On August 20, 2001, the Centers for Medicare and Medicaid Services (CMS) published a revised Proposed Rule for Medicaid Managed Care. There are several important changes from the January 2001 version of these regulations, which were never allowed to go into effect by the Bush Administration. The regulations still contain critical requirements for States and managed care organizations to identify and serve enrollees and potential enrollees, including persons with limited English proficiency (LEP). The Proposed Rule also includes requirements for the provision of written materials in prevalent non-English languages, oral interpretation services free of charge, and notification that these services are available and how to access them.
While advocates for improving linguistic access in government programs applaud the inclusion of these provisions, the revised Proposed Rule greatly weakens the requirements for the provision of culturally competent services by managed care organizations compared to previous versions of the rule. CMS has asked for public comment on the Proposed Rule. While this provides additional opportunity for input, it also allows those opposed to the linguistic access requirements to organize and urge the weakening or elimination of those requirements.
The Asian and Pacific Islander American Health Forum (APIAHF) is urging all parties to send comments to CMS on these regulations. A sample letter is attached. Please include one original and three copies to the address on the letter. All public comments must be received at CMS before October 19. CMS will not be accepting faxed or e-mailed comments. For more information contact Jan Liu, APIAHF Policy Analyst, at 415-954-9952 or jliu@apiahf.org . To view the Proposed Rule, visit http://www.hcfa.gov/medicaid/omchmpg.htm.
SAMPLE LETTER
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-2104-P
P.O. Box 8016
Baltimore, MD 21244-8016
[DATE]
Re: CMS-2104-P. Medicaid Program; Medicaid Managed Care; Proposed Rule.
To Whom It May Concern:
[Short description of your organization] We are writing to provide comments regarding the Medicaid Managed Care Proposed Rule published in the Federal Register, August 20, 2001.
First, we would like to applaud the inclusion of the information reporting requirements in §438.10, which would reinforce existing language requirements under Title VI of the Civil Rights Act of 1964 to prohibit discrimination on the basis of national origin. The provision of translated written materials, oral interpretation services, and notification of language rights helps to ensure equal access to services for limited English speaking persons.
While we support the retention of these critical provisions for ensuring linguistic access for all Medicaid clients, we are disappointed in the decision to weaken provisions of §438.206 requiring managed care organizations to provide culturally competent care. The original provision required each managed care organization (MCO) or prepaid health plan (PHP) to "ensure that services are provided in a culturally competent manner to all enrollees" but the current Proposed Rule only requires health care organizations to participate in States’ efforts to promote the delivery of services in a culturally competent manner. While we certainly support any provision that would require health plans to comply with State quality improvement efforts as stated in §438.206 of the Proposed Rule, we recommend the restoration of the original language as published in the January 19, 2001 Federal Register, Medicaid Managed Care, Final Rule.
Health care consumers are becoming an increasingly diverse population. Systems of care must be designed to be respectful of and responsive to cultural and linguistic needs in order to provide equal access to quality health care. Furthermore, ensuring that services are delivered in a culturally appropriate manner contributes to the national objectives promoted by the U.S. Department of Health and Human Services Initiative to Eliminate Racial and Ethnic Disparities in Health and the Department’s goals in Healthy People 2010.
We appreciate your consideration of these recommendations. Thank you.
Sincerely,
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