Donald Berwick, M.D.
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building, Room 314G
200 Independence Ave. SW
Washington, DC 20201
RE: FY 10 CMS Strategic LEP Plan Outcome Report
Dear Dr. Berwick,
The undersigned organizations are pleased to submit comments and feedback on CMS? Strategic LEP Plan Outcome Report. As you know, almost 20% of the population speaks a language other than English at home. Over 24 million, or 8.7% of the population, speak English less than very well and should be considered limited English proficient (LEP) for healthcare purposes.1 This includes 47% of Spanish speakers, 33% of speakers of other Indo-European languages, 49% of speakers of Asian and Pacific Islander languages, and 30% of speakers of other languages.
Numerous studies have documented the problems associated with a lack of language services, including one by the Institute of Medicine, which stated that:
Language barriers may affect the delivery of adequate care through poor exchange of information, loss of important cultural information, misunderstanding of physician instruction, poor shared decision-making, or ethical compromises (e.g. difficulty obtaining informed consent). Linguistic difficulties may also result in decreased adherence with medication regimes, poor appointment attendance, and decreased satisfaction with services. (Cites omitted.) 2
We thus applaud CMS development of its LEP Plan and welcome the opportunity to provide comments and feedback. The remainder of this document provides more detailed feedback on particular aspects of the Plan.
We urge CMS to continue its work on implementing this plan and expanding its language services. CMS? language services are supported by Executive Order 13166 which extended the application of Title VI to the federal agencies themselves. The Attorney General recently released a memo, Federal Government's Renewed Commitment to Language Access Obligations Under Executive Order 13166, reaffirming the Administration?s commitment to providing effective language services. In addition, § 1557 of the Patient Protection and Affordable Care Act forbids discrimination on the grounds of sex, race, national origin, disability or age in health programs or activities receiving federal financial assistance or by programs administered by an Executive Agency or any entity established under Title I of the ACA. Because § 1557 applies broadly to federally conducted programs and to entities that receive federal funding or assistance, it is essential that CMS consistently take the requirements of §1557 into account. As CMS? activities are administered by an Executive Agency, we recommend that the Departments clarify that the LEP Plan also is essential to ensuring effective implementation of § 1557.
We appreciate that the 1-800-MEDICARE helpline offers bilingual staff and access to interpreters. We believe that this is an important resource for LEP Medicare enrollees to receive information.
We also support the Plan?s recognition of the need for a comprehensive notification plan and look forward to providing feedback as CMS consults with stakeholders. We suggest that CMS consider a public outreach campaign, particularly utilizing ethnic media, to improve knowledge of this service and heighten awareness of the availability of services in non-English languages that. We also suggest that, on the inside cover of the Medicare & You Handbook, CMS include a multi-lingual page with taglines in multiple languages. This page would inform recipients that free language services are available through 1-800-MEDICARE in multiple languages to provide enrollees with information. This can be an easy method of educating Medicare beneficiaries who may be limited English proficient but are receiving the Handbook in English.
To assist State Health Insurance Counseling and Assistance Programs (SHIPs) who provide services to LEP clients, we also suggest that CMS expand the scope of its telephonic interpreting contract to allow access to SHIPs to communicate with LEP clients. CMS could provide an access number for each SHIP to allow tracking and monitoring and the SHIP would benefit from having ready access to telephonic interpreters when needed to supplement competent in-house or on-site language services.
We also support the Plan?s recognition of the need for a comprehensive notification plan and look forward to providing feedback as CMS consults with stakeholders.
TRANSLATION OF VITAL MEDICARE DOCUMENTS
We are extremely supportive of the decision of CMS to translate 160 Medicare vital documents into 15 languages (in addition to Spanish and English). For years, many organizations have been asking CMS to translate these federal forms that must be used by all Medicare providers across the country with millions of LEP Medicare beneficiaries. As Medicare providers are subject to Title VI and EO 13166, they have each had an individual responsibility to translate vital documents such as these forms. This has created unnecessary costs, redundancies and inefficiencies as multiple providers may translate the forms multiple times. With over 5,000 hospitals in the U.S., one could imagine the costs and resources needed if each hospital had to evaluate the need for and translate many of these documents. We strongly encourage CMS to ensure that funding is available for any translation that is done.
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