fail to meet federal and
state standards in order to exclude them from participation in
the exchange.
  (f) Promote fair competition of carriers participating in the
exchange by certifying multiple health plans as qualified under
ORS 741.310.
  (g) Grade health plans in accordance with criteria established
by the United States Secretary of Health and Human Services and
by the corporation.
  (h) Establish open and special enrollment periods for all
enrollees, and monthly enrollment periods for Native Americans in
accordance with federal law.
  (i) Assist individuals and groups to enroll in qualified health
plans, including defined contribution plans as defined in section
414 of the Internal Revenue Code and, if appropriate, collect and
remit premiums for such individuals or groups.
  (j) Facilitate community-based assistance with enrollment in
qualified health plans by awarding grants to entities that are
certified as navigators as described in 42 U.S.C. 18031(i) { +
and in accordance with rules adopted under section 1 of this 2013
Act + }.
  (k) Provide information to individuals and employers regarding
the eligibility requirements for state medical assistance
programs and assist eligible individuals and families in applying
for and enrolling in the programs.
  (L) Provide employers with the names of employees who end
coverage under a qualified health plan during a plan year.
  (m) Certify the eligibility of an individual for an exemption
from the individual responsibility requirement of section 5000A
of the Internal Revenue Code.
  (n) Provide information to the federal government necessary for
individuals who are enrolled in qualified health plans through
the exchange to receive tax credits and reduced cost-sharing.
  (o) Provide to the federal government:
  (A) Information regarding individuals determined to be exempt
from the individual responsibility requirement of section 5000A
of the Internal Revenue Code;
  (B) Information regarding employees who have reported a change
in employer;
  (C) Information regarding individuals who have ended coverage
during a plan year; and
  (D) Any other information necessary to comply with federal
requirements.
  (p) Take any other actions necessary and appropriate to comply
with the federal requirements for a health insurance exchange.
  (q) Work in coordination with the Oregon Health Authority, the
Oregon Health Policy Board and the Department of Consumer and
Business Services in carrying out its duties.
  (2) The corporation may sue and be sued.
  (3) The corporation may:
  (a) Acquire, lease, rent, own and manage real property.
  (b) Construct, equip and furnish buildings or other structures
as are necessary to accommodate the needs of the corporation.
  (c) Purchase, rent, lease or otherwise acquire for the
corporation's use all supplies, materials, equipment and services
necessary to carry out the corporation's duties.
  (d) Sell or otherwise dispose of any property acquired under
this subsection.
  (e) Borrow money and give guarantees to finance its facilities
and operations.
  (4) Any real property acquired and owned by the corporation
under this section shall be subject to ad valorem taxation.
  (5) The corporation may not borrow money or give guarantees
under subsection (3)(e) of this section unless the obligations of
the corporation are payable solely out of the corporation's own
resources and do not constitute a pledge of the full faith and
credit of the State of Oregon or any of the revenues of this
state. The State Treasurer and the State of Oregon may not pay
bond-related costs for an obligation incurred by the corporation.
A holder of an obligation incurred by the corporation does not
have the right to compel the exercise of the taxing power of the
state to pay bond-related costs.
  (6) The corporation may adopt rules necessary to carry out its
mission, duties and functions.
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