CEC Roles and Regulations 2 — Questions and Answers
Question 1: Under the ACA, what is the maximum penalty an enrollment counselor can face for willfully disclosing a consumer's personally identifiable information without authorization?
- $100 fine per violation
- $25,000 fine and up to 10 years imprisonment (Correct answer)
- $10,000 fine only
- License suspension for 30 days
Correct answer: $25,000 fine and up to 10 years imprisonment
Willful disclosure of PII by a Navigator or certified application counselor can result in criminal penalties including fines up to $25,000 and imprisonment up to 10 years.
Question 2: Which federal law primarily governs the privacy protections that enrollment counselors must uphold when handling consumer health information on the Marketplace?
- FERPA
- HIPAA
- Section 1411 of the ACA (Correct answer)
- The Privacy Act of 1974
Correct answer: Section 1411 of the ACA
Section 1411 of the Affordable Care Act establishes the privacy and security requirements specifically for Marketplace consumer data handled by assisters.
Question 3: A Certified Application Counselor (CAC) is prohibited from doing which of the following?
- Assisting consumers with completing applications
- Charging consumers a fee for enrollment assistance (Correct answer)
- Explaining plan differences in plain language
- Helping consumers gather required documents
Correct answer: Charging consumers a fee for enrollment assistance
CACs are prohibited from charging consumers fees for their enrollment assistance services, as they must provide help free of charge.
Question 4: Which entity is responsible for designating organizations as Certified Application Counselor (CAC) organizations in a state using the federal Marketplace?
- State Department of Insurance
- CMS (Centers for Medicare & Medicaid Services) (Correct answer)
- The individual CAC themselves
- The U.S. Department of Labor
Correct answer: CMS (Centers for Medicare & Medicaid Services)
CMS designates CAC organizations for states using the federally facilitated Marketplace (FFM), while state-based marketplaces may have their own designation processes.
Question 5: What does the term 'scope of practice' mean for a Certified Enrollment Counselor?
- The geographic territory where they can enroll clients
- The specific tasks and services they are authorized to perform under their certification (Correct answer)
- The number of clients they are allowed to assist per month
- The insurance carriers they are approved to represent
Correct answer: The specific tasks and services they are authorized to perform under their certification
Scope of practice defines the specific functions, tasks, and services an enrollment counselor is trained, certified, and legally permitted to perform.
Question 6: An enrollment counselor discovers that a consumer has provided fraudulent information on their Marketplace application. What is the counselor's correct course of action?
- Complete the application and report it later
- Refuse to assist and advise the consumer to provide accurate information (Correct answer)
- Submit the application but note the discrepancy internally
- Ignore it if the consumer insists the information is correct
Correct answer: Refuse to assist and advise the consumer to provide accurate information
Enrollment counselors must refuse to knowingly assist with fraudulent applications and should advise consumers to provide only accurate and truthful information.
Question 7: Which of the following describes a key difference between a Navigator and a Certified Application Counselor (CAC)?
- Navigators can charge fees; CACs cannot
- Navigators receive federal grant funding; CACs are employed by designated organizations (Correct answer)
- CACs must be licensed insurance agents; Navigators do not
- Navigators only serve Medicare clients; CACs serve Marketplace clients
Correct answer: Navigators receive federal grant funding; CACs are employed by designated organizations
Navigators are funded through federal or state grants, while CACs are employees or volunteers of organizations designated by CMS or the state marketplace.
CEC Roles and Regulations 2
Under the ACA, what is the maximum penalty an enrollment counselor can face for willfully disclosing a consumer's personally identifiable information without authorization?