Health Care Reform requires non-grandfathered group health plans and health insurance issuers to provide certain language assistance services (in a “culturally and linguistically appropriate manner”) in counties where at least 10% of the population is literate only in the same non-English language (Spanish, Chinese, Tagalog, or Navajo). (The determination of which counties meet the 10% threshold is based on U.S. Census data, specifically the American Community Survey (ACS) data.) CMS updates this list annually, and recently posted the December 2014 updated list, for 2015. (The 10-page list is at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/2009-13-CLAS-County-Data_12-05-14_clean_508.pdf)
In the counties that meet the 10% threshold, group health plans and health insurers must provide:
- Certain language assistance services in the applicable language, and
- Written documents translated into the applicable language, if requested by participants, and
- Summaries of Benefits and Coverage (SBCs) and claims and appeals notices provided to participants in these counties must include a one-sentence statement (in the applicable language) stating that language assistance is available.
o The statement, in each of the four languages, is included in model notices and in the sample SBC.
The new list is much the same as last year’s list. Numerous counties meet the threshold for Spanish, and CMS notes that Sullivan County in Missouri has been added as a county that meets the 10 percent threshold for Spanish.
The following counties meet the 10% threshold for Chinese: San Francisco County, CA
The following counties meet the 10% threshold for Tagalog: Aleutians East Borough & Aleutians West Census Area, AK
The following counties meet the 10% threshold for Navajo: Apache County, AZ
The requirement to provide certain notices in a culturally and linguistically appropriate manner is at PHS Act section 2719, and implementing regulations are at
26 C.F.R. § 54.9815-2715 (http://www.ecfr.gov/cgi-bin/text-idx?SID=699265127e2e1e829b728cd0abb81fc3&node=se26.17.54_19815_62715&rgn=div8 ), 29 C.F.R. § 2590.715-2715 (http://www.gpo.gov/fdsys/pkg/CFR-2012-title29-vol9/pdf/CFR-2012-title29-vol9-sec2590-715-2715.pdf ), and 45 C.F.R. § 147.200.