Centers for Medicare & Medicaid Services:

CMS Should Develop an Agencywide Policy for Translating Medicare Documents into Languages Other Than English

GAO-09-752R: Published: Jul 30, 2009. Publicly Released: Jul 30, 2009.

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William B. Shear
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The Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for administering the Medicare program for nearly 45 million beneficiaries, including beneficiaries with limited English proficiency (LEP)--meaning they may not be proficient or are limited in their ability to communicate in the English language. Medicare beneficiaries face a complex set of health care choices that require them to obtain information about the comparative benefits, costs, and quality of available options. CMS is responsible for providing clear, accurate, and timely information about this program and making the information accessible to beneficiaries. Under section 601 of Title VI of the Civil Rights Act of 1964, entities that receive federal financial assistance are prohibited from discriminating against or otherwise excluding individuals from their programs or activities on the basis of race, color, or national origin. In 1964, as directed under section 602 of Title VI, HHS first published regulations applying these prohibitions to entities receiving federal financial assistance from HHS, including health care organizations. In 2000, Executive Order 13166 was published, requiring federal agencies to take certain step to clarify Title VI requirements. Specifically, this order required federal agencies to publish guidance addressing how their recipients of federal financial assistance can provide LEP individuals meaningful access to programs and activities that recipients normally provide in English, and thus do not discriminate on the basis of national origin in violation of Title VI and implementing regulations. As a result, HHS published guidance, which clarified these responsibilities for all recipients of federal financial assistance from HHS. This guidance provides a method of analysis for providers to use in determining the extent to which oral and written language assistance services for LEP individuals is needed, if any, in order to comply with Title VI and the implementing regulations.

CMS components translated 87 percent of the 134 Medicare documents we identified into Spanish and, to a limited extent, other languages, including Chinese, Korean, and Vietnamese. The translated documents provide information about the Medicare program, specific health care conditions, and information specific to an individual beneficiary's Medicare coverage. For example, CMS translated into Spanish Medicare & You, a handbook that is sent to all Medicare beneficiaries every year, which summarizes program benefits and beneficiaries' rights and protections, and answers the most frequently asked questions about the program. CMS officials we interviewed were unaware of any agencywide translation policy related to Medicare documents, echoing findings from a prior GAO report that identified shortcomings in CMS's implementation of HHS's LEP plan. Because of the absence of an agencywide translation policy, the extent to which Medicare documents were translated depended entirely on decisions made by individual CMS components. For example, the Office of External Affairs and the Center for Drug and Health Plan Choice--the two CMS components that translated the majority of the documents into Spanish--did so because it is the most common language spoken by LEP Medicare beneficiaries. The roughly 13 percent of documents that were not translated by CMS varied in terms of their content. Some were templated forms or notices that require health care providers to add beneficiary-specific information, including information related to benefit exclusions or changes to the beneficiary's portion of costs. In addition, some documents that were not translated contain information about how to manage certain health conditions or the Medicare program--information similar to what is included in other documents that CMS translated into Spanish. In response to our recommendation in the 1-800-MEDICARE report, CMS recently appointed an individual in its Office of Equal Opportunity and Civil Rights (OEOCR) to develop an LEP plan, but this plan is still in development, and agency officials have not informed us how their LEP plan will address the translation of written materials. Without an agencywide policy, there is no guarantee that CMS can ensure that Medicare documents containing vital beneficiary information will consistently be translated in the future for the various groups of beneficiaries that have limited English proficiency.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: In response to our recommendation to prepare a written, agencywide policy for translation of written documents as part of its LEP plan, the Centers for Medicare and Medicaid Services (CMS) produced the Strategic Language Access Plan. As we recommended, the plan addresses written translations, including defining vital documents that should be translated and assessing the language needs of current and potential beneficiaries. The plan further states that CMS Components/Consortia that support limited English proficient (LEP) populations will prepare the CMS Annual Language Access Assessment report to identify (1) the languages into which vital documents have been translated,(2) the percentage of the beneficiary LEP population that utilizes these translated documents, (3) the emerging languages that would within one year's time exceed the 10 percent LEP population criteria, (4) the URL for the Web site where the translated documents are posted, and (5) the resources used for material translation. The plan also identifies the CMS Civil Rights Agency Liaison to serve as the CMS Language Access Plan point of contact as well as the central point of contact for the annual assessment reports to ensure that CMS has complete and accurate information on translation of documents. These actions will help improve the consistency and transparency of CMS's policies for translating documents into languages besides English.

    Recommendation: To improve the consistency and transparency of CMS's decisions to translate its documents into other languages, the Administrator of the Centers for Medicare & Medicaid Services should direct the appropriate CMS offices or LEP plan manager to include a written, agencywide policy for translation of written documents as part of its LEP plan. Such a policy should include criteria for translating documents, including assessing the language needs of current and potential beneficiaries, and a process for ensuring that the CMS office or individual responsible for managing the LEP plan has complete and accurate information about CMS's efforts to translate documents.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services


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