If you are a payor, provider, or insurer in the Medicare Advantage network, you’re already under significant pressure to provide preferred language materials for your community members with Limited English Proficiency (LEP).
Recent regulatory updates have intensified this pressure.
As you may know, the Centers for Medicare & Medicaid Services (CMS) unveiled the 2024 Medicare Advantage (MA) and Part D final rule, which aims to increase the quality and availability of care for MA recipients up to the standards of traditional Medicare.
The ruling increases accountability for healthcare providers, includes guidelines for streamlining processes, and reinforces penalties for non-compliance. Several provisions in the new rule involve expanding the availability of translation and interpretation services to benefit the Limited English Proficiency (LEP) population.
Here’s an example of the issues the ruling is trying to solve: CMS surveys have found that Individualized Care Plans (ICPs) aren’t consistently translated into the enrollee’s preferred language, even when the enrollee has indicated their need for translation. The new rule addresses this by requiring providers to always send all healthcare communication in the preferred language after the initial request, so enrollees can better understand their benefits and more effectively achieve their health goals.
Compliance with the new CMS final rule is non-negotiable, and penalties for non-compliance will start in 2024. On the plus side, the positive impacts of investing in high-quality language services provide powerful benefits for both your organization and the members you serve.
Let’s take a closer look at the new requirements, their benefits, and some strategies to make sure your organization is prepared to meet them.
What CMS Final Rule Means for the Language Services You Provide
There are three components of the new rule that will significantly impact how you provide language services:
- Health Equity: Language barriers are one cause of health disparities in marginalized communities. By expanding the availability of language services, health equity is improved. The new ruling increases funding for health initiatives that address disparities in healthcare access, quality, and outcomes among different populations enrolled in Medicare Advantage and Part D plans.
- Star Ratings Adjustments: The Star Ratings system now evaluates MA and Part D plans based on quality and performance, including how well they serve non-English speakers. Plans that offer a positive experience to limited English proficiency (LEP) individuals are likely to see higher ratings, helping them retain and attract more members.
- Marketing and Communications: Stricter regulations are in place to ensure marketing and communications from MA and Part D plans are clear and accurate. This means plans must provide LEP patients with marketing materials in their preferred language to meet these new standards.
Let’s take a deeper look at why all of this makes a huge positive difference in our communities.
The Significance of Translation & Interpretation in Improving Outcomes and Achieving Health Equity
When patients don’t speak English, there is a formidable obstacle to getting quality healthcare, affecting patient outcomes and satisfaction. The new ruling requires healthcare organizations to make sure that all patients, regardless of their preferred language, can access services easily and effectively.
Tackling language barriers is a critical step in this journey, since understanding healthcare materials directly influences the LEP population’s ability to:
- Gain adequate coverage: Providing insurance materials in multiple languages empowers LEP individuals to make informed decisions about their healthcare options, leading to greater coverage and fewer gaps in care. Insurance policies are very complex in the United States, and it is in everyone’s best interests if every detail is clearly understood.
- Understand benefits and coverage: Imagine receiving a large bill and a corresponding Explanation of Benefits (EOB) that you don’t understand. If a community member receives this information in their own language, they have a much better chance of navigating their policy and managing their bills (even handling errors) than otherwise.
- Access the care they need: 48% of adults with LEP have experienced a language barrier in a healthcare setting within the last three years. Common experiences like filling out complicated paperwork, scheduling appointments or explaining problems to a provider are all much more difficult in a language you struggle with. Translation and interpretation services help LEP patients navigate the healthcare system more effectively and receive timely and appropriate care without the confusion these barriers can cause. Members that don’t speak English deserve the same level of care as those who speak English.
- Manage their health for better outcomes: When patients fully understand their treatment plans—whether it’s medicine dosages or physical therapy instructions—they are more likely to follow through, improving their health outcomes. This leads to fewer medical complications and reduces the need for expensive emergency interventions. Clear communication in a patient’s preferred language can make all the difference.
The Specifics of Language Access Compliance with CMS Final Rule
The Health Equity portion of the rule aims to improve patient access to language translation and interpretation services.
Here are the key requirements:
- Comprehensive language assistance services: Healthcare providers for Medicare Advantage and Part D patients must offer complete language support. This includes providing access to qualified interpreters and translating important documents and notices quickly when requested by patients — whether or not they are required by the existing 5% threshold.
- Culturally competent care: This provision requires services to be delivered in a way that respects the cultural, social, and linguistic needs of beneficiaries from diverse linguistic and cultural backgrounds. For example, a patient may need communication in a specific dialect of a recognized language or prefer a different treatment plan based on their cultural background. Preventative care advice, like dietary recommendations, is also easier for patients to follow when it takes their cultural preferences (like food or activities) into account.
- Easy access to language services: To promote health equity, the rule stresses that language services should be easily available and free to patients. Providers must let patients know that these services are offered at no cost.
- Monitoring and reporting: Medicare Advantage and Part D plans are required to monitor the use and effectiveness of language assistance services and report on these measures. This can help CMS and plan providers identify service gaps and improve access to care and health information.
- Providers who speak community languages. Organizations must have providers who speak multiple languages or offer access to professional interpretation services in Medicare Advantage (MA) and Part D plan networks. This will help ensure that enrollees receive care that is both accessible and culturally responsive.
- Availability of translated materials. Once a patient asks for materials in a non-English language, Medicare Advantage and Part D sponsors must always provide materials in that language without requiring additional requests.
With these changes, CMS Final Rule seeks to break down language barriers and make sure all Medicare beneficiaries receive high-quality care, no matter their preferred language.
How the New Language Service Requirements Affect Star Ratings
The Star Rating system for Medicare Advantage and Part D plans measures the quality of health and drug services provided. These ratings help enrollees compare and choose plans.
Star ratings directly impact a plan’s success, so maximizing that rating is a strategic move that can improve growth and profitability. For example, research shows that a one-star improvement can boost enrollment by 8 to 12 percent year over year and revenue by 13.4 to 17.6 percent.
What does language access have to do with Star Ratings? Medicare Advantage plans are partly scored on how well they respond to member questions and solve problems. For individuals with LEP, this can only happen if language assistance is available. So, the evaluation includes the availability of foreign language interpreters and TTY services for individuals with speech impairments.
Both Part C and Part D plans are judged based on how well these plans provide essential services like foreign language interpreters and TTY support. To make sure that plans meet these standards, the Centers for Medicare & Medicaid Services (CMS) conducts an Accuracy & Accessibility Study.
As a result, the availability and quality of a plan’s language services directly affects its Star Ratings. This reflects the plan’s commitment to delivering accessible, high-quality care to all members.
It also aligns with CMS’s mission to help Medicare consumers and their caregivers make informed healthcare decisions by providing clear information about quality, benefits, and costs.
Language Access Promotes Clarity and Understanding in Marketing and Communications
The 2024 Final Rule also introduces stricter standards for Medicare marketing and communications. These changes ensure that individuals with limited English proficiency (LEP) and disabilities can access important information in non-English languages and accessible formats. By providing marketing information in enrollees’ preferred languages, the new standards will make it easier for them to choose plans that meet their needs and make full use of their benefits.
How BIG Helps with Translation and Interpretation Services for a More Inclusive Healthcare System
BIG’s LanguageExpress™ service is a workflow offering, specifically designed to help healthcare organizations meet language access requirements. LanguageExpress™ offers round-the-clock, rapid translation support for critical communications, including coverage determination letters, explanation of benefits (EOBs), and more. Through this proprietary system, we are able to provide our healthcare customers with speed, service, savings, and high quality.
Our automated workflows and secure, HIPAA-compliant translation platform provide quick and accurate translations in hundreds of languages by linguists with medical expertise and knowledge of Medicare and Medicaid regulations. The system can handle massive scale: tens or hundreds of thousands of documents per month, per customer. We also uphold the highest security standards with SOC 2 and HITRUST certifications, guaranteeing the confidentiality and integrity of sensitive data.
What sets LanguageExpress™ apart is our commitment to customization. We understand that no two healthcare organizations are the same, which is why we offer tailored solutions to meet your specific needs. Our platform integrates smoothly with your existing workflows, providing full transparency, reporting capabilities, and a single access point for all translation tasks.
By taking advantage of LanguageExpress™, you’re setting a new standard for accessible, high-quality care that reaches all patients, regardless of their language or accessibility needs. This proactive approach not only enhances patient satisfaction but also strengthens your organization’s reputation as a leader in providing inclusive, high-quality healthcare.
Take the next step in delivering exceptional, inclusive care, all while meeting regulatory requirements. Contact us today to learn how LanguageExpress™ can help your organization improve patient outcomes, and stand out as a leader in the healthcare industry.
Chief Customer Officer
