Introduction

The Centers for Medicare and Medicaid (CMS) have introduced changes that are posited to have a direct influence on how healthcare information is communicated and distributed to diverse populations, including those with limited English proficiency (LEP.).  These rules were established to promote more equitable care for members – regardless of their preferred language.

The 2024 Final Rule, which came into effect January 1, 2024, revises various aspects of Medicare Advantage Part C and D plans, with particular impact felt in Marketing and Communications, Star Ratings Programs, and Provider Directories. Keeping abreast of these revisions is key to remaining compliant with CMS guidelines and broader regulatory requirements, while also providing organizations with an opportunity to make operational adjustments without impacting on quality or timelines.

CMS 2024 Final Rule Overview

Within the terms of the Final Rule is a set of comprehensive changes designed to enhance the quality and accessibility of health plans and coverage within the Medicare programs. As of 2021, the total population of individuals with LEP in the United States stands at 25.7 million, accounting for 8% of the population. As this figure continues to climb, the importance of linguistic diversity in coverage materials cannot be understated. Evidence illustrates that subpar communication is intrinsically linked to knowledge gaps and inadequate coverage relative to individual health needs, directly contributing to disproportionately poor health outcomes.

The revisions to existing guidance places emphasis on bridging these gaps through bolstered multilingual communication and marketing efforts. Namely, the Final Rule introduces several key changes to translation requirements to enforce standards of health equity, while also protecting existing and prospective beneficiaries from ambiguous or confusing marketing materials. Furthermore, it expands guidance to implement culturally competent service offerings that address the unique challenges of under-resourced communities, e.g., those living in rural or otherwise deprived communities.

Key Changes to Translation Requirements

• Expanded Language Access Requirements: As outlined, a key component of the Final Rule is emphasis on the importance of clear, unambiguous, and accurate communication to all individuals.  Furthermore, the rule reinforces the mandate of fulfilling translation requirements where a language is spoken by at least 5% of the population in a plan’s service area.
• Qualified Interpreters and Translation Services: Within the expansion of language services, the rule underscores the value of using qualified, subject matter expert interpreters to facilitate streamlined, accurate, culturally competent communication. Providers will therefore need to implement strategies to identify language needs within their service areas and ensure appropriate resourcing to manage translation and interpretation demand.
• Cultural Competency Training: To further optimize communication with linguistically and culturally diverse beneficiaries, the CMS encourages organizations to facilitate continuous, comprehensive cultural competency training among their staff. In doing so, participating providers can assure improved understanding and sensitivity to the cultural nuances of the communities they serve, thereby proactively mitigating knowledge gaps and fostering trust between providers and their communities.

Key Changes to Alternative Format Requirements

• Accessibility Standards Compliance: The Final Rule addresses the importance of accessibility in the development and distribution of coverage communications. Beneficiaries with disabilities should have equitable access to plan materials, upholding and ensuring compliance with accessibility standards across paper and digital formats, such as WCAG 2.0. This includes rendering documents and websites accessible to those with visual or cognitive impairments, and providing additional accessibility supports where needed.
• Timely Provision of Alternative Formats: As part of a broader initiative to bolster accessibility in Medicare materials, the provision of alternative formats is obligatory. In other words, providers should provide beneficiaries with disabilities information in appropriate alternative formats in a timely manner. This includes formats such as large print, Braille, electronic formats compatible with screen readers, and audio recordings.
• Accessibility Features in Electronic Health Records (EHRs): Elevated accessibility standards extends to the integration of accessibility features in EHRs and facilitating the seamless provision of information in alternative formats. This is indicative of broader progress towards ensuring that individuals with disabilities can independently and seamlessly access their health information.

Implications for Healthcare Providers

• Investment in Language Services: Providers should assess their capacity to align with the expectations outlined in the Final Rule, with considerations for any additional investment into language services, including qualified interpreters and translation services. A comprehensive review of beneficiary language demographics against specific guidelines, such as the 5% language threshold, should be conducted to meet expanded language access requirements. This may entail closer collaboration with language service providers, or the development of in-house language access programs.
• Technology Integration for Accessibility: Organizations should evaluate, and upgrade where necessary, their technological infrastructure to ensure that electronic modalities and communications, including websites and EHRs, are designed in alignment with accessibility requirements and guidelines. This may involve working with IT professionals to implement features such as text-to-speech functionality, and enhanced compatibility with assistive technologies.
• Training and Education Initiatives: In compliance with cultural competency and accessibility standards as outlined by CMS, providers should prioritize training and education initiatives for their staff. This includes extensive continuous accessibility standards education and training programs focused on effective communication with diverse populations. They should also ensure that personnel are familiarized in the use of accessibility features in technology.

Conclusion

The CMS 2024 Final Rule represents a significant step forward in enhancing language access and communication for diverse populations within the healthcare system. By addressing translation and alternative format requirements, the rule aims to improve the overall quality of care and accessibility of information. Healthcare providers must proactively adapt to these changes, investing in language services, upgrading technology, and prioritizing training initiatives to ensure compliance and, more importantly, to provide equitable and inclusive healthcare services for all.

Keep up to date with shifting CMS guidance and ensure your members have access to critical information about their coverage in any language in 2024 and beyond. Since the effective date for the new regulations, TransPerfect translates over 1,000 member letters per day – most requiring same-day or next day delivery.  Chat to our team today to learn how we can assist with your language preference initiatives.

Erin Marino, Senior Director

emarino@transperfect.com

614.747.3746

Jack Meere, Senior Director

jmeere@transperfect.com