Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2012 and Other Proposed Changes (CMS-4144-P)
2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24 2011-02-24
CMS-2010-0258-0126 CMS-2010-0258-0161 CMS-2010-0258-0242 CMS-2010-0258-0020 CMS-2010-0258-0034 CMS-2010-0258-0049 CMS-2010-0258-0025 CMS-2010-0258-0026 CMS-2010-0258-0041 CMS-2010-0258-0103
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https://api.regulations.gov/v4/comments/CMS-2010-0258-0126 https://api.regulations.gov/v4/comments/CMS-2010-0258-0161 https://api.regulations.gov/v4/comments/CMS-2010-0258-0242 https://api.regulations.gov/v4/comments/CMS-2010-0258-0020 https://api.regulations.gov/v4/comments/CMS-2010-0258-0034 https://api.regulations.gov/v4/comments/CMS-2010-0258-0049 https://api.regulations.gov/v4/comments/CMS-2010-0258-0025 https://api.regulations.gov/v4/comments/CMS-2010-0258-0026 https://api.regulations.gov/v4/comments/CMS-2010-0258-0041 https://api.regulations.gov/v4/comments/CMS-2010-0258-0103
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Resubmitting NHIA January 11, 2011 comment letter as a Word file.  Previous submission was a pdf file.  Comments on both formats are identical. The Alliance of Community Health Plans (ACHP) appreciates the opportunity to comment on the proposed rule published in the Federal Register on November 22, 2010 relating to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs for Contract Year 2012. ACHP is a national leadership organization representing community-based and regional health plans and provider organizations that collectively provide health care and coverage for approximately 18 million Americans.  Our members are not-for-profit health plans or subsidiaries of not-for-profit health systems; most cover substantial numbers of Medicare Advantage enrollees. Member plans share longstanding commitments to their communities, close partnerships with providers, and substantial investments in the innovative approaches and infrastructure necessary to provide health care that is coordinated, affordable and high quality.ACHP appreciates the work that CMS has done to implement provisions of the Affordable Care Act to date.  In the current proposed rule, we are especially pleased that CMS has moved forward on the Medicare Advantage quality incentive provisions, reflecting Congressional intent to incorporate value-based payment across Medicare.  In this letter, we discuss a number of areas where our member plans have expressed concerns about the proposed rule and recommend modifications.  Please see detailed recommendations in the uploaded file.   Please accept my comments on the proposed rule to set a threshold of 10% for translated Medicare materials.  Even in California, where we have a very diverse population, many languages would be dropped from translated materials with this threshold.  A 5% threshold is a much more appropriate one and is consistent with the many California administrative, regulatory, and legislative threshold, not to mention the DHHS OCR guidance letter on Title VI.At Asian Health Services (community health center in Oakland, CA), we routinely translate written communications with our patients, even for those who make up less than 3% of our patient population.  This means our materials are routinely written and produced in English, Chinese, Vietnamese, Korean, Khmer and many times in Tagalog too.Thank you for your attention to this very important issue for limited English speaking health care purchasers.   On behalf of Lincoln Behavioral Services and myself, I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here. I am Chair of the Board of Directors of Lincoln Behavioral Services, a Community Mental Health agency.The 10% standard is far too high.  A more appropriate standard would be 5% of population, or 500 persons in service area.  10% should not be used here.  Many of our clients are refugees or immigrants who have limited English.  If they cannot receive written materials in a language they can understand, they cannot access theiir services and are deprived of equal protection of the law. On behalf of myself and the millions of LEP seniors, I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here.  I am the Director of Health Education for the California Family Health Council and have been assisting public health providers in improving their responsiveness to the linguistic and cultural health care needs of their clients. The 10% standard is far too high.  A more appropriate standard would be 5% of population, or 500 individuals served in an agency as a whole(includes multiple clinic sites), whichever is lower.  10% should not be used here. The impact on our clients when they cannot get documents in a language that they understand is enormous. This population is very vulnerable, not only because of their age and their increasing health needs, but also because of their limited reading skills. their ability to manage their health conditions is compromised when they are given materials that they cannot read.  The regimens provided are usually very complicated and must be followed precisely as indicated (i.e., cataract surgery requires the use of 4 to 8 different types of eye drops before and after surgery, in different dosages and at different times). One client not understanding their regimens is one too many.  The consequences of not understanding can be devastating, especially with this population who often times have multiple health conditions.  Are health outcomes no longer important to our health care system? I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here.  I am daughter of two immigrant parents, a former teacher in an immigrant community, and an immigrant rights advocate; I know the struggles faced by non-English speaking individuals and families.  I also know that smaller immigrant populations are often overlooked in our attempts to the service the larger, more common ethnic groups.  The 10% standard will only perpetuate this neglect of smaller linguistic groups.  A more appropriate standard would be 5% of population, or 500 individuals served, whichever is lower.  10% should not be used here.  Furthermore, access to documents in a language that the individual understands is especially critical in the health care field since it often involves technical and medical language that even intermediate English speakers may not understand.  Finally, the income based disparities in health care services and outcomes has been well documented by Dr. Paul Farmer and others, and this 10% rule will only exacerbate this growing divide.  For the foregoing reasons, I ask that the new rule apply the 5%, or 500 individuals served, standard. The proposed rule change that would result in a new, higher threshhold of 10% of a population as the trigger point at which Medicare plan documents must be translated into the recipients language is TOO HIGH!  This would have a huge impact on communication with Limited English Proficient Medicare recipients, and would ultimately lead to poor care and poor outcomes, potentially increasing health care costs in the aggregate.  As a health care professional with many years of experience in working to improve improve language access for LEP patients, and who has seen first-hand the impact of language barriers in health care, I strongly urge that this threshhold be set at 5% of the population or 500 individuals as the trigger for translation of plan documents into non-English languages.Sincerely,Sharon Englert, MBADirector, Patient Relations and Interpreter ServicesLoyola University Health System(708) 216-5142 On behalf of myself, my employer - Language Line Services, and the individuals who will be most affected by this rule - the millions of limited English proficient patients who utilize Medicare services, I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here.  I have personal experience with a similar rule.  As a former New York State Health Official back in 2006, we worked closely with the healthcare industry and the patient advocate organizations to develop a regulation which provided enhanced patient equity for limited English proficient patients while also providing a reasonable and cost-effective threshold for the healthcare providers.  The 10% standard is far too high.  A more appropriate standard would be 1% of population.  This is the standard that was used by the New York State Department of Health.  This standard is codified in 10NYCRR 405.7 of the New York State Health regulations.  I think that CMS should review this regulation and discuss with officials from the New York State Department of Health how this threshold was arrived at and the impact of the threshold.  I personally feel that the 1% threshold goes a long way to reduce healthcare disparities that exist between English speaking patients and those that have limited English proficiency.  Any threshold higher than 1% continues a policy of providing unequal treatment for these individuals.  Additionally, studies have shown that with better communication - both written and oral - higher patient satisfaction is achieved as well as improved health outcomes.  With the US population becoming more diverse, it is time for CMS to set a positive example for the country and select a 1% threshold.   I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here.  I am a graduate student at University of Pennsylvania, studying TESOL - teaching English to the students of Other Languages. I interact many bright and smart students of diverse ethnic and age group, who makes our society more fruitful and posperous. The 10% standard is far too high.  A more appropriate standard would be 5% of population, or 500 individuals served, whichever is lower.  10% should not be used here.Because this will really affect my students, their parents and family, this issue is rather personal to me. Please consider altering this law, to make every individuals need and concern.Thank you. On behalf of the National Center for Youth Law (NCYL), I wish to comment on the 10% threshold for translating Medicare plan materials that is codified here.  I am a staff attorney at NCYL and represent Medicaid-eligible children, many of whom have limited English proficiency or whose parents or adults who make healthcare decisions for them have limited English proficiency.  A core element of NCYLs work for these children is to ensure that they and the adults making healthcare decisions for them receive adequate notice of services available under Medicaid as well as notice of reductions, terminations, and denials of services and their right to a fair hearing.  Although the proposed regulations at issue are intended to affect only adult Medicare beneficiaries, such regulations could set precedent for regulations governing Medicaid and other health plans and health insurance exchanges currently under development, including those affecting children.  The 10% standard is far too high.  If a similar standard was used for Medicaid plans, many of our clients would not receive translated materials.  This could greatly impact their ability to access important services or exercise their right to a fair hearing if important services are reduced, terminated, or denied.  A more appropriate standard would be 5% of population, or 500 persons in service area, which would affect a much smaller population.  10% should not be used here.