A Q1, 2024 Update
In the spring of 2023, 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.
Who is affected by the 2024 Medicare Advantage and Part D Final Rule?
Providers and insurers that are part of the Medicare Advantage network, as well as Limited English Proficiency (LEP) members of the plans impacted.
Objectives of the 2024 Medicare Advantage and Part D Final Rule
The ruling increases accountability for healthcare providers, includes guidelines for streamlining processes, and reinforces penalties for non-compliance. Several of the provisions in the new rule involve increasing the availability of translation and interpretation services to benefit the Limited English Proficiency (LEP) population. Language services are especially affected by these three components of the new rule:
- Health Equity: the availability of language services greatly impacts health equity. The new ruling aims to increase 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: Changes have been made to the Star Ratings system, which rates Medicare Advantage and Part D plans based on quality and performance. This aims to ensure that ratings more accurately reflect the experiences and outcomes of enrollees, including those who are not fluent in English.
- Marketing and Communications: The rule introduces stricter regulations around marketing and communications to protect consumers from misleading information and to ensure clarity and accuracy in the information provided by Medicare Advantage and Part D plans. Therefore, it is necessary to provide LEP patients with marketing materials in their preferred language.
The Significance of Language Services in Achieving Health Equity
Language barriers have long been a formidable obstacle in healthcare, affecting patient outcomes and satisfaction. The new rule’s focus on language access represents a clear mandate: healthcare organizations must now ensure that all patients, regardless of their primary language, can access services effectively and efficiently.
- CMS surveys found that Individualized Care Plans (ICPs) aren’t consistently translated into the enrollee’s primary languages, even when the enrollee has indicated their need for translation. The new rule requires providers to send all healthcare communication in the desired language after the initial request.
Within the context of members with limited English proficiency, the Health Equity portion of the rule aims to improve patient access to language translation and interpretation services.
- Enhanced Language Assistance Services: Healthcare facilities caring for Medicare Advantage and Part D patients are expected to provide comprehensive language assistance. This includes providing access to qualified interpreters and the translation of key documents and notices in a timely and consistent manner when requested by patients – whether or not they are required by the existing 5% threshold.
- Culturally Competent Care: requires providing services in a way that respects the cultural, social, and linguistic needs of the beneficiaries from diverse linguistic and cultural backgrounds. For example, the patient may benefit from communication in a specific dialect, i.e., a subset of a recognized language.
- Accessibility of Language Services: To promote health equity, the rule highlights the importance of making language assistance services readily available and easily accessible to beneficiaries. Providers need to notify beneficiaries that these language services are available at no cost to them.
- Monitoring and Reporting: Medicare Advantage and Part D plans are required to monitor the utilization and effectiveness of language assistance services and report on these measures. This can help CMS and plans identify gaps in service and areas for improvement to ensure that language barriers do not impede access to care and health information.
- Inclusion of providers who speak multiple languages or have access to professional interpretation services in MA and Part D plan networks. The rule requires MA and Part D sponsors to provide materials on a standing basis in any non-English language.
By focusing on improving access to language translation and interpretation services, the Health Equity portion of the 2024 Medicare Advantage and Part D final rule aims to reduce language barriers that can contribute to disparities in healthcare access and outcomes. This initiative is part of a broader effort to ensure that all Medicare beneficiaries, regardless of their primary language, have equitable access to high-quality healthcare services.
The Impact of Language Services on Star Ratings
The availability of language services affects the Star Rating system for Medicare Advantage and Part D plans. The Star Ratings system measures the quality of health and drug services received by consumers enrolled in these plans.
An important component of this system is evaluating how well the Medicare Advantage plan handles members’ inquiries and promptly and accurately resolves their issues. This includes the availability of foreign language interpreters and TTY services (for speech-impaired people).
Both Part C and D plans have domains dedicated to customer service. These domains each have measures for foreign-language interpreters and TTY availability. To determine a plan’s compliance with these measures, CMS conducts the Accuracy & Accessibility Study.
Therefore, the availability of language services can impact a plan’s Star Rating, reflecting the plan’s commitment to providing accessible and high-quality service to all beneficiaries, regardless of their primary language. This is part of CMS’s effort to provide Medicare consumers and their caregivers with meaningful information about quality, benefits and costs to assist them in making informed healthcare decisions.
Enhancing Marketing and Communications to Ensure Clarity and Understanding
CMS enacted the additional adjustments outlined in the 2024 Final Rule to enforce additional Medicare marketing and communication standards upon health plans. CMS anticipates this will aid in providing individuals with limited English proficiency and disabilities access to critical information and content in non-English languages and accessible formats to increase their ability to make informed healthcare decisions and remove any ambiguity associated with MA and Part D plan responsibilities.
Translation and Interpretation Services For a More Inclusive Healthcare System
While compliance with the new rule is non-negotiable and new penalties are being enforced starting in 2024, the benefits of investing in high-quality language services extend far beyond meeting regulatory requirements. Effective, timely translation and interpretation are instrumental in fostering a patient-centered healthcare environment. They contribute to a better understanding of medical advice, increased patient engagement, and, ultimately, improved health outcomes.
As healthcare continues to evolve, the demand for language services will only grow. Proactively enhancing language support not only prepares organizations for future regulatory changes but also positions them as leaders in the push toward a more inclusive healthcare system.
Chief Customer Officer
