How Health Plans Ensure Claims and Appeals Notices Are Culturally and Linguistically Appropriate

How Health Plans Ensure Claims and Appeals Notices Are Culturally and Linguistically Appropriate

by | Aug 23, 2024 | Blog

Health plans must communicate effectively with all members, regardless of their language. The Affordable Care Act (ACA) mandates that claims and appeals notices be provided in a culturally and linguistically appropriate manner. Here’s how health plans can meet these requirements.

Key Requirements

1. Population Threshold: If 10% or more of a county’s population speaks a non-English language, notices must include a statement in that language explaining how to get help. This is based on U.S. Census data and updated on government websites.

2. Oral Language Services: Health plans must offer phone assistance in the non-English language to answer questions and help with claims and appeals.

3. Written Notices: All English notices must have a clear statement in the non-English language about how to access language services.

4. Translation Upon Request: Full notices must be provided in the non-English language if requested.

Implementation Tips

  • Stay Updated: Regularly check the Department of Labor (DOL) and Health and Human Services (HHS) websites for the latest information.
  • Use Provided Language: Utilize the sample statements provided by the agencies to ensure compliance.
  • Train Staff: Ensure customer service representatives are trained to assist in multiple languages.

Conclusion

Providing notices in different languages is crucial for fair access to healthcare information. By following these guidelines, health plans can better serve their diverse members and comply with the ACA.

Source: Thomson Reuters

CMS Fact Sheet Addresses End of COV-19 Public Health Emergency

CMS Fact Sheet Addresses End of COV-19 Public Health Emergency

by | Mar 2, 2023 | Blog

HHS’s Center for Medicare & Medicaid Services (CMS) has issued a fact sheet addressing the end of the COVID-19 public health emergency (PHE), which (along with the COVID-19 national emergency) is anticipated to end on May 11, 2023. The fact sheet, which is addressed to individuals, confirms that HHS is expecting the PHE to expire at the end of the day on May 11 and provides information about the implications for coverage under private health insurance, as well as Medicare, Medicaid, and CHIP. Here are highlights relevant to employer-sponsored group health plans: 

  • COVID-19 Vaccines, Testing, and Treatments. Most plans must continue to cover vaccines furnished by in-network providers without cost sharing but may require individuals receiving vaccines from out-of-network providers to share part of the cost. When the PHE ends, mandatory coverage for OTC and laboratory-based COVID-19 PCR and antigen tests will end. Plans may choose to cover these tests but may require cost sharing, prior authorization, or other forms of medical management. The end of the PHE will not change how COVID-19 treatments are covered; plans that require cost sharing or apply deductibles may continue to do so. 
  • Access to Telehealth Services. As is currently the case during the PHE, coverage for telehealth and other remote care services may vary from plan to plan after the PHE ends. When covered, plans may impose cost-sharing, prior authorization, or other forms of medical management. 

Source: Thomson Reuters