ENROLLED - CORRECTED COPY Page 1 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. ACT No. 635 Regular Session, 2014 HOUSE BILL NO. 764 BY REPRESENTATIVE PEARSON AN ACT1 To amend and reenact R.S. 44:4.1(B)(11), to enact R.S. 22:1566, and to repeal R.S.2 22:753(H)(5), relative to health insurance navigators and similar individuals or3 entities; to provide for definitions; to provide with respect to regulation by the4 commissioner of insurance, including registration or licensing of individuals and5 entities acting as navigators or providing similar services; to authorize the6 commissioner to assess fees and impose penalties; to provide for an exemption from7 the Public Records Law; and to provide for related matters.8 Be it enacted by the Legislature of Louisiana:9 Section 1. R.S. 22:1566 is hereby enacted to read as follows: 10 §1566. Health insurance navigators; definitions11 A. As used in this Section:12 (1) "Commissioner" means the commissioner of insurance.13 (2) "Exchange" means any health benefit exchange established or operating14 in this state, including any exchange established or operated by the United States15 Department of Health and Human Services or any other federal office or agency.16 (3) "Navigator" means any individual or entity who meets at least one of the17 following requirements:18 (a) Receives any funding, directly or indirectly, from an exchange, the state,19 or the federal government to perform any of the activities and duties identified in 4220 U.S.C. 18031(i).21 (b) Is described or designated by an exchange, the state, or any office or22 agency of the federal government, or who could be reasonably described or23 designated as a navigator.24 ENROLLED - CORRECTED COPYHB NO. 764 Page 2 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (c) Is employed by or is a volunteer on behalf of a navigator or navigator1 entity for the purposes of conducting consumer outreach or education, or for the2 purposes of facilitating enrollment in qualified health plans.3 (4) "Non-navigator personnel" means any individual or entity that facilitates4 enrollment of individuals or employers in a health benefit plan or public insurance5 program offered through an exchange and is certified, designated, or reasonably6 described as an in-person assister, enrollment assister, application counselor, or7 application assister.8 B.(1) The legislature finds that regulation of navigators and non-navigator9 personnel, including registration or licensure by the commissioner, to ensure that10 they are properly trained and knowledgeable in the subject matter of individual and11 group health insurance benefit plans and insurance coverages is necessary to avoid12 substantial risk to the health, safety, and welfare of the people of this state.13 (2) Navigators and non-navigator personnel shall be subject to regulation by14 the commissioner as provided in this Section.15 (a) No individual or entity shall act as, offer to act as, or market any service16 as a navigator in this state unless licensed as a navigator by the commissioner17 pursuant to this Section.18 (b) Individuals or entities conducting activities as non-navigator personnel,19 such as in-person assisters, enrollment assisters, application counselors, or20 application assisters, shall register with the commissioner in the manner and form21 prescribed by the commissioner. An entity conducting non-navigator activities may22 register its non-navigator personnel with the commissioner on their behalf.23 (3) The following individuals or entities are exempt from the provisions of24 this Section and shall not be considered navigators or non-navigator personnel:25 (a) Individuals who facilitate enrollment in a health benefit plan without26 receiving any form of direct or indirect compensation or who are employed by an27 employer who directly or indirectly benefits from enrollment in a health benefit plan,28 such as individuals assisting in the enrollment of family members, tutors acting for29 a minor child or acting as a continuing tutor, individuals with the authority to30 ENROLLED - CORRECTED COPYHB NO. 764 Page 3 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. contract on behalf of interdicted persons, or a mandatary with the authority to1 contract on behalf of a principal.2 (b) Employees of an employer who facilitates enrollment in the health3 benefit plan of the employer.4 (c) A licensed insurance producer.5 (d) An attorney in good standing who is licensed or authorized to act as an6 attorney in this state.7 (e) An employee of a health insurance issuer, including a health maintenance8 organization.9 (f) Any individual or entity granted an exemption by the commissioner. For10 the purposes of granting exemptions from the provisions of this Section, the11 commissioner may grant exemptions in a manner and form determined by the12 commissioner.13 C.(1) An individual applying for registration as non-navigator personnel with14 the commissioner shall complete a registration form as prescribed by the15 commissioner.16 (2) Any individual applying for a navigator license shall make application17 to the commissioner on a form prescribed by the commissioner. Such individual18 shall meet each of the following requirements:19 (a) Be at least eighteen years of age.20 (b) Intends to conduct business as a navigator in this state.21 (c) Is not disqualified for having committed any act that would be grounds22 for denial or revocation of an insurance producer license pursuant to R.S. 22:1554.23 (d) Has completed all required training and education prescribed by any24 office or agency of the federal government or by an exchange.25 (e) Has identified the entity licensed as a navigator with which he is26 affiliated and by which he is supervised, if applicable.27 (3) Each entity licensed as a navigator shall, in a manner and frequency28 prescribed by the commissioner, provide the commissioner with an accurate list of29 ENROLLED - CORRECTED COPYHB NO. 764 Page 4 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. all licensed individual navigators that it employs, in addition to completing an1 application for a navigator license.2 (4) A navigator license shall be valid for a period of two years from the date3 the license is issued. The commissioner shall prescribe the form for an application4 for renewal of a license.5 (5) An individual applying for a navigator license shall submit any6 documents that the commissioner deems necessary to verify the information7 contained in a license application, shall submit a full set of fingerprints to the8 commissioner, and shall successfully complete a criminal history and regulatory9 background check as provided for pursuant to this Section.10 (6) For any individual applying for licensure as or licensed as a navigator,11 the commissioner may prescribe any education, training, or examinations in addition12 to education, training, or examinations required by any office or agency of the13 federal government or by an exchange; however, such additional education, training,14 or examinations shall not exceed thirty hours for initial education, training, or15 examinations and fifteen hours per year for continuing educational purposes when16 combined with education, training, or examinations required by any office or agency17 of the federal government or by an exchange.18 D.(1) In order to make a determination of license eligibility for individuals19 applying for a navigator license, the commissioner shall require fingerprints of20 applicants and submit the fingerprints and the fees required to perform the criminal21 history record checks to the Louisiana Bureau of Criminal Identification and22 Information for state and national criminal history record checks. The commissioner23 shall require a criminal history record check on each applicant in accordance with24 this Subsection. The commissioner shall require each applicant to submit a full set25 of fingerprints in order for the commissioner to obtain and receive national criminal26 history records from the Criminal Justice Information Services Division of the27 Federal Bureau of Investigation.28 (2) The commissioner may contract for the collection, transmission, and29 resubmission of fingerprints required under this Subsection. If the commissioner30 ENROLLED - CORRECTED COPYHB NO. 764 Page 5 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. does so, the fee for collecting and transmitting fingerprints and the fee for the1 criminal history record check shall be payable directly to the contractor by the2 applicant. The commissioner may agree to a reasonable fingerprinting fee to be3 charged by the contractor.4 (3) The commissioner shall treat and maintain an applicant's fingerprints and5 any criminal history record information obtained pursuant to this Section as6 confidential, shall apply security measures consistent with the Criminal Justice7 Information Services Division of the Federal Bureau of Investigation standards for8 the electronic storage of fingerprints and necessary identifying information, and shall9 limit the use of records solely to the purposes authorized in this Section. The10 fingerprints and any criminal history record information shall be exempt from the11 Public Records Law, R.S. 44:1 et seq., shall not be subject to subpoena, other than12 a subpoena issued in a criminal proceeding or investigation, shall be confidential by13 law and privileged, and shall not be subject to discovery or admissible in evidence14 in any private civil action.15 E.(1) A navigator may:16 (a) Provide fair and impartial information and services in connection with17 eligibility, enrollment, and program specifications of any health benefit plan issued18 or issued for delivery in this state, including information about the costs of coverage,19 advanced payment of premium tax credits, and cost sharing reductions.20 (b) Facilitate the selection of a health benefit plan offered for sale on an21 exchange.22 (c) Initiate the enrollment process for a health benefit plan offered for sale23 on an exchange.24 (d) Provide referrals to the Department of Insurance or other local, state, or25 federal offices or agencies for any grievance, complaint, or inquiry in connection26 with a health benefit plan or health insurance issuer, including a health maintenance27 organization.28 (e) Carry out any activities required or authorized pursuant to 42 U.S.C.29 18031(i).30 ENROLLED - CORRECTED COPYHB NO. 764 Page 6 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (2) Non-navigator personnel may carry out the functions and duties1 authorized for non-navigator personnel under 45 CFR Part 155 and shall:2 (a) Disclose all conflicts of interest that the non-navigator personnel may3 have with health insurance issuers to enrollees and potential enrollees in a health4 benefit plan.5 (b) Not receive any form of compensation, whether direct or indirect, from6 a health insurance issuer or an issuer of health stop loss insurance if prohibited by7 federal law.8 (c) Not disclose any information obtained in the course of non-navigator9 personnel activities where such information is confidential or protected from10 disclosure by law.11 F. Unless an individual navigator or non-navigator personnel possesses an12 accident and health insurance producer license, no navigator or non-navigator13 personnel shall:14 (1) Sell, solicit, or negotiate a health benefit plan or any form of accident and15 health insurance.16 (2) Engage in any activity that would exclusively require an insurance17 producer license.18 (3) Provide partial advice concerning the benefits, terms, and features of19 health benefit plans or offer advice about which health benefit plan, health insurance20 issuer, or health maintenance organization is better or worse for a particular21 individual or employer.22 (4) Recommend or endorse a particular health benefit plan or health23 insurance issuer or health maintenance organization.24 (5) Provide any plan specific or product specific information or services25 related to any health benefit plan issued or issued for delivery in this state if such26 health benefit plan is not offered for sale on an exchange.27 (6) Disclose any information obtained in the course of navigator activities28 where such information is confidential or protected from disclosure by law.29 ENROLLED - CORRECTED COPYHB NO. 764 Page 7 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (7) Violate any of the provisions of 45 CFR 155.260 or other state or federal1 laws or regulations.2 G.(1) The commissioner may place on probation, suspend, revoke, or refuse3 to issue, renew, or reinstate a navigator license, levy a fine not to exceed five4 hundred dollars for each violation, or take any combination of actions for any one5 or more violations of this Section or R.S. 22:1554 or for other good cause.6 (2) The commissioner may examine and investigate the business affairs and7 records of any navigator to determine whether the individual or entity has engaged8 or is engaging in any violation of the provisions of this Section.9 (3) A navigator entity license may be suspended or revoked, or renewal or10 reinstatement thereof may be refused, or a fine may be levied, with or without a11 suspension, revocation, or refusal to renew a license, if the commissioner finds that12 an individual navigator licensee's violation was known or should have been known13 by the employing or supervising entity and the violation was not reported to the14 commissioner on a timely basis.15 (4) In the event that the commissioner suspends or revokes a navigator16 license, refuses the renewal or reinstatement of a license, or levies a fine, with or17 without suspension, revocation, or refusal to renew a license, the commissioner, in18 accordance and compliance with R.S. 49:961, shall notify the licensee in writing of19 the determination. An aggrieved party affected by the commissioner's decision, act,20 or order may demand a hearing in accordance with Chapter 12 of this Title, R.S.21 22:2191 et seq.22 H.(1) An individual navigator shall report to the commissioner any23 administrative action taken by a governmental agency against him in any jurisdiction24 within thirty calendar days of the final disposition of the matter. This report shall25 include a copy of the order or other relevant legal documents.26 (2) Within thirty days of the initial pretrial hearing date, an individual27 navigator shall report to the commissioner any criminal prosecution of the navigator28 instituted in any jurisdiction. The report shall include a copy of the initial complaint29 filed, the order resulting from the hearing, and any other relevant legal documents.30 ENROLLED - CORRECTED COPYHB NO. 764 Page 8 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (3) An entity that acts as a navigator that terminates the employment,1 engagement, affiliation, or other relationship with an individual navigator shall2 notify the commissioner within thirty days following the effective date of the3 termination, using a format prescribed by the commissioner, if the reason for4 termination is one of the reasons set forth in R.S. 22:1554 or the entity has5 knowledge that the individual navigator was found by a court or governmental6 agency to have engaged in any of the activities set forth in R.S. 22:1554. Upon the7 written request of the commissioner, the entity shall provide additional information,8 documents, records, or other data pertaining to the termination or activity of the9 individual navigator.10 I. The provisions of R.S. 22:1964 and any related rules or regulations shall11 apply to navigators. The activities and duties of navigators shall be deemed to12 constitute transacting the business of insurance.13 J. A navigator that is required to file annual and quarterly progress reports14 or annual financial reports with the Centers for Medicare and Medicaid Services15 shall also file such reports with the commissioner within fifteen days of filing with16 the appropriate federal office or agency.17 K. The commissioner may promulgate such rules and regulations as may be18 necessary or proper to carry out the provisions of this Section. Such rules and19 regulations shall be promulgated and adopted in accordance with the Administrative20 Procedure Act, R.S. 49:950 et seq.21 L. The commissioner may, in addition to his enforcement discretion,22 establish an enforcement moratorium for the provisions of this Section relating to the23 license requirement for navigators, the registration process for non-navigator24 personnel, and any prescribed training, education, or examinations for the purposes25 of properly effectuating the provisions of this Section.26 Section 2. R.S. 44:4.1(B)(11) is hereby amended and reenacted to read as follows:27 §4.1. Exceptions28 * * *29 ENROLLED - CORRECTED COPYHB NO. 764 Page 9 of 9 CODING: Words in struck through type are deletions from existing law; words underscored are additions. B. The legislature further recognizes that there exist exceptions, exemptions,1 and limitations to the laws pertaining to public records throughout the revised2 statutes and codes of this state. Therefore, the following exceptions, exemptions, and3 limitations are hereby continued in effect by incorporation into this Chapter by4 citation:5 * * *6 (11) R.S. 22:2, 14, 31(B), 42.1, 88, 244, 461, 572, 572.1, 574, 618, 732, 752,7 753, 771, 1019.2(B)(5)(a), 1203, 1460, 1466, 1546, 1566(D), 1644, 1656, 1723,8 1927, 1929, 1983, 1984, 2036, 23039 * * *10 Section 3. R.S. 22:753(H)(5) is hereby repealed in its entirety.11 Section 4. If any provision or provisions of this Act or its application to a particular12 circumstance is held to be invalid by a court of competent jurisdiction, the invalidity does13 not affect the other provisions or applications of this Act. A court of competent jurisdiction14 shall properly sever provisions that are held to be invalid, and the valid portions, provisions,15 or applications shall retain full force and effect.16 Section 5. This Act shall become effective upon signature by the governor or, if not17 signed by the governor, upon expiration of the time for bills to become law without signature18 of the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If19 vetoed by the governor, and subsequently approved by the Legislature, this Act shall become20 effective on the day following such approval.21 SPEAKER OF THE HOUSE OF REPRESENTATI VES PRESIDENT OF THE SENATE GOVERNOR OF THE STATE OF LOUISIANA APPROVED: