The federal exchange navigators will have a lot of work ahead ofthem, and a few at the very top will get paid up to $48 anhour.

According to newly released projections from the Centers forMedicare & Medicaid Services, the federal navigators hiredto help Americans buy insurance on the coming exchanges willprovide 1.7 million “help” sessions a year.

A navigator will likely spend an average of one hour per client,with about 10 minutes of each hour being devoted to recordkeeping.The exchanges are at first expected to generally serve uninsuredindividuals buying coverage, rather than employers.

In its latest word on how the system should work, CMS said aclient-level navigator/caseworker should be paid about $20 perhour, while the time of a mid-level project leader will be about$29 per hour. Senior-level executives will earn $48 perhour.

The Patient Protection and Affordable Care Act requires eachPPACA health insurance exchange to hire navigators — who are notpaid by health insurers — to help consumers understand how to usethe exchange system.

Navigators will be hired in the 34 states in which the federalgovernment is running the coming Obamacare marketplaces or wherethe state is engaged in a partnership with the federal government.In those states, the Department of Health and Human Services ismaking available $54 million.

The administration has said that navigators do not have to belicensed agents or brokers and may not be paid by insurancecompanies, a move that angered many in the industry. Republicanshave slammed the navigator programs, and stood upfor brokersand agents, arguing they are trained professionals who have theexperience and requirements to guide consumers in their health planoptions.

The new CMS navigator reporting system would affect onlynavigators in states with all-federal, “federally facilitatedexchanges,” and the states with federal-state “state partnershipexchanges.”

CMS prepared the navigator activity projections when estimatingthe cost of the CMS-10463 navigator reporting program. CMS came upwith the cost estimates to comply with federal Paperwork ReductionAct of 1995 requirements.

The agency is expecting to provide federal exchangenavigator organization grants for 264 organizations, with eachorganization employing an average of seven “caseworkers,” or staffnavigators.

At a typical navigator organization, officials said, sevencaseworkers will spend about 1,078 hours per year on navigator helpsession recordkeeping.

If total help session time amounts to six times sessionrecordkeeping time, then the caseworkers would be spending 8,124hours per year on help sessions. That would be enough time toprovide 8,124 one-hour help sessions.

CMS put the navigator recordkeeping system through a 60-daypublic comment period that began April 12.

“Several commenters suggested navigator awardees reportingrequirements be expanded to include demographics and [other]standards, specifically sexual orientation and gender identity,”officials said.

CMS decided against including information about clients' sexualorientation or gender identity, such as whether consumers aretranssexual, in the navigator reporting program. Complying withthat kind of requirement would be impractical, because navigatorswill not be retaining personal information on a consumer other thana consent form that will let the navigator help the consumer,officials said.

“The only demographic information associated with a consumer isthe information provided by the consumer in their application forcoverage through the marketplace,” officials said. “Navigators willnot retain copies of the application.”