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Medicare and Part DLetter Regarding LEP Beneficiaries with Medicare Part D Change NoticesJune 27, 2007 TO: June 27, 2007 Re: LEP-Related Comments on the Model Combined Annual Notice of Change/Evidence of Coverage Dear Ms. Tudor and Mr. Lewis, The undersigned organizations write to urge CMS to require plans to provide language appropriate Annual Notices of Change/Evidences of Coverage to limited English proficient (LEP) beneficiaries. While the document is overly complex, confusing, misleading and difficult to understand for all beneficiaries, those beneficiaries who do not read or understand English will be at a particular disadvantage if plans are not required to make the notices available in alternative languages. Our comments are focused not on the content of the ANOC/EOC but rather its form. We urge CMS to recognize the needs of LEP Medicare beneficiaries as it finalizes these notices. CMS should require plans to translate these notices into multiple languages. In addition, since plans are not currently required to collect language data on their members and, therefore, do not have information about the language needs of their members, plans should be required to include taglines in various languages on the front page of each notice informing recipients that the notice is important and that oral interpretation of the notices and/or translated versions can be obtained by contacting the plan directly. Once the plans collect necessary demographic data on their enrollees, the plans should automatically send translated notices to their LEP enrollees who require notices in other languages. For the population over 65 – those most likely to be Medicare beneficiaries – about 2.3 million or nearly 7% do not speak English or speak it less than “very well.” The 2000 Census documented that over 38% of all Spanish speakers over 65 and 40.9% of all Asian and Pacific Island language speakers over 65 speak English “not well” or “not at all.” Research documents how the lack of language services creates a barrier to and diminishes the quality of health care for limited English proficient individuals. Nowhere is this easier to understand than in the Part D context. The privatized structure of Part D demands that beneficiaries ‘shop around’ and find the plan that best suits their needs. If beneficiaries are not able to get information in a language they understand, they will not be able to evaluate plan changes and make informed decisions about their 2008 drug coverage. When plans do not provide language appropriate materials, the burden of assisting beneficiaries falls on their healthcare providers, community based organizations, friends and family. As noted in a Los Angeles Times article last year, “elderly immigrants are swamping clinics, community centers and pharmacies, unable to read the litany of Medicare-related mailings and or even ask questions about their new plans.” One pharmacist noted that he has spent countless hours helping many Chinese-speaking seniors, stating: “Oftentimes they have a whole bunch of letters in their hand and we have to review them and explain to them what is going on.” Spending time explaining these documents reduces the amount of time healthcare providers can spend actually providing care and the time community based organizations could be assisting LEP Medicare beneficiaries in choosing appropriate Part D plans. These inefficiencies hinder the overall effectiveness of the Part D program. The undersigned organizations make the following recommendations: Recommendation: Require plans to translate the ANOC/EOC into non-English languages. Such translations are necessary to comply with the requirements of Title VI of the 1964 Civil Rights Act. In order to conserve resources, CMS and plans could work together to translate the model document into various languages. CMS should not expect that plans will provide these materials if not required to do so. In a survey conducted during last Fall’s Annual Enrollment Period, not a single benchmark plan in California was able to provide callers with written materials in a non-English language. Recommendation: Require plans to include a tagline on the front page of the document or as a separate insert included with the document that explains, in a variety of languages, that the material is important and that translated versions can be obtained by contacting the plan directly. The tagline should also notify members that oral interpretation of the contents is available upon request. This is not only necessary to assist those beneficiaries for whom translated materials are not available but also for those beneficiaries who are not literate in English or their primary language. CMS and plans could again conserve resources by working together to create a universal tagline that could be used by all plans on all communications with beneficiaries. The current model draft does contain a note that the document is available in alternative formats. This note is in English and appears on page 21. LEP beneficiaries are not likely to make it to page 21 of an English document. If they do get there, they are unlikely to understand it if they do not read English. Information about the availability of alternative formats must be at the front of the document. Recommendation: Require plans to collect racial, ethnic and primary oral and written language data from members at enrollment. In order to ensure that the translated material is culturally and linguistically appropriate, these key demographic data elements should be collected. Once plans have information about members’ primary written language preferences, they can send them notices in their primary written language. Recommendation: Simplify the ANOC/EOC and create a separate Low Income Subsidy specific ANOC. As mentioned in other comments from advocates, the ANOC/EOC is much too complex and confusing in any language. The document needs to be pared down and simplified. Low-income clients that our agencies serve were particularly bewildered by last year’s notices which provided both LIS and non-LIS premium, co-payment and deductible information in the same letter. This year’s model notices are even worse. Subsidy information is buried in over a hundred pages of non-LIS specific information. In addition to requiring plans to translate these notices, we believe CMS should adopt our recommendations as an ongoing policy for all information sent by the plans. Once the plans undertake the translation of the taglines, there would be no additional costs to including the information in all outgoing materials. Translating documents will save money, time and resources that healthcare providers, community organizations and Medicare enrollees could put to better use in ensuring and obtaining access to affordable prescription drugs for all enrollees. Finally, requiring plans to collect language data from members will allow plans to communicate efficiently and effectively, and in culturally appropriate ways, with members in their preferred language instead of sending materials that will not be read or comprehended. Any questions you have about these comments can be directed to Kevin Prindiville at 510-663-1055, ext. 307 or kprindiville@nsclc.org. Thank you in advance for your consideration of these recommendations. Sincerely, Kevin Prindiville On behalf of: Asian & Pacific Islander American Health Forum |
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