CACs and CDOs
The Virginia Health Benefit Exchange is excited to be transitioning its Exchange from healthcare.gov to its own state-based Exchange platform – Virginia’s Insurance Marketplace! Virginia’s Insurance Marketplace platform soft launch is scheduled for approximately October 10, at www.marketplace.virginia.gov. Regarding CDO platform accounts, for those that the Exchange received complete and accurate contact information, accounts will be created and an email invite sent around October 10. All others will be created by HBE upon receipt of CDO contact information. Instructions and training videos will be made available soon related to managing your CDO account. HBE staff will also be available by email at AssisterPrograms@scc.virginia.gov to assist with any questions or account issues, and we will have a dedicated assister line in our call center.
Virginia’s Insurance Marketplace is a marketplace for Virginia, by Virginia. Our collaboration will focus on:
- Meeting the health coverage needs of Virginians
- Supporting consumer choice and education
- Assisting consumers with access to programs and financial assistance
- Supporting continuity of coverage
- Reducing the number of uninsured in Virginia
The Assister-Navigator FAQs file provides a cumulative record of questions and answers. The file is updated frequently, but will always include all existing content so everyone has access to all the information.
Town Hall Meetings
- HBE Agent & Assister-Navigator Town Hall – Oct. 18, 2023
- HBE Agent & Assister-Navigator Town Hall – Sept. 20, 2023
- HBE Assister-Navigator Town Hall – August 23, 2023
- HBE Assister-Navigator Town Hall – July 28, 2023
- HBE Assister-Navigator Town Hall – June 28, 2023
- HBE Assister-Navigator Town Hall – May 24, 2023
- HBE Assister-Navigator Town Hall – April 27, 2023
- HBE Assister-Navigator Town Hall – March 28, 2023
Information on CDO and CAC regulations are found in 14 VAC 7-10 – Rules Governing the Certified Application Counselor Program.
Questions? Call 804-371-1532 or email Assisterprograms@scc.virginia.gov.
What is a Certified Application Counselor Designated Organization (CDO)?
CDOs are a vital component of the assister community. They oversee Certified Application Counselors (CACs), who are trained and able to help consumers seeking health insurance coverage options through the Virginia Health Benefit Exchange. CDOs must be designated by the Virginia Exchange to operate in Virginia. CDOs designated by the Virginia Exchange certify CACs.
CDO Designation Requirements:
The Virginia Health Benefit Exchange published rules to outline the designation requirements that CDOs will need to meet to be designated in Virginia. CDO and CAC regulations are found in 14 VAC 7-10 – Rules Governing the Certified Application Counselor Program. CDO Designation Requirements are as follows:
- Submit a Virginia Certified Application Counselor Designated Organizations application (CDO Application) through Assisterprograms@scc.virginia.gov.
You will need to provide the following as part of the application:
- Execute a Virginia Health Benefit Exchange – Certified Application Counselor Designated Organization Agreement in accordance with 14 VAC 7-10-30 and submit the signed agreement and a sample of their CAC agreement to Assisterprograms@scc.virginia.gov.
With this agreement CDOs attest to:
- Certifying individuals to serve as CACs and execution of an agreement with CACs pursuant to 14 VAC 7-10-50,
- Requiring application counselors complete required training,
- Maintaining a registration process and method to track the performance of CACs as specified in 14 VAC 7-10-40,
- Administration of a system to handle and protect personally identifiable information (PII) and provision of a PII authorization form attesting to adherence to all terms and conditions of privacy and security pursuant to 45 CFR 155.260(b),
- Provide data and information to the Exchange regarding the number and performance of its CACs in accordance with 45 CFR 155.225(b)(3).
The Exchange will create a CDO portal account on the VIM Platform for your organization.
- Require assisters to complete required training through the VIM Learning Management System. Assisters will need to send a request for a new LMS account along with their name, unique email, unique cell number, and certification number (as applicable) to MarketplaceLMS@scc.virginia.gov.
- Create assister portal accounts on the VIM Platform for all CACs that have completed training and been certified by your organization.
- Maintain a CAC registration process, a method to track the performance of CACs, and maintain procedures to withdraw certification from or refuse to recertify any individual certified application counselor upon a finding of noncompliance with the requirements for certification or a failure to perform duties as required in accordance with 14 VAC 7-10-40.
- Administer a system to handle and protect personally identifiable information (PII) and require a PII authorization form attesting to adherence to all terms and conditions of privacy and security pursuant to 45 CFR § 155.260(b)(2).
Quarterly Reporting Requirements
Beginning with PY 2024 Open Enrollment, each CDO must submit quarterly reports that include, at a minimum, data regarding the number and identifying information of individuals who have been certified by the organization; the total number of consumers who received application and enrollment assistance from the organization; and of that number, the number of consumers who received assistance in applying for and selecting a qualified health plan or qualified dental plan, enrolling in a qualified health plan or qualified dental plan, or applying for Medicaid or Children’s Health Insurance Program (CHIP).
CDOs are required to renew their registration with the Virginia Exchange by 10/31 of every even-numbered year.
What is a Certified Application Counselor (CAC)?
A CAC is an individual staff member or volunteer who is certified by a CAC designated organization (CDO) and trained to help consumers look for health coverage options through the Virginia Exchange and Virginia's Medicaid program. This includes helping consumers complete the eligibility and enrollment process. Their services are free to consumers.
What are the certification requirements for a CAC?
- Successfully complete assister training through Virginia’s Insurance Marketplace (VIM) Learning Management System (LMS) required this year.
- Current Virginia CACs will be eligible to complete a shorter training program for plan year 2024. You would have received an auto-generated email from firstname.lastname@example.org providing your login ID. Visit Virginia's Insurance Marketplace Learning Management System to begin.
- CACs new to the Virginia Exchange will take the full VIM training program for plan year 2024. Assisters without LMS accounts will need to send a request for a new LMS account along with their name, CDO name, unique email, unique cell number, and certification number (if applicable) to MarketplaceLMS@scc.virginia.gov.
- Training will be completed at Virginia's Insurance Marketplace Learning Management System
- To receive certification of training completion, you must receive a passing score of 80 on the VIM Exam. Complete training and pass the exam by October 10 for November 1 Exchange Certification.
- Execute privacy and security agreements with your CDO.
- Receive certification from CDO.
- Your CDO will create an assister portal account on the VIM Platform on your behalf.
- Verify your profile information in collaboration with your organization.
CACs are not required to register with the Virginia Exchange. CDOs will register and provide a list of CACs certified to operate through that organization.
- CAC/CDO Regulation: 14 VAC 7-10 – Rules Governing the Certified Application Counselor Program
- Frequently Asked Questions for this topic are being developed
- Consumer Authorization Form (Formulario de Autorización del Consumidor Versíon en Español)
- Contact us with any questions at Assisterprograms@scc.virginia.gov