Cal. Code Regs. tit. 10 § 6706

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 6706 - Training and Certification Standards

(a) All entities who apply to become a PBEE shall have their Authorized Contact and any designees complete certification training for the management of PBEs, prior to any affiliated PBEs carrying out any consumer assistance functions under this Article.

(b) To ensure that all PBEs are knowledgeable about the Individual Exchange, all individuals or entities who carry out enrollment assistance functions shall complete training in the following subjects prior to carrying out any enrollment assistance functions pursuant to this Article:

(1) QHPs (including the metal levels described at 45 C.F.R. § 156.140(b)) and how they operate, including benefits covered, payment processes, rights and processes for appeals and grievances;

(2) The range of Insurance Affordability Programs, including Medi-Cal, and other public programs;

(3) The tax implications of enrollment decisions;

(4) Eligibility requirements for Advanced Premium Tax Credit (APTC), as defined in Section 6410 of Article 2 of this chapter, and cost-sharing reductions, and the impacts of APTC on the cost of premiums;

(5) Contact information for appropriate federal, state, and local agencies for consumers seeking additional information about specific coverage options not offered through the Exchange;

(6) Basic concepts about health insurance and the Exchange; the benefits of having health insurance and enrolling through the Exchange; and the individual responsibility to have health insurance;

(7) Eligibility and enrollment rules and procedures, including how to appeal an eligibility determination;

(8) Providing culturally and linguistically appropriate services;

(9) Ensuring physical and other accessibility for people with a full range of disabilities;

(10) Understanding the Individual Exchange marketplace and differences among health plans;

(11) Privacy and security requirements in 45 CFR § 155.260 for handling and safeguarding consumers' personally identifiable information;

(12) Working effectively with, and not discriminating against, individuals of various racial and ethnic backgrounds, persons with limited English proficiency, people with a full range of disabilities, people of any gender identity, people of any sexual orientation, and vulnerable, rural, and underserved populations;

(13) Customer service standards;

(14) Outreach and education methods and strategies;

(15) Applicable administrative rules, processes and systems related to Exchanges and QHPs; and

(16) PBE voter registration protocol pursuant to Section 6462 of Article 4 of this chapter.

(c) Training pursuant to this Section shall be provided by the Exchange through computer-based training (CBT), or through another method at the discretion of the Exchange on a case by case basis when the CBT is unavailable.

(d) PBEs shall pass a recertification exam testing the subject matter in subdivisions (b)(1)-(16) of this Section, which shall be administered by the Exchange on an annual basis, in order to maintain certification with the Exchange.

Cal. Code Regs. Tit. 10, § 6706

1. New section filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 4-1-2014 as an emergency; operative 4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-26-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014 (Register 2014, No. 26). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
4. New section refiled with amendment of subsections (a), (b), (b)(4) and (d) 10-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 10-2-2014 (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
5. Editorial correction of HISTORY 3 (Register 2014, No. 51).
6. 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 9-30-2016 or the language in the emergency order of 10-2-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
7. Certificate of Compliance as to 10-2-2014 order, including further amendment of section, transmitted to OAL 4-12-2016 and filed 5-23-2016; amendments effective 5-23-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 22).

Note: Authority cited: Section 100504, Government Code. Reference: Section 100503, Government Code; and 45 Code of Federal Regulations, Sections 155.205(d), 155.415, 155.260 and 156.1230.