Following the release of the 2020 census data, the Centers for Medicare and Medicaid has announced the issuance of updated “County Data for Culturally and Linguistically Appropriate Services” (“CLAS County Data”). This data is effective for plan years (policy years for individual market coverage) beginning on or after January 1, 2025. What is the significance of this update? The Affordable Care Act (“ACA”) requires that certain group health plan materials be provided in a “culturally and linguistically appropriate manner.” The group health plan materials at issue include the summary of benefits and coverage (“SBC”) and appeal notices under the enhanced group health plan claims procedures. The prior list was issued in 2012, and demographics have changed, and with that requirements for non-English language accommodation may have changed. This means that insurers and plan sponsors need to make sure that they know which non-English languages they will need to address. In addition to shifts in population, the CLAS County Data has increased from four languages to eight. To illustrate some of the changes consider the effects of the following:
- In Florida, based on the 2012 data, there were eight counties in which Spanish was the primary language for at least 10% of those living there. In this new report, there are nine counties to which that applies, Broward County joining the list.
- In Alaska, based on the 2012 data there were two counties in which both Spanish and Tagalog made the list. In this updated list, there are three counties specifying Tagalog, and Spanish is not listed.
- Under the 2012 data, Indiana had no counties on the list, in 2023 there is one county where Pennsylvania Dutch is prevalent.
So, things have changed and it’s time for a review of notice procedures.
The Requirements
Speaking of a review, let’s look at the requirements: The rules generally provide that in specified counties of the United States, plans and insurers must provide interpretive services and written translations upon request, in certain non-English languages. The “applicable counties” are those in which at least 10% of the population residing in the county is literate only in the same non-English language. This determination is based on U.S. Census data and includes the following languages: Spanish, Navajo, Traditional Chinese, Pennsylvania Dutch, Tagalog, Samoan, Carolinian and Chamorro. Employers and insurers may voluntarily offer these services to participants who do not live in an applicable county as well.
SBCs
- SBCs sent to addresses in an applicable county must include a statement clearly indicating how to access the language services provided by the plan (or insurer). This statement should be included on the page of the SBC with the “Your Rights to Continue Coverage” and “Your Grievance and Appeals Rights.” Sections.
- Written translations of the SBC must be provided upon request in the required non-English languages.
In order to assist with compliance with this language requirement, written translations of the SBC template and uniform glossary in the four applicable languages are available on the CMS website, along with an oral translation (in MP3 format) in Navajo.
Claims Notices
- Claims notices sent to addresses in an applicable county must include a statement, prominently displayed in the non-English language, clearly indicating how to access the language services provided by the plan or insurer (sample language, in each of the four languages, appears in the Department of Labor’s model claims determination notices);
- Oral language services (such as a telephone customer assistance hotline) must be provided that include answering questions in any applicable non-English language and assistance with filing claims and appeals (including external review) in any applicable non-English language; and
- Upon request, provide a notice must be provided in any applicable non-English language.
For a review of these requirements and the non-English language requirements under ERISA, see our previous blog post on this topic.