Navigator Insulin Payment Policy

This policy applies to navigator organizations that have an executed contract amendment to assist consumers as part of the Alec Smith Insulin Affordability Act.

Policy Details

In accordance with Minnesota Statutes, Section 151.74, MNsure will issue payments to contracted organizations for navigator assistance with accessing an insulin manufacturer’s patient assistance program. To be eligible, a navigator must:

• Be actively certified with an agency that has an executed contract amendment that includes Attachment C.
• Complete the required online insulin program training.
• Submit a properly completed Insulin Case Association Form to MNsure within 30 days of assisting a consumer with an eligible activity.

If an organization has received an assistance bonus under Section 62V.05, subdivision 4, or 256.962, subdivision 5 (a navigator per-enrollee payment) for that same consumer within the past 12 months, the organization shall not receive compensation for assisting with applying for the insulin manufacturer’s assistance program.

MNsure will pay eligible organizations quarterly based on timely submission of the required Insulin Case Association Form. Payments will be issued within 60 days following the end of the quarter.

Effective July 1, 2020, the payment rate will be no less than $25 per case and no more than $70 per case. The payment rate will be dependent on the amount of funding available for the quarter and the number of valid Insulin Case Association Forms submitted.

Payments are based on the availability of funding.

Activities Eligible for Payment

A navigator is eligible for a one-time payment if they assist a consumer with one or more of the following activities. Note, a navigator is not eligible for a separate payment for each activity, but is eligible for a single, one-time payment for assisting an individual with one or a combination of the eligible activities below:

• Completing a manufacturer’s application for the patient assistance program (including assisting with activities listed in Minnesota Statutes, Section 151.74, Subd. 4).
• Submitting additional information as requested by the manufacturer to verify the consumer’s eligibility (including assisting with activities listed in Minnesota Statutes, Section 151.74, Subd. 5).
• Appealing a manufacturer’s determination of eligibility for the patient assistance program (including assisting with activities listed in Minnesota Statutes, Section 151.74, Subd. 8).
• Filling an insulin prescription once approved by a manufacturer’s patient assistance program (including assisting with activities listed in Minnesota Statutes, Section 151.74, Subd. 6).
• Accessing an additional 30-day urgent need insulin supply if the consumer meets the requirements, including checking MNsure eligibility status (including assisting with activities listed in Minnesota Statutes, Section 151.74, Subd. 9).

Activities Not Eligible for Payment

The following are activities navigators may assist with that are not eligible for payment:

• Assisting a consumer with applying for the urgent need supply of insulin (unless the consumer has applied for the manufacturer’s patient assistance program and requires an additional 30-day urgent need insulin supply).
• Providing information regarding other affordable insulin assistance programs.
• Assisting a consumer with insulin program activities when the navigator organization has received a navigator per-enrollee payment for the same consumer within the past 12 months.
• Other activities unrelated to the Minnesota Insulin Safety Net Program.

Procedures

If a navigator assists a consumer with one or more of the eligible activities, they must submit the online Insulin Case Association Form within 30 days of assisting the consumer with the eligible activity.

MNsure will review all submitted Insulin Case Association Forms on a quarterly basis. For example, forms submitted by October 30, 2020, for activities completed July 1, 2020, through September 30, 2020, will be processed in November 2020 and payments issued by November 30, 2020. MNsure will review all submitted Insulin Case Association Forms to confirm that the agency has not already received a navigator per-enrollee payment for the same consumer within the past 12 months