Section 6906 - Roles and Responsibilities(a) Certified Medi-Cal Managed Care Plans and Certified Medi-Cal Managed Care Plan Enrollers shall perform the following functions: (1) Maintain expertise in eligibility, enrollment, and Exchange program specifications;(2) Provide information and services in a fair, accurate, and impartial manner, which includes: providing information that assists consumers with submitting the eligibility application; clarifying the distinctions among health coverage options, including QHPs; and helping consumers make informed decisions during the health coverage selection process. Such information must acknowledge the existence of other health programs (i.e., Medi-Cal and Children's Health Insurance Programs);(3) Facilitate selection of a QHP and/or insurance affordability programs;(4) Provide referrals to any applicable office of health insurance Consumer Assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, 42 U.S.C. § 300gg-93, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage;(5) Comply with the privacy and security requirements in 45 C.F.R. § 155.260 (September 6, 2016), hereby incorporated by reference;(6) Ensure that voter registration assistance is available in compliance with section 6462 of Article 4 of this Chapter; and(7) Comply with any applicable federal or state laws and regulations.(b) To ensure that information provided as part of any Consumer Assistance is culturally and linguistically appropriate to the needs of the population being served, including individuals with limited English proficiency, a Certified Medi-Cal Managed Care Plan and its affiliated Certified Medi-Cal Managed Care Plan Enrollers shall comply with the requirements of section 6664(b)(1) through (b)(6) of Article 8.(c) To ensure that Consumer Assistance is accessible to people with disabilities, Certified Medi-Cal Managed Care Plans and affiliated Certified Medi-Cal Managed Care Plan Enrollers shall comply with the requirements of section 6664(c)(1) through (c)(5) of Article 8.(d) To ensure that no consumer is discriminated against, Certified Medi-Cal Managed Care Plans and Certified Medi-Cal Managed Care Plan Enrollers shall provide the same level of service to all individuals regardless of age, disability, culture, sexual orientation, or gender identity and seek advice of experts when needed.(e) Certified Med-Cal Managed Care Plan Enrollers shall complete the Certified Enrollment Counselor section of a consumer's application to the Exchange, including the following: (1) Name and certification number of the Certified Medi-Cal Managed Care Plan Enroller.(2) Name of the Certified Medi-Cal Managed Care Plan and the Certified Medi-Cal Managed Care Plan Number: and(3) Signature and date of signature by the Certified Medi-Cal Managed Care Plan Enroller.(f) If any of the information listed in subdivision (e) of this section is not included on the consumer's original application, it shall not be added at a later time.(g) Certified Medi-Cal Managed Care Plan Enrollers shall wear the badge issued by the Exchange at all times when providing assistance pursuant to this Article.(h) The Certified Medi-Cal Managed Care Plan and Certified Medi-Cal Managed Care Plan Enroller shall never: (1) Have a conflict of interest as defined in section 6907;(2) Mail the paper application for the consumer;(3) Coach the consumer to provide inaccurate information on the application regarding income, residency, immigration status and other eligibility rules;(4) Coach or recommend one plan or provider over another;(5) Accept and premium payments from the consumer;(6) Input any premium payment information on behalf of the consumer;(7) Pay any part of the premium or any other type of consideration to or on behalf of the consumer;(8) Induce or accept any type of direct or indirect remuneration from the consumer;(9) Intentionally create multiple applications from the same household, as defined in 42 C.F.R. § 435.603(f) (November 30, 2016), hereby incorporated by reference;(10) Invite, influence, or arrange for an individual whose existing coverage through an eligible employer-sponsored plan is affordable and provides minimum value, as described in 26 USC § 36B(c)(2)(C)) and in 26 C.F.R. § 1.36B-2(c)(3)(v) and (vi) (July 26, 2017), hereby incorporated by reference, to separate from employer-based group health coverage;(11) Solicit any consumer for application or enrollment assistance by going door-to-door or through other unsolicited means of direct contact, including calling a consumer to provide application or enrollment assistance without the consumer initiating the contact, unless the consumer has a pre-existing relationship with the individual Certified Medi-Cal Managed Care Plan Enroller or Certified Medi-Cal Managed Care Plan and other applicable State and Federal laws are otherwise complied with; or(12) Initiated any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Certified Medi-Cal Managed Care Plan Enroller or Certified Medi-Cal Manged Care Plan has a relationship with the consumer and so long as other applicable State and Federal laws are otherwise complied with.(i) Certified Medi-Cal Managed Care Plan Enrollers shall report to the Exchange any subsequent arrests for which they have been released on bail or personal recognizance and criminal convictions, in accordance with section 6456(c) of Article 4, and administrative actions taken by any other agency, within 30 calendar days of the date of the arrest or final administrative action order.(j) Certified Medi-Cal Managed Care Plans shall notify the Exchange of any change in Contact information for the Certified Medi-Cal Managed Care Plan or its Certified Medi-Cal Managed Care Plan Enrollers.Cal. Code Regs. Tit. 10, § 6906
1. New section filed 3-12-2020; operative 3-12-2020 pursuant to Government Code section 11343.4(b)(3) (Register 2020, No. 11). Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 26 C.F.R. Section 1.36B-2; and 45 C.F.R. Section 155.260.
1. New section filed 3-12-2020; operative 3/12/2020 pursuant to Government Code section 11343.4(b)(3) (Register 2020, No. 11). For prior history, see Register 2019, No. 39.