Ill. Admin. Code tit. 50 § 4500.140

Current through Register Vol. 48, No. 43, October 25, 2024

Section 4500.140 - State Awards for Navigators and In-Person Counselor Organizations, and Certifications for Certified Application Counselor Organizations and Certified Application Counselors

a) The Exchange will offer State awards for Navigators and certifications to Certified Application Counselor Organizations. The Exchange may elect to offer State awards for In-Person Counselors. The Exchange may delegate the administration of its agreements, certifications, or State awards under this Section to an eligible entity as allowed under 45 CFR 155.110(a) through (b) (Mar. 27, 2012) (no later editions or amendments).

b) As required by Section 50 of GATA, for all State awards under this Part, the Exchange hereby incorporates by reference 2 CFR 200, Subparts A through F and Appendices I through XII as those provisions of the Code of Federal Regulations were in effect on January 12, 2024 (no later editions or amendments).

1) The terminology equivalences listed at 44 Ill. Adm. Code 7000.200(b)(1) apply to the incorporation of 2 CFR 200.

2) Copies of the materials incorporated by reference are available for inspection at the Illinois Department of Insurance, 320 West Washington Street, Floor 4, Springfield, Illinois 62767 and online via the U.S. Government Publishing Office at http://www.ecfr.gov.

3) The Exchange or its designee may submit a request for specific exceptions or exemptions from GATA. Those exceptions or exemptions granted by the Grant Accountability and Transparency Unit within the Illinois Governor's Office of Management and Budget will be recorded in the Catalog of State Financial Assistance. This subsection (b)(3) does not apply when different provisions are required by State or federal law.

c) To receive, renew, or maintain a State award as a Navigator or In-Person Counselor, an entity or individual must:

1) for Navigators, meet the criteria in 45 CFR 155.210(c)(1) (Apr. 27, 2023) (no later editions or amendments), including having an active certification from the Department under 50 Ill. Adm. Code 4515;

2) for In-Person Counselors, have an active certification from the Department under 50 Ill. Adm. Code 4515;

3) comply with the applicable conflict-of-interest standards in 45 CFR 155.215(a) (Apr. 25, 2019) (no later editions or amendments);

4) not engage in any conduct or hold any status prohibited under 45 CFR 155.210(d);

5) comply with the applicable cultural, linguistic, and accessibility standards in Section 4500.160(b);

6) enter an agreement to perform and in fact perform the duties described in 45 CFR 155.210(e);

7) comply with any other requirements or standards specified in the NOFO, grant agreement, or cooperative agreement, as applicable; and

8) for new and renewed grants, satisfactorily complete the following application process:

A) pursuant to 44 Ill. Adm. Code 7000.320, registration with the State of Illinois, prequalification, and being determined "qualified" as described in 44 Ill. Adm. Code 7000.70;

B) pursuant to 44 Ill. Adm. Code 7000.330, submission of the uniform grant application and uniform budget template;

C) pursuant to 44 Ill. Adm. Code 7000.350, receipt of a successful determination under the merit review process; and

D) any other applicable requirements under the GATA and 44 Ill. Adm. Code 7000.

d) To receive, renew, or maintain certification by the Exchange as a Certified Application Counselor Organization, an entity must:

1) comply with 45 CFR 155.225(b)(1) (Apr. 27, 2023) (no later editions or amendments);

2) enforce the standards of certification for its own Certified Application Counselors specified in 45 CFR 155.225(d), including the requirement that the Certified Application Counselor have an active certification from the Department under 50 Ill. Adm. Code 4515;

3) comply with the availability of information and authorization requirements in 45 CFR 155.225(f);

4) comply with the applicable accessibility standards in Section 4500.160(b);

5) meet the terms and conditions of the agreement entered with the Exchange or its designee;

6) not engage in the conduct described in 45 CFR 155.225(g). The Illinois Exchange adopts the provisions applicable to Federally-facilitated Exchanges; and

7) for new and renewal certifications, successfully make an application on a form prescribed by the Exchange addressing the requirements of this subsection (d).

e) To receive, renew, or maintain certification to perform the duties in 45 CFR 155.225(c) as a Certified Application Counselor, an individual must:

1) meet the standards provided in 45 CFR 155.225(d), including the requirement that the Certified Application Counselor have an active certification from the Department under 50 Ill. Adm. Code 4515;

2) comply with the availability of information and authorization requirements in 45 CFR 155.225(f);

3) meet the terms and conditions of the agreement entered with the Certified Application Counselor Organization; and

4) not engage in the conduct described in 45 CFR 155.225(g). The Illinois Exchange adopts the provisions applicable to Federally-facilitated Exchanges.

f) Denials, suspensions, terminations, withdrawals, and appeals

1) For Navigator and In-Person Counselor award applications, nothing in this subsection (f) supersedes the requirements for the merit review and appeals process described in 44 Ill. Adm. Code 7700.350.

2) The Exchange may deny, suspend, or terminate a Navigator or In-Person Counselor award, or deny, suspend, or withdraw a Certified Application Counselor Organization certification, if the applicant, certificate holder, or recipient:

A) provides incorrect, misleading, incomplete, or materially untrue information in the award or certificate application;

B) violates any insurance law, or violates any rule, subpoena, or order of the Director or of another state's insurance Director;

C) obtains or attempts to obtain an award or certificate through misrepresentation or fraud;

D) obtains or attempts to obtain any monies or property from Illinois consumers while conducting business under this Section;

E) intentionally misrepresents the terms of an actual or proposed insurance contract;

F) has been convicted of a felony, unless the applicant, certificate holder, or recipient demonstrates to the Director sufficient rehabilitation to warrant the public trust in accordance with Section 4515.140;

G) has admitted or been found to have committed any insurance unfair trade practice or fraud;

H) uses fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this State or elsewhere;

I) has a Navigator or In-Person Counselor award or Certified Application Counselor Organization certificate, or its equivalent, denied, suspended, terminated, or withdrawn by HHS or by the American Health Benefit Exchange for any other state, province, district, or territory;

J) forges a name to an application for insurance or a document related to an insurance transaction;

K) fails to comply with an administrative or court order imposing a child support obligation;

L) fails to pay Illinois State income tax or penalty or interest, or to comply with any administrative or court order directing payment of Illinois state income tax, or fails to file a return or to pay any final assessment of any tax due to the Illinois Department of Revenue; or

M) fails to make satisfactory repayment to the Illinois Student Assistance Commission for a delinquent or defaulted student loan.

3) If the Exchange determines that any of the grounds listed in subsection (f)(2) exists, the Exchange or its designee will send a written notice to the entity or individual identifying the nature of the disciplinary action to be taken, the specific reasons for the action, an effective date 10 days from the date the notice is issued, and information about how to request a hearing on the decision. The entity or individual may appeal by submitting a request for hearing to the Department within 10 days. The appeal will stay the effective date of the disciplinary action pending the outcome of the hearing and any further administrative review. The hearing will be conducted in accordance with 50 Ill. Adm. Code 2402. An entity or individual may reapply for certification or an award one calendar year after certification has been withdrawn or the award has been terminated.

4) A Certified Application Counselor Organization must have procedures to withdraw a certification it has issued to a Certified Application Counselors when the individual does not comply with the requirements of this Section.

Ill. Admin. Code tit. 50, § 4500.140

Added at 48 Ill. Reg. 12312, effective 8/1/2024