Indiana Navigator - IN.gov

1 Indiana Navigator training Resource Manual Version (as of June 18, 2014) Published by: Indiana Department of Insurance 311 West Washington Street Indianapolis, Indiana 46204 *IMPORTANT DISCLAIMER* Content contained in this manual is subject to change due to ongoing changes in federal and state laws and regulations. If course providers use this manual as a resource, they are expected to know if any discrepancies exist, and if so, take proper steps to ensure that their students receive the most accurate, up-to-date information that will enable them to properly serve as Indiana navigators .

2 Indiana Navigator training Resource Manual Table of Contents Version (as of June 18, 2014) Page 2 of 298 Table of Contents Table of Contents .. 2 Index of Tables .. 10 Index of Figures .. 12 I. Consumer Assistance Basics .. 13 A. Chapter Objectives .. 13 B. Key Terms .. 13 C. Introduction to Consumer Assistance .. 17 D. Federally-mandated Consumer Assistants .. 17 1. Federal navigators .. 18 a. Definition and Purpose of Federal navigators .. 18 b. Federal Navigator Roles and Responsibilities.

3 18 c. Becoming a Federal Navigator .. 19 d. Federal navigators serving Hoosiers State Requirements .. 20 2. Certified Application Counselors .. 20 a. Definition and Purpose of Certified Application Counselors .. 20 b. Certified Application Counselors - Roles and Responsibilities .. 21 c. Becoming a Certified Application Counselor .. 21 d. Certified Application Counselors Serving Hoosiers State Requirements .. 22 3. Non- Navigator Assistance Personnel .. 22 a. Definition and Purpose of Non- Navigator Assistance Personnel .. 22 b. Non- Navigator Assistance Personnel Roles and Responsibilities.

4 23 c. Becoming Non- Navigator Assistance Personnel .. 23 d. Non- Navigator Assistance Personnel serving Hoosiers State requirements .. 24 E. State of Indiana Roles and Responsibilities with Consumer Assistance .. 24 1. State Role in the Certification/Registration and Re-certification/Re-registration processes .. 25 a. State monitoring and oversight .. 25 b. State enforcement actions .. 25 2. Indiana navigators and Application Organizations Requirements for Completing Certification and Registration .. 26 a. Requirements Proscribed by State Legislation.

5 27 b. Consequences for Not Meeting Requirements .. 28 F. State-certified Consumer 28 1. Who needs to be certified as an Indiana Navigator or Application Organization?.. 28 2. Application Organizations .. 30 a. Application Organization Roles and Responsibilities .. 30 b. Becoming an Application Organization .. 32 Indiana Navigator training Resource Manual Table of Contents Version (as of June 18, 2014) Page 3 of 298 i. Becoming an Application Organization - Registration.

6 32 ii. Becoming an Application Organization Conflict of Interest .. 33 iii. Becoming an Application Organization Privacy and Security .. 34 c. Obtaining and Maintaining Application Organization registration - Reporting Requirements . 34 d. Maintaining Application Organization Registration: Renewal .. 36 3. Indiana navigators .. 37 a. Indiana Navigator roles and responsibilities .. 37 b. Becoming an Indiana Navigator - Application .. 38 c. Becoming an Indiana Navigator - Precertification training and Certification Exam .. 40 d. Maintaining Indiana Navigator Certification.

7 41 e. Indiana Navigator Certification Renewal .. 42 f. Options and requirements for Indiana Navigator Applicants .. 42 g. State limitations for Indiana navigators .. 44 i. Conflict of Interest Policy .. 44 aa. Financial Conflict of Interest .. 44 bb. Conflict of Loyalty .. 45 cc. Changes in Potential or Actual Conflicts of Interest .. 46 dd. Conflict of Interest Disclosure Form .. 46 ii. Additional requirements for federally-designated entities .. 46 iii. Receiving compensation .. 46 iv. Privacy & Security Agreement and Confidentiality Standards.

8 47 v. Advice on Plan Selection .. 48 4. Health Insurance Producers, Agents, and Brokers .. 49 Source: (2014), Difference between Health Insurance Agents and Brokers, .. 50 G. Ethics for Indiana navigators and Application Organizations .. 50 1. Ethical Standard: Commitment to clients .. 51 2. Ethical Standard: Self-determination .. 51 3. Ethical Standard: Informed consent .. 52 4. Ethical Standard: Competence .. 52 5. Ethical Standard: Cultural competence .. 53 6. Ethical Standard: Conflicts of interest .. 53 7. Ethical Standard: Privacy and confidentiality.

9 53 8. Ethical Standard: Access to records .. 54 9. Ethical Standard: Professional conduct .. 54 H. Vulnerable and Underserved populations .. 55 1. Serving different cultures and languages (CLAS Standards) .. 55 2. Serving persons with disabilities .. 57 Indiana Navigator training Resource Manual Table of Contents Version (as of June 18, 2014) Page 4 of 298 II. Medicaid Basics and Indiana Health Coverage Programs (IHCPs) .. 59 A. Chapter Objectives .. 59 B. Key Terms.

10 59 C. Introduction .. 65 D. Overview of Indiana Health Coverage Programs .. 65 1. Hoosier Healthwise .. 65 2. Healthy Indiana Plan .. 66 a. Hoosier Healthwise & HIP - Managed Care Entities .. 68 3. Care Select .. 70 4. Traditional Medicaid (Fee-for-Service) .. 72 5. Works .. 73 6. 590 Program .. 75 7. Home & Community Based Services Waivers (HCBS) .. 75 a. Behavioral and Primary Healthcare Coordination Program .. 77 8. Medicare Savings Program .. 78 9. Family Planning Eligibility Program .. 79 10. Spend Down .. 81 11. Breast and Cervical Cancer Program.