Md. Code Regs. 14.35.12.04

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.12.04 - Scope of Authority

A. A designated application counselor sponsoring entity may employ or engage certified application counselors to:

(1) Provide information to consumers about the full range of qualified health plan and qualified dental plan options and insurance affordability programs, including advance premium tax credits and cost-sharing subsidies, the Maryland Medical Assistance Program, and the Maryland Children's Health Program, for which they are eligible;

(2) Assist consumers with the application process for determining eligibility for insurance affordability programs, including advance premium tax credits and cost-sharing subsidies, the Maryland Medical Assistance Program, and the Maryland Children's Health Program;

(3) Facilitate plan selection and enrollment of eligible individuals in qualified health plans, qualified dental plans, and access to advance premium tax credit and other cost-sharing subsidies; and

(4) Provide to consumers uniform, factual, and unbiased information approved by the Maryland Medical Assistance Program about all participating managed care organizations, including report cards, lists of enhanced benefits and covered services, and participating providers.

B. A designated application counselor sponsoring entity may not permit certified application counselors to:

(1) Enroll Maryland Medical Assistance Program/Maryland Children's Health Program eligible individuals into managed care organizations; or

(2) Express a personal or professional assessment about which Maryland Medical Assistance Program/Maryland Children's Health Program managed care organization may be most appropriate for an eligible individual, may not make a managed care organization selection on the applicant's behalf and may not otherwise counsel an applicant about the selection of a managed care organization.

C. If a Maryland Medical Assistance Program/Maryland Children's Health Program eligible consumer seeks further counseling or additional assistance in choosing a managed care organization, a designated application counselor sponsoring entity shall instruct the certified application counselor to refer the consumer to the Consolidated Services Center or to a local agency caseworker.

D. An Individual Exchange connector entity may also be a designated application counselor sponsoring entity only under the following conditions:

(1) No agent, employee, or volunteer of the Individual Exchange connector entity may hold more than a single certification as either an Individual Exchange navigator or a certified application counselor;

(2) All Individual Exchange connector entity grant funds must be wholly segregated from certified application counselor program funding, if applicable;

(3) No certified application counselor may be compensated in whole or in part from Individual Exchange connector entity grant funding, and no Individual Exchange navigator may be compensated in whole or in part from application counselor program funding, if applicable; and

(4) All utilities, computer systems, and other components of operations which are utilized jointly by both the Individual Exchange connector and application counselor programs, including executive and administrative staff, shall be cost allocated as directed by the Maryland Health Benefit Exchange and Maryland Department of Health in relation to the percentage of consumers served by the entity who are determined eligible for Maryland Medical Assistance Program/Maryland Children's Health Program, advance premium tax credits, or cost-sharing subsidies, and who are enrolled in qualified health plans and managed care organizations.

Md. Code Regs. 14.35.12.04

Regulation .04 adopted effective 42:11 Md. R. 726, eff.6/8/2015; amended effective 47:12 Md. R. 597, eff. 6/15/2020