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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
financial assistance, Medicaid, the Childrens Health Insurance Program CHIP, and the Basic Health Program.
Currently, pursuant to 155.210e9ii, Navigators in the FFEs are permitted to provide information and assistance to consumers with regard to understanding and applying for exemptions from the individual shared responsibility payment that are granted through the Exchange, understanding the availability of exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment that are claimed through the tax filing process and how to claim them, and understanding the availability of the Internal Revenue Service IRS resources on this topic. We propose to amend 155.210e9ii slightly to reinstitute as a requirement that Navigators in the FFEs must help consumers understand and apply for exemptions from the requirement to maintain minimum essential coverage granted by the Exchange. Although consumers who do not maintain minimum essential coverage no longer need to receive an exemption from the individual shared responsibility payment to avoid having to make such a payment, Navigators can still assist consumers age 30 or above with filing an exemption to qualify to enroll in catastrophic coverage under 155.305h. We believe that this proposal is consistent with Navigators duty under section 1311i3B and C
of the ACA to distribute fair and impartial information concerning enrollment in QHPs, since impartial information concerning the availability of exemptions for consumers age 30 or above to enroll in catastrophic coverage would help consumers make informed decisions about whether or not to enroll in such coverage. This assistance with Exchange-granted exemptions from the requirement to maintain minimum essential coverage would include informing consumers about the availability of the exemption; helping consumers fill out and submit Exchange-granted exemption applications and obtain any necessary forms prior to or after applying for the exemption; explaining what the exemption certificate number is and how to use it; and helping consumers understand and use the Exchange tool to find catastrophic plans in their area.
In addition, we propose to reinstitute as a requirement at 155.210e9iii that Navigators must help consumers with the Exchange-related components of the PTC reconciliation process and with understanding the availability of
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IRS resources on this process. This would include ensuring consumers have access to their Forms 1095A and receive general, high-level information about the purpose of this form that is consistent with published IRS guidance on the topic. This proposal stems from the requirement under section 1311i3B of the ACA that Navigators distribute fair and impartial information concerning the availability of the PTC
under section 36B of the Code.
Consumers who receive premium assistance through APTC may need help with a variety of issues related to the requirement to reconcile the APTC with the PTC allowed for the year of coverage. FFE Navigators would be required to help consumers obtain IRS
Forms 1095A and 8962, and the instructions for both, and to provide general information, consistent with applicable IRS guidance, about the significance of the forms. Navigators would also be required to help consumers understand 1 how to report errors on the Form 1095A; 2 how to find silver plan premiums using the Exchange tool; and 3 the difference between APTC and PTC and the potential implications for enrollment and reenrollment of not filing a tax return and reconciling the APTC paid on consumers behalf with their PTC for the year.
Navigators would still not be permitted to provide tax assistance or advice, or interpret tax rules and forms within their capacity as FFE Navigators.
However, their expertise related to the consumer-facing aspects of the Exchange, including eligibility and enrollment rules and procedures, would uniquely qualify them to help consumers understand and obtain information from the Exchange that is necessary to understand the PTC
reconciliation process. Because this proposal includes a proposed requirement that Navigators provide consumers with information and assistance understanding the availability of IRS resources, Navigators would be expected to familiarize themselves with the availability of materials on irs.gov, including the Form 8962 instructions, IRS Publication 974
Premium Tax Credit, and relevant FAQs, and to refer consumers with questions about tax law to those resources or to other resources, such as free tax return preparation assistance from the Volunteer Income Tax Assistance or Tax Counseling for the Elderly programs.
To help ensure consumers have seamless access to Exchange-related tax information beyond the basic information that Navigators can provide,
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we propose to reinstitute as a requirement at 155.210e9v that FFE Navigators must refer consumers 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, and PTC reconciliations.29
We interpret the Navigator duties to facilitate enrollment in QHPs in section 1311i3C of the ACA, to distribute fair and impartial information concerning enrollment in QHPs under section 1311i3B of the ACA, and to conduct public education activities to raise awareness about the availability of QHPs in section 1311i3A of the ACA to include helping consumers understand the kinds of decisions they will need to make in selecting coverage, and how to use their coverage after they are enrolled. We have previously stated that one of the overall purposes of consumer assistance programs is to help consumers become fully informed and health literate.30
To improve consumers health literacy related to coverage generally, and to ensure that individual consumers are able to use their coverage meaningfully, we propose to reinstitute at 155.210e9iv the requirement that Navigators in the FFEs must help consumers understand basic concepts and rights related to health coverage and how to use it. We also propose to expand our interpretation of this requirement and the activities that fall within its scope. These activities could be supported through the use of existing resources such as the CMS From Coverage to Care initiative, which we encourage Navigators to review, and which are now available in multiple languages at https
marketplace.cms.gov/c2c. This proposal would improve consumers access to health coverage information, not just when selecting a plan, but also when using their coverage.
We believe expanding our interpretation of the requirement that Navigators help consumers understand basic concepts and rights related to health coverage and how to use it and 29 We note that we are not proposing to reinstitute at 155.210e9v the requirement that Navigators must provide referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment in light of the fact that the individual shared responsibility payment was reduced to zero for months beginning after December 31, 2018 under the Tax Cuts and Jobs Act Pub. L. 11597, December 22, 2017.
30 See 79 FR 30276.

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