CEC - Certified Enrollment Counselor Privacy and Security Standards Questions and Answers — Questions and Answers
Question 1: A Certified Enrollment Counselor (CEC) is working with a consumer who is hesitant to provide their Social Security Number on the Marketplace application. According to the privacy and security standards CECs must follow, what is the most appropriate action for the CEC to take?
- Advise the consumer that providing the SSN is voluntary, but failing to do so may prevent or delay a determination of eligibility for health coverage and financial assistance. (Correct answer)
- Refuse to assist the consumer further until they agree to provide their Social Security Number, as it is a mandatory field.
- Suggest the consumer enter a fake Social Security Number to proceed with the application and correct it later.
- Inform the consumer that the CEC can skip that section and the Marketplace will obtain the information from the IRS directly.
Correct answer: Advise the consumer that providing the SSN is voluntary, but failing to do so may prevent or delay a determination of eligibility for health coverage and financial assistance.
According to the Privacy Act Statement on the HealthCare.gov application, providing a Social Security Number (SSN) is voluntary. However, Certified Enrollment Counselors must also inform consumers of the potential consequences of not providing it, which can include delays or an inability to determine eligibility for coverage or financial assistance programs. Refusing assistance, suggesting false information, or claiming the Marketplace can bypass the consumer's input are all incorrect and violate CEC standards.
Question 2: Under 45 CFR § 155.260, a core regulation for Marketplace privacy and security, a CEC must only collect, use, and disclose a consumer's Personally Identifiable Information (PII) to the extent necessary to perform which of the following?
- Share with local insurance brokers who may offer better plans.
- Conduct market research for the Certified Enrollment Entity.
- Fulfill authorized functions like assisting with eligibility and enrollment. (Correct answer)
- Provide to community partners for outreach and fundraising purposes.
Correct answer: Fulfill authorized functions like assisting with eligibility and enrollment.
45 CFR § 155.260 and related CMS guidance strictly limit the use of a consumer's PII to the functions necessary for the efficient operation of the Marketplace. For a CEC, this means using the information solely for authorized activities such as helping a consumer determine eligibility and enroll in a Qualified Health Plan or insurance affordability program. Using PII for marketing, research, or fundraising is a violation of these standards.
Question 3: A consumer emails their CEC copies of their pay stubs and driver's license. The CEC downloads the documents to their personal, unencrypted laptop to review them before entering the information into the Marketplace portal. Which security principle has the CEC most clearly violated?
- Individual Choice
- Openness and Transparency
- Data Quality and Integrity
- Safeguards (Correct answer)
Correct answer: Safeguards
The 'Safeguards' principle, as outlined in 45 CFR § 155.260, requires that Personally Identifiable Information (PII) be protected with reasonable operational, administrative, technical, and physical safeguards to ensure its confidentiality and prevent unauthorized access. Storing sensitive consumer documents on a personal, unencrypted device fails to meet this standard and puts the consumer's data at significant risk.
Question 4: Before a Certified Enrollment Counselor can access a consumer's Personally Identifiable Information (PII) to assist with their Marketplace application, what must the CEC obtain from the consumer?
- A signed, multi-year service agreement.
- Payment for the assistance service.
- Informed consent and authorization. (Correct answer)
- A copy of the consumer's birth certificate.
Correct answer: Informed consent and authorization.
A fundamental privacy standard for CECs is obtaining informed consent and authorization from the consumer before accessing their PII. This ensures the consumer understands who is helping them, what information will be accessed, and for what purpose. CECs are prohibited from charging for their services, and while certain documents may be needed for the application, they are not a prerequisite for the CEC to simply begin the assistance process with authorization.
Question 5: Which of the following is a key requirement a Certified Application Counselor Designated Organization (CDO) must impose on its Certified Enrollment Counselors (CECs) regarding privacy and security training?
- Training is recommended but not mandatory for experienced CECs.
- CECs must complete a one-time privacy training upon hiring.
- CECs must successfully complete role-based privacy and security training before accessing PII and on an ongoing basis. (Correct answer)
- Only CECs who have been involved in a data breach must undergo remedial training.
Correct answer: CECs must successfully complete role-based privacy and security training before accessing PII and on an ongoing basis.
CMS standards require that Certified Application Counselor Designated Organizations ensure their counselors complete privacy and security training tailored to their role and responsibilities. This training is mandatory and must be completed *before* the counselor is granted access to any consumer PII. There is also an expectation of ongoing or annual refresher training to keep CECs aware of their obligations.
Question 6: A CEC leaves a consumer's completed paper application on their desk in a shared office space overnight. The application contains the consumer's name, address, income, and Social Security Number. This action constitutes a breach of which specific type of safeguard?
- Technical Safeguard
- Physical Safeguard (Correct answer)
- Administrative Safeguard
- Consent Safeguard
Correct answer: Physical Safeguard
This is a violation of physical safeguards. Physical safeguards are measures taken to protect physical access to PII. Leaving a paper application with sensitive information in an unsecured, shared location fails to protect it from unauthorized viewing or theft. Technical safeguards relate to electronic data (like encryption), and administrative safeguards relate to policies and procedures.
CEC - Certified Enrollment Counselor Privacy and Security Standards Questions and Answers
A Certified Enrollment Counselor (CEC) is working with a consumer who is hesitant to provide their Social Security Number on the Marketplace application.
According to the privacy and security standards CECs must follow, what is the most appropriate action for the CEC to take?