Affordable Care Act Patient Navigators: Why Background Checks are Critical

Affordable Care Act Patient Navigators: Why Background Checks are Critical
Senior Director of Marketing

When it comes to background checks, the State of Texas has been active. On November 4, Texas filed a complaint against the Equal Opportunity Commission (EEOC). As the Texas Attorney General’s office explains, “Under Texas law, certain state agencies are prohibited from employing convicted felons and have enacted policies that require criminal background checks to ensure convicted felons do not hold positions of public trust.” The Attorney General’s lawsuit against the EEOC challenges the Commission’s ban against employers from excluding convicted felons from certain jobs. And more recently, according to a December 4 article from The Washington Post, the Texas Department of Insurance proposed imposing a series of checks in order for healthcare navigators to acquire a license to help uninsured Texans navigate through the complicated process of buying health insurance.

Texas’ ACA Patient Navigator Screening Recommendations

According to the rules proposed on December 3, 2013, Texas would require patient navigators to:

  • Prove their citizenship or employment eligibility
  • Undergo a background check
  • Show evidence of financial responsibility
  • Receive 40 hours of education on Texas-specific Medicaid and privacy standards
  • Show proof of proper training to guide consumers to the right health plans

As a Texan, I personally feel grateful that my state not only values my privacy and identity as a resident, but is also taking appropriate steps to protect the privacy of my information as a consumer.

13 Attorneys General React to Security Risks of ACA Patient Navigator Program

Texas’ recent action towards the proper screening of navigators is not the first time this issue has been addressed. In August, Texas Attorney General Greg Abbott was one of 13 attorneys general that sent a letter to the Department of Health and Human Services (HHS) declaring the navigator program as a “security disaster waiting to happen.”

In the letter, the states’ chief legal officers outlined a list of deficiencies in HHS’ patient navigator program. The following represent the areas critical to “ensuring effective safeguards for the protection of consumer’s private data through the navigator, assister, application counselor, or other consumer outreach programs”:

  1. Screening Personnel – It is important to have a process for screening staff that may pose risks to consumer data privacy, including:
    • Verifying the navigator’s education degree and verifying whether they have past experience or expertise in the health insurance field or data privacy
    • Running criminal background checks and credit reports
  2. Guidance to Program Personnel – It is recommended that HHS provide guidance to navigators about consumer data privacy protections, particularly concerning consequences of unauthorized disclosure of patient information.
  3. Monitoring Program Personnel – HHS should monitor navigators and non-navigator assistance personnel to ensure that employees do not retain and abuse personal information.
  4. Notice to Consumers – Consumers should be advised of their data privacy rights and of the program’s liability before they decide to receive assistance.
  5. Liability – In the case that an outreach program caused harm to a consumer through the misuse of personal information, HHS could benefit from requiring entities receiving federal or exchange-generated funds to carry professional liability insurance.
  6. Fraud Prevention and Remedies – HHS should provide assistance and relief to defrauded consumers while also be proactive and taking measures to prevent potential fraud by individuals and entities who may falsely represent themselves as navigators or other assistors to consumers.
    Click here to read the original letter dated August 14, 2013.

Safeguarding Patients from Potential Harm

Granted, partisan politics come into play in both of the aforementioned examples, but protecting patient safety is something that is dear to our hearts in everything that we do here at PreCheck. We are a healthcare exclusive background screening firm.  And we understand that in a highly regulated industry like healthcare, there are special considerations when it comes to patient care and protecting sensitive consumer information. Requiring criminal background checks or even credit reports, given the nature of the role of a patient navigator, is not an unreasonable precaution. I’m sure consumers would agree. On the other hand, if background checks were not conducted, and a patient navigator with related criminal history stole patients’ identification and caused financial damages, the accusatory “Why didn’t they run background checks?” would be resounding.

PreCheck Background Screening Resource Kit