Section 6664 - Roles and Responsibilities(a) Certified Enrollment Entities and Certified Enrollment Counselors shall perform the following functions: (1) Maintain expertise in eligibility, enrollment, and program specifications. Individuals and entities registered under the Navigator Program must also conduct outreach and education to raise awareness about the Exchange;(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 and services shall include assistance with all other insurance affordability programs (e.g., Medicaid and Children's Health Insurance Programs);(3) Facilitate selection of a QHP;(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;(6) Prior to receiving access to any consumer's personally identifiable information as defined in Section 6650 of Article 8, the Certified Enrollment Counselor shall: (A) Inform the consumer that the Certified Enrollment Counselor must obtain his or her authorization prior to accessing any personally identifiable information;(B) Inform each consumer of the roles and responsibilities of the Certified Enrollment Counselor as set forth in Section 6664, subdivisions (a)(1)-(5), (7);(C) Obtain oral or written authorization from the consumer to access the consumer's personally identifiable information; 1. Written authorization shall contain a consumer's signature and a written attestation completed by the Certified Enrollment Counselor affirming under penalty of perjury that the Certified Enrollment Counselor: i. Is a Certified Enrollment Counselor affiliated with a Certified Enrollment Entity in the Navigator program as defined in Section 6650;ii. Conveyed all the information required under this subdivision to the consumer in a language and manner which he or she understands; andiii. Obtained written authorization from the consumer consenting to the release of his or her personally identifiable information in order to fulfill the duties as described in Section 6664.2. Oral authorization shall be accompanied by a written attestation completed by the Certified Enrollment Counselor affirming under penalty of perjury that the Certified Enrollment Counselor: i. Is a Certified Enrollment Counselor affiliated with a Certified Enrollment Entity in the Navigator program as defined in Section 6650;ii. Conveyed all the information required under this subdivision to the consumer in a language and manner which he or she understands; andiii. Obtained oral authorization from the consumer consenting to the release of his or her personally identifiable information in order to fulfill the duties as described in Section 6664.(D) Inform the consumer that the Certified Enrollment Counselor cannot choose a health insurance plan on the consumer's behalf;(E) Inform the consumer that the Certified Enrollment Counselor will provide the consumer with information regarding the health insurance options and insurance affordability programs for which he or she may be eligible;(F) Inform the consumer that his or her personally identifiable information will be kept private and secure in accordance with 45 C.F.R. § 155.260;(G) Inform the consumer that if the Certified Enrollment Counselor cannot assist the consumer, he or she will refer the consumer to another Certified Enrollment Counselor or the Covered California call center;(H) Inform the consumer that the Certified Enrollment Counselor will not charge a fee in exchange for performing the duties described in Section 6664;(I) Inform the consumer that the assistance is based only on the information provided by the consumer, and if the information given is inaccurate or incomplete, the Certified Enrollment Counselor may not be able to offer assistance;(J) Inform the consumer that the authorization set forth in Section 6664, subdivision (a)(6)(C), may be revoked at any time; and(K) Maintain a record of such authorization for a minimum of ten (10) years.(7) Ensure that voter registration assistance is available in compliance with Chapter 6 of the California Elections Code;(8) For Certified Enrollment Entities only, maintain a physical presence in the state of California so that face-to-face assistance can be provided to applicants and enrollees;(9) Provide information regarding the process of filing Exchange eligibility appeals;(10) Provide referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Exchange application and enrollment process, exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment, and premium tax credit reconciliations;(11) Inform each consumer that Certified Enrollment Entities and Certified Enrollment Counselors are not acting as tax advisors or attorneys when providing enrollment assistance and cannot provide tax or legal advice within their capacity as a Certified Enrollment Entity or Certified Enrollment Counselor;(12) Provide targeted assistance to serve underserved or vulnerable populations, as identified by the Exchange, within the Exchange service area; and(13) 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 as required by 45 C.F.R. §§ 155.205(c)(2) and 155.210(e)(5), Certified Enrollment Entities and Certified Enrollment Counselors shall: (1) Develop and maintain general knowledge about the racial, ethnic, and cultural groups in their service area, including each group's diverse cultural health beliefs and practices, preferred languages, health literacy, and other needs;(2) Collect and maintain updated information to help understand the composition of the communities in the service area, including the primary languages spoken;(3) Provide consumers with information and assistance in the consumer's preferred language, at no cost to the consumer, including the provision of oral interpretation of non-English languages and the translation of written documents in non-English languages when necessary to ensure meaningful access. Use of a consumer's family or friends as oral interpreters can satisfy the requirement to provide linguistically appropriate services only when requested by the consumer as the preferred alternative to an offer of other interpretive services;(4) Provide oral and written notice to consumers with limited English proficiency informing them of their right to receive language assistance services and how to obtain them;(5) Receive ongoing education and training in culturally and linguistically appropriate service delivery; and(6) Implement strategies to recruit, support, and promote a staff that is representative of the demographic characteristics, including primary languages spoken, of the communities in their service area.(c) To ensure that Consumer Assistance is accessible to people with disabilities, Certified Enrollment Entities and Certified Enrollment Counselors shall: (1) Ensure that any consumer education materials, websites, or other tools utilized for Consumer Assistance purposes are accessible to people with disabilities, including those with sensory impairments, such as visual or hearing impairments, and those with mental illness, addiction, and physical, intellectual, and developmental disabilities;(2) Provide auxiliary aids and services for individuals with disabilities, at no cost, where necessary for effective communication. Use of a consumer's family or friends as interpreters can satisfy the requirement to provide auxiliary aids and services only when requested by the consumer as the preferred alternative to an offer of other auxiliary aids and services;(3) Provide assistance to consumers in a location and in a manner that is physically and otherwise accessible to individuals with disabilities;(4) Ensure that legally authorized representatives are permitted to assist an individual with a disability to make informed decisions; and(5) Acquire sufficient knowledge to refer people with disabilities to local, state, and federal long-term services and support programs when appropriate.(d) To ensure that no consumer is discriminated against, Certified Enrollment Entities and Certified Enrollment Counselors shall provide the same level of service to all individuals regardless of age, disability, culture, sexual orientation, or gender identity and seek advice or experts when needed.(e) Certified Enrollment Counselors shall complete the Certified Enrollment Entity and Certified Enrollment Counselor section of a consumer's application to the Exchange, including the following: (1) Name and certification number of the Certified Enrollment Counselor;(2) Name of the Certified Enrollment Entity and the Certified Enrollment Entity Number; and(3) Signature and date of signature by the Certified Enrollment Counselor;(f) If any of the information listed in subdivision (e) of this Section is not included on the consumer's original application, it may not be added at a later time.(g) Certified Enrollment Counselors shall wear the badge issued by the Exchange at all times when providing Consumer Assistance.(h) The Certified Enrollment Entity and Certified Enrollment Counselor shall never: (1) Have a conflict of interest as defined in Section 6666;(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 any 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);(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 U.S.C. § 36B(c)(2)(C)) and in 26 C.F.R. § 1.36B-2(c)(3)(v) and (vi), to separate from employer-based group health coverage;(11) Provide gifts, including gift cards or cash or provide promotional items that market or promote the products or services of a third party, to any applicant or potential enrollee as an inducement for enrollment. The value of gifts provided to applicants and potential enrollees for purposes other than as an inducement for enrollment must not exceed nominal value, either individually or in the aggregate, when provided to that individual during a single encounter. The nominal value is equal to or less than $15. Gifts of nominal value may not include beer, wine, liquor, cigarettes, tobacco, or lottery tickets. Gifts, gift cards, or cash may be provided for the purpose of providing reimbursement for legitimate expenses incurred by a consumer in effort to receive Exchange application assistance, such as, but not limited to, travel or postage expenses;(12) Use Exchange funds to purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant or potential enrollee;(13) 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 Enrollment Counselor or Certified Enrollment Entity and other applicable State and Federal laws are otherwise complied with. Outreach and education activities may be conducted by going door-to-door or through other unsolicited means of direct contact, including calling a consumer; or(14) Initiate 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 Enrollment Counselor or Certified Enrollment Entity has a relationship with the consumer and so long as other applicable State and Federal laws are otherwise complied with.(i) Certified Enrollment Counselors shall report to the Exchange any subsequent arrests for which they have been released on bail or personal recognizance and criminal convictions, received by the Exchange in accordance with Section 6456, subdivision (c), and administrative actions taken by any other agency, within 30 calendar days of the date of each occurrence.Cal. Code Regs. Tit. 10, § 6664
1. New section filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2014, No. 7).
3. New section filed 2-10-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 5-12-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be repealed by operation of law on the following day.
5. New section, including new subsections (a)(6)-(a)(6)(K) and subsection renumbering, refiled 7-21-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats 2014, c. 31); operative 7-21-2014 (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
6. Refiling of 7-21-2014 action on 12-12-2014, including further amendment of section and NOTE, as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats 2014, c.31); operative 12-12-2014 (Register 2014, No. 50). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
7. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 2-10-2017 or the language in the emergency order of 12-12-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
8. Certificate of Compliance as to 7-21-2014 order, including further amendment of section, transmitted to OAL 11-6-2015 and filed 12-23-2015 (Register 2015, No. 52).
9. Redesignation of former subsections (a)(6)(K)(1)-(2) as subsections (a)(7)-(8), amendment of newly designated subsection (a)(8), new subsections (a)(9)-(12), subsection renumbering and amendment of subsection (h)(11) filed 12-12-2016 as an emergency; operative 12-12-2016 (Register 2016, No. 51). Pursuant to Government Code section 100504, this is a deemed emergency. A Certificate of Compliance must be transmitted to OAL by 12-12-2021 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (a)(6) and (a)(6)(K) filed 3-7-2018; operative 3-7-2018 pursuant to Government Code section 11343.4(b)(3) (Register 2018, No. 10).
11. Editorial correction of HISTORY 9 (Register 2021, No. 13).
12. Certificate of Compliance as to 12-12-2016 order, including amendment of subsections (a)(6)(F) and (a)(7), transmitted to OAL 8-27-2021 and filed 10-7-2021; amendments effective 10-7-2021 pursuant to Government Code section 11343.4(b)(3) (Register 2021, No. 41). Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 1043, 100502 and 100503, Government Code; and 45 C.F.R. §§ 155.205, 155.210, 155.215 and 155.260.
1. New section filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2014, No. 7).
3. New section filed 2-10-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 5-12-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be repealed by operation of law on the following day.
5. New section, including new subsections (a)(6)-(a)(6)(K) and subsection renumbering, refiled 7-21-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats 2014, c. 31 ); operative 7-21-2014 (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
6. Refiling of 7-21-2014 action on 12-12-2014, including further amendment of section and Note, as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats 2014, c. 31 ); operative 12/12/2014 (Register 2014, No. 50). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
7. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 2-10-2017 or the language in the emergency order of 12-12-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
8. Certificate of Compliance as to 7-21-2014 order, including further amendment of section, transmitted to OAL 11-6-2015 and filed 12-23-2015 (Register 2015, No. 52).
9. Redesignation of former subsections (a)(6)(K)(1)-(2) as subsections (a)(7)-(8), amendment of newly designated subsection (a)(8), new subsections (a)(9)-(12), subsection renumbering and amendment of subsection (h)(11) filed 12-12-2016 as an emergency; operative 12-12-2016 (Register 2016, No. 51). A Certificate of Compliance must be transmitted to OAL by 12-12-2021 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (a)(6) and (a)(6)(K) filed 3-7-2018; operative 3/7/2018 pursuant to Government Code section 11343.4(b)(3) (Register 2018, No. 10).