Medicare Prescription Drug Plans Fail Limited English Proficient Beneficiaries

Medicare prescription drug plans are required to provide multi-lingual services to Limited English Proficient (LEP) persons. The National Senior Citizens Law Center recently released a study documenting the failure of California plans to offer adequate interpreter and translation services. What follows is excerpts from the executive summary of that report.

The market-based design of the Medicare prescription drug program (known as Part D) expects beneficiaries to operate as educated consumers when making difficult choices about coverage. To make wise choices, beneficiaries must have ready access to information. Whether shopping for a Medicare prescription drug plan or trying to access benefits, beneficiaries must be able to obtain information directly from Part D plans regarding cost-sharing, drug coverage, pharmacy networks, exceptions and appeals, and more. Without this information, the beneficiary is left stranded in an extremely complex environment, unable to understand and obtain the full benefits of the program. Recognizing that all beneficiaries must have access to information, the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare prescription drug program, requires that the call centers of participating plans provide language services to LEP beneficiaries.

The ability to obtain linguistically appropriate information is particularly important for individuals who qualify for both Medicare and Medicaid (dual eligibles). Dual eligibles are the sickest and poorest Medicare beneficiaries. They are also more likely to be Limited English Proficient than other Medicare beneficiaries. Almost 30% of the approximately one million dual eligibles in California are Limited English Proficient.

Key Findings

  1. Plan sponsors are only able to serve Limited English Proficient dual eligible beneficiaries in their primary language 54.7% of the time.
  2. Non-Spanish speaking LEP beneficiaries have even less success communicating with their plans. Plan sponsors are only able to serve non-Spanish speaking Limited English Proficient dual eligible beneficiaries in their primary language 36.6% of the time.

Caller Experiences

  1. The majority of the calls completed during the survey ended without connecting to an individual who spoke the language of the caller.
  2. More than 50% of all calls completed ended without any attempt by the plan representative to connect the caller to someone speaking the caller’s language.
  3. Representatives failed to connect callers to individuals speaking the language of the caller for a variety of reasons. Unsuccessful calls were most often the result of the representative’s inability either to recognize that the caller was speaking a language other than English, or to identify the language being spoken. There were, however, also calls during which the representative correctly identified the language spoken, but still made no attempt to connect the caller to an interpreter. Many representatives told callers that they must speak English if they wanted assistance.
  4. Calls that successfully connected to an interpreter speaking the appropriate language did not always result in a successful exchange of information. While interpreters were generally linguistically competent, they did not always meet professional interpretation standards requiring complete, accurate and undistorted transmission of communications. A lack of health systems literacy among interpreters used by plans resulted in multiple reports of miscommunication and misinterpretation. There were also reports of rudeness and inappropriate interference by interpreters.
  5. Translated materials were not available to callers. With two exceptions, all requests for written materials in a non-English language were denied.

Recommendations

The survey results reveal that plans are falling far short of their obligation to provide service to LEP beneficiaries. In order to comply with the requirements, Medicare prescription drug plans must take the following steps.

  1. Develop detailed plans with comprehensive strategies for providing services to LEP individuals. Plans should take note of existing national standards and best practices for serving culturally and linguistically diverse populations.
  2. Provide ongoing monitoring of organizational compliance with LEP plans and strategies and with federal requirements for serving LEP clients.
  3. Provide customer service and language assistance training, including cultural and linguistic competency training and training in procedures to communicate with and correctly identify LEP beneficiaries, to all plan staff that interact with beneficiaries. Simply contracting with a language assistance line is not sufficient to satisfy the requirement of providing services to LEP beneficiaries. Customer service representatives must be aware of and able to utilize language assistance services.
  4. Provide ongoing oversight of contracted and in-house interpreters to ensure knowledge of health systems concepts and terminology and adherence to professional norms of conduct, in addition to language proficiency. Plans should carefully hire and monitor their interpreters to ensure that they are qualified interpreters (mere bilingual ability alone is not sufficient), that they are familiar with health care systems concepts (such as premiums, co-payments, formularies and more) and that they comply with the standards and ethics of interpretation.
  5. Develop and distribute written translated materials.
Adapted from: Medicare Prescription Drug Plans Fail Limited English Proficient Beneficiaries, February 2007 the National Senior Citizens Law Center. See the full report at: http://www.nsclc.org/areas/medicare-part-d/article.2007-02-27.2718724527/at_download/attachment