101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3161

 

Introduced 2/11/2020, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 121/5
215 ILCS 121/10
215 ILCS 121/15
215 ILCS 121/30
215 ILCS 121/35
215 ILCS 121/45
215 ILCS 121/20 rep.
215 ILCS 121/25 rep.
215 ILCS 121/40 rep.

    Amends the Navigator Certification Act. Provides that certified application counselors are subject to the same certification requirements as navigators. Provides that navigators or certified application counselors may not engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice related to the health insurance marketplace or to that individual's or entity's absence of a conflict of interest in connection with the enrollment of any individuals or employees in a particular private health benefit plan. Provides that a navigator or certified application counselor who fails to timely file for certificate renewal shall be charged a late fee in an amount prescribed by the Director of Insurance. Replaces provisions concerning criteria and requirements for entities or individuals applying for a navigator certificate with language allowing the Director of Insurance to establish certification terms and requirements for completed applications and exemptions from certification by rule for navigator or certified application counselor certificates. Revises the meaning of the terms "certified application counselor" and "navigator". Makes other changes. Effective immediately.


LRB101 16275 BMS 66182 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3161LRB101 16275 BMS 66182 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Navigator Certification Act is amended by
5changing Sections 5, 10, 15, 30, 35, and 45 as follows:
 
6    (215 ILCS 121/5)
7    Sec. 5. Definitions. As used in this Act:
8    "Certified application counselor" has the same meaning as
9in federal regulations and guidelines, including 45 CFR
10155.225.
11    "Director" means the Director of Insurance.
12    "Exchange" means any health benefit exchange established
13or operating in this State, including any exchange established
14or operated by the United States Department of Health and Human
15Services.
16    "Navigator" means a person or entity selected to perform
17the activities and duties identified in 42 U.S.C. 18031(i) in
18this State. "Navigator" includes any person or entity who
19receives grant funds from the United States Department of
20Health and Human Services, the State of Illinois, or an
21exchange or private funds to perform any of the activities and
22duties identified in 42 U.S.C. 18031(i), including, but not
23limited to, in-person assisters as defined by federal

 

 

SB3161- 2 -LRB101 16275 BMS 66182 b

1regulations or guidelines.
2(Source: P.A. 98-524, eff. 8-23-13.)
 
3    (215 ILCS 121/10)
4    Sec. 10. Certificate required.
5    (a) No individual or entity shall perform, offer to
6perform, or advertise any service as a navigator or certified
7application counselor in this State or receive navigator grant
8funding from the United States Department of Health and Human
9Services, the State of Illinois, or an exchange or private
10funds unless certified as a navigator or certified application
11counselor by the Director under this Act.
12    (b) The Director may establish exemptions from
13certification by rule. A navigator who complies with the
14requirements of this Act shall do the following:
15        (1) conduct public education activities to raise
16    awareness of the availability of qualified health plans;
17        (2) distribute fair and impartial information
18    concerning enrollment in qualified health plans offered
19    within the exchange and the availability of the premium tax
20    credits under Section 36B of the Internal Revenue Code of
21    1986, 26 U.S.C. 36B, and cost-sharing reductions under
22    Section 1402 of the federal Patient Protection and
23    Affordable Care Act;
24        (3) facilitate enrollment in qualified health plans;
25        (4) provide referrals to appropriate federal and State

 

 

SB3161- 3 -LRB101 16275 BMS 66182 b

1    agencies for any enrollee with a grievance, complaint, or
2    question regarding their health plan or coverage or a
3    determination under such plan or coverage;
4        (5) provide information in a manner that is culturally
5    and linguistically appropriate to the needs of the
6    population being served by the exchange.
7    (c) A navigator or certified application counselor may not:
8        (1) sell, solicit, or negotiate, as these terms are
9    defined in Section 500-10 of the Illinois Insurance Code,
10    any of the classes of insurance enumerated in Section 4 of
11    the Illinois Insurance Code;
12        (2) offer advice about which health plan is better or
13    worse for a particular individual or employer;
14        (3) recommend or endorse a particular health plan or
15    advise consumers about which health plan to choose;
16        (4) provide any information or services related to
17    health benefit plans or other insurance products not
18    offered in the exchange, except for health care providers
19    when furnishing information or services related to a
20    patient's existing health benefit plan or other existing
21    health insurance coverage; or
22        (5) accept any compensation or consideration, directly
23    or indirectly, from any issuer of accident and health
24    insurance or stop-loss insurance that is dependent, in
25    whole or in part, on whether a person enrolls in or
26    purchases a particular private health benefit plan; or .

 

 

SB3161- 4 -LRB101 16275 BMS 66182 b

1        (6) engage in an unfair method of competition or a
2    fraudulent, deceptive, or dishonest act or practice with
3    respect to the health insurance marketplace or with respect
4    to that individual's or entity's absence of a conflict of
5    interest in connection with the enrollment of an individual
6    or employee in a particular private health benefit plan.
7    (d) Items (1), (2), (3), (4), and (5) of subsection (c) of
8this Section do not apply to navigators or certified
9application counselors when assisting individuals with the
10enrollment process in the State Medicaid program or other
11public programs.
12(Source: P.A. 98-524, eff. 8-23-13.)
 
13    (215 ILCS 121/15)
14    Sec. 15. Application for certificate.
15    (a) An entity or individual applying for an initial or
16renewal a navigator or certified application counselor
17certificate shall make application to the Director on a form
18developed by the Director and declare under penalty of refusal,
19suspension, or revocation of the certificate that the
20statements made in the application are true, correct, and
21complete to the best of the individual's or entity's knowledge
22and belief. Before approving the application, the Director
23shall find that the individual:
24        (1) is at least 18 years of age;
25        (2) resides in this State or maintains his or her

 

 

SB3161- 5 -LRB101 16275 BMS 66182 b

1    principal place of business in this State;
2        (3) is not disqualified due to having committed any act
3    that would be grounds for denial, suspension, or revocation
4    of a navigator certification in accordance with Section 30
5    of this Act;
6        (4) has successfully completed the federal and State
7    training provided by the exchange or equivalent State
8    requirements as determined by the Department; and
9        (5) when applicable, has the written consent of the
10    Director pursuant to 18 U.S.C. 1033, or any successor
11    statute regulating crimes by or affecting persons engaged
12    in the business of insurance whose activities affect
13    interstate commerce.
14    (b) The Director shall establish certification terms and
15requirements for completed applications, including educational
16requirements, by rule. An entity that acts as a navigator,
17supervises the activities of individual navigators, or
18receives funding to perform such activities shall obtain a
19navigator entity certificate. An entity applying for a
20navigator entity certificate shall make application on a form
21containing the information prescribed by the Director and shall
22list the individuals acting as navigators under the entity
23certificate.
24        (1) The entity shall designate a certified navigator
25    responsible for the navigator entity's compliance with the
26    laws of this State and the exchange.

 

 

SB3161- 6 -LRB101 16275 BMS 66182 b

1        (2) The entity, under penalty of revocation,
2    suspension, or other discipline prescribed by the
3    Director, shall certify that each individual completes the
4    mandatory training required by item (4) of subsection (a)
5    of Section 15 of this Act.
6    (c) The Director may require any documents deemed necessary
7to verify the information contained in an application submitted
8in accordance with subsections (a) and (b) of this Section.
9    (d) Any navigator or certified application counselor who
10fails to timely file for certificate renewal shall be charged a
11late fee in an amount prescribed by the Director Entities
12certified as navigators shall provide the Director with a list
13of all individual navigators that it employs, supervises, or is
14affiliated with at renewal.
15    (e) The Director may require, in a manner determined by the
16Director, that each entity that acts as a navigator or
17certified application counselor demonstrate a level of
18financial responsibility capable of protecting all persons
19against the wrongful acts, misrepresentations, or negligence
20of the navigator or certified application counselor.
21    (f) Prior to any exchange becoming operational in this
22State, the Director, in coordination with the exchange, shall
23prescribe the initial training and continuing education
24requirements for navigators and certified application
25counselors.
26    (g) Certificate holders must inform the Director, in

 

 

SB3161- 7 -LRB101 16275 BMS 66182 b

1writing, of a change of address within 30 days after the
2change.
3    (h) In order to assist in the performance of the Director's
4duties, the Director may contract with the National Association
5of Insurance Commissioners (NAIC), or any affiliates or
6subsidiaries that the NAIC oversees, to perform any ministerial
7functions, including the collection of fees, related to
8certification that the Director and the nongovernmental entity
9may deem appropriate.
10(Source: P.A. 98-524, eff. 8-23-13.)
 
11    (215 ILCS 121/30)
12    Sec. 30. Certificate denial, nonrenewal, or revocation.
13    (a) The Director may place on probation, suspend, revoke,
14or refuse to issue or renew a navigator or certified
15application counselor navigator's certificate or may levy a
16civil penalty as established by rule.
17    (b) If an action by the Director is to nonrenew, suspend,
18or revoke a certificate or to deny an application for a
19certificate, then the Director shall notify the applicant or
20certificate holder and advise, in writing, the applicant or
21certificate holder of the reason for the suspension,
22revocation, or denial or nonrenewal of the applicant's or
23certificate holder's certificate. The applicant or certificate
24holder may make written demand upon the Director within 30 days
25after the date of mailing for a hearing before the Director to

 

 

SB3161- 8 -LRB101 16275 BMS 66182 b

1determine the reasonableness of the Director's action. The
2hearing must be held within not fewer than 20 days nor more
3than 30 days after the mailing of the notice of hearing and
4shall be held pursuant to Part 2402 of Title 50 of the Illinois
5Administrative Code.
6    (c) A navigator or certified application counselor entity
7certificate may be suspended, revoked, or refused or
8information turned over to the U.S. Department of Health and
9Human Services and applicable state agencies if the Director
10finds, after hearing, that a certified individual's violation
11was known or should have been known by one or more of the
12partners, officers, or managers acting on behalf of the
13navigator entity.
14    (d) In addition to or instead of any applicable denial,
15suspension, or revocation of a certificate, a person may, after
16hearing, be subject to a civil penalty in accordance with
17emergency rules issued by the Director.
18    (e) The Director has the authority to enforce the
19provisions of and impose any penalty or remedy authorized by
20this Act against any person who is under investigation of or
21charged with a violation of this Act or rules, even if the
22person's certificate has been surrendered or has lapsed by
23operation of law.
24    (f) Upon the suspension, denial, or revocation of a
25certificate, the certificate holder or other person having
26possession or custody of the certificate shall promptly deliver

 

 

SB3161- 9 -LRB101 16275 BMS 66182 b

1it to the Director in person or by mail. The Director shall
2publish all suspensions, denials, or revocations after the
3suspensions, denials, or revocations become final in a manner
4designed to notify the public.
5    (g) A person whose certificate is revoked or whose
6application is denied pursuant to this Section is ineligible to
7apply for any certificate for 3 years after the revocation or
8denial. A person whose certificate as a navigator or certified
9application counselor has been revoked, suspended, or denied
10may not be employed, contracted, or engaged in an
11exchange-related capacity during the time the revocation,
12suspension, or denial is in effect.
13(Source: P.A. 98-524, eff. 8-23-13.)
 
14    (215 ILCS 121/35)
15    Sec. 35. Reporting to the Director.
16    (a) Each navigator or certified application counselor
17shall report to the Director within 30 calendar days after the
18final disposition of a matter that violates the provisions set
19forth in this Act that results in any administrative action
20taken against the navigator or certified application counselor
21him in another jurisdiction or by another governmental agency
22in this State. The report shall include a copy of the order,
23consent to order, or other relevant legal documents.
24    (b) Within 30 days after the initial pretrial hearing date,
25a navigator or certified application counselor shall report to

 

 

SB3161- 10 -LRB101 16275 BMS 66182 b

1the Director any criminal prosecution of the navigator or
2certified application counselor of a matter that violates the
3provisions set forth in this Act taken in any jurisdiction. The
4report shall include a copy of the initial complaint filed, the
5order resulting from the hearing, and any other relevant legal
6documents.
7    (c) An entity that is certified acts as a navigator or
8certified application counselor that terminates the
9employment, engagement, affiliation, or other relationship
10with an individual navigator or certified application
11counselor shall notify the Director within 30 days following
12the effective date of the termination, using a format
13prescribed by the Director, if the reason for termination is
14related to the requirements or standards one of the reasons set
15forth in this Act or the rules adopted by the Director pursuant
16to this Act, or the entity has knowledge the navigator or
17certified application counselor was found by a court or
18government body to have engaged in any of the activities
19prohibited by this Act or the rules adopted by the Director
20pursuant to this Act. Upon the written request of the Director,
21the entity shall provide additional information, documents,
22records, or other data pertaining to the termination or
23activity of the individual.
24(Source: P.A. 98-524, eff. 8-23-13.)
 
25    (215 ILCS 121/45)

 

 

SB3161- 11 -LRB101 16275 BMS 66182 b

1    Sec. 45. Other laws; rulemaking authority.
2    (a) The requirements of this Act shall not apply to any
3individual or entity licensed as an insurance producer in this
4State.
5    (b) Pursuant to the authority granted by this Act, the
6Director may adopt rules as may be necessary or appropriate for
7the administration and enforcement of this Act. Such rules may
8not conflict with or prevent the application of the provisions
9of Title I of the Patient Protection and Affordable Care Act or
10the federal regulations promulgated under such provisions.
11(Source: P.A. 98-524, eff. 8-23-13.)
 
12    (215 ILCS 121/20 rep.)
13    (215 ILCS 121/25 rep.)
14    (215 ILCS 121/40 rep.)
15    Section 10. The Navigator Certification Act is amended by
16repealing Sections 20, 25, and 40.
 
17    Section 99. Effective date. This Act takes effect upon
18becoming law.