Reporting Elements

Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges
Final Reporting Requirements
CMS-10463
Navigator Weekly Progress Report
During one-on-one interactions with consumers, indicate the number of consumers Navigators
have directly assisted with:
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Addressing general inquiries about health insurance options
*Understanding and using health insurance:
 Health insurance literacy
 Locating providers
 Billing and payment questions
Enrolling or re-enrolling in a QHP:
 Electronically using the Marketplace Website
 Telephonically using Marketplace Call Center
 In writing using a paper Marketplace Application
Medicaid/CHIP applications or referrals
*Answering questions about and/or making referrals to:
 Agents/brokers
 Medicare
 Other consumer assistance/health insurance programs
 Issuers
 State departments of insurance
*Marketplace tax forms (1095-A)
*Filing Marketplace exemptions
*Submitting Marketplace or insurance coverage appeals
*Complex cases and other Marketplace issues, such as:
 Data matching issues/Periodic data matching issues
 SEP eligibility
 Employer-sponsored coverage issues
 APTC/CSR
 Other (text field)

*PERMISSIBLE ASSISTANCE: The HHS Notice of Benefit and Payment Parameters for 2020 (HHS
2020 Payment Notice 1) amended federal regulations at 45 C.F.R. § 155.210(e)(9) to make
See HHS 2020 Payment Notice: https://www.federalregister.gov/documents/2019/04/25/2019-08017/patientprotection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2020
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Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges
Final Reporting Requirements
CMS-10463
certain types of assistance, including post-enrollment duties for FFE Navigators permissible, but
not required as had previously been the case. To coincide with this regulatory change, weekly
reporting on the data fields associated with the duties outlined in 45 C.F.R. §155.210(e)(9) will
now be optional as well. Both the regulatory and reporting changes will apply to Navigator
grants awarded in 2019 and beyond.

Navigator Monthly Progress Report
Indicate the total amount of grant funds spent to date as of the last day of the previous month
Indicate the total amount of grant funds remaining as of the last day of the previous month
Please indicate the activity that you have done this month, as applicable:
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Number of site visits conducted with sub-grantees/sub-recipients
Number of internal assister training with staff and sub-grantees/sub-recipients
Number of background checks for Assisters
Number of breaches with protocols for collecting PII or retaining consent forms

Please explain how you ensure successful performance of your sub-grantees/sub-recipients, if
applicable.
Describe how you have collaborated with the CMS regional office this month. Please note what
is working well and any challenges you face.
Provide at least one example of a best practice this month in each of the categories:
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Successful outreach and education tactics
Collaboration with others in the community, including partnering organizations, local
businesses, etc.
Work with CACs (if applicable)

Provide a complete list of the sub-grantee organizations you are currently supporting with your
Navigator grant funds to perform Navigator duties. If there are any changes to the
organizations who have served as sub-grantees (additions/deletions) during the current budget
period, please indicate those changes along with a brief description.

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Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges
Final Reporting Requirements
CMS-10463
Events and Marketing/Promotion Activities
Provide a list of events and/or marketing/promotion activities.
For each event, include the date, time, name of event, sponsor/partner, event description,
location, point of contact information, and type of population-based event {faith based,
women, youth, African American, American Indian/Alaskan Native, Latino/Hispanic, Asian
American/Pacific Islander, Lesbian/Gay/Bisexual/Transgender}, if applicable).
For marketing/promotion activities, provide a description of the activity and the number of
consumers expected to be reached through social media impressions, viewership, listenership,
etc.

Navigator Quarterly Progress Report
Provide at least one example of a best practice describing how your organization has adhered
to Culturally and Linguistically Appropriate Services (CLAS) standards this quarter.
Provide at least one example of a best practice describing how your organization has ensured
that consumers with disabilities have reasonable modifications and accommodations to access
your Marketplace assistance services this quarter.
List up to five most common languages, other than English, spoken by consumers you have
assisted this quarter.
Provide at least one example of a best practice describing how your organization has collected,
retained, and protected consumers’ Personally Identifiable Information (PII) this quarter.
Upload a copy of your consent form (only required for quarter 1, unless modified) and describe
how your organization has retained consent forms this quarter.

Navigator Annual Progress Report
The data collection for the Annual Progress Report will capture submitted updates from each
quarterly report. In an effort to decrease the estimated burden for reporting, CMS will use the
same questions from the quarterly reports to serve as a cumulative activity report for the entire
grant cycle.

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Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges
Final Reporting Requirements
CMS-10463
CMS will also collect information from Navigator organizations to inform the public about the
availability of consumer enrollment services from the designated organizations. This
information will be displayed on a public facing website. Any updates, additions, or deletions to
that information can be submitted electronically by the Assister organization to ensure that
accurate and current information is available to the public.

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