Md. Code Regs. 14.35.13.04

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

Section 14.35.13.04 - Scope of Authority

A. A certified application counselor may:

(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 certified application counselor may not 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 certified application counselor shall refer the consumer to the Consolidated Services Center or a local agency caseworker.

D. A certified application counselor may not concurrently hold an Individual Exchange navigator certification.

Md. Code Regs. 14.35.13.04

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