Mandated Member Communications: The Most Important Parts of the Census to Health Plans

With the 2010 Census information released this week, it will be interesting to see the demographic shifts across the U.S. While to the general public, understanding how the population is shifting is a “nice to know," for health plans, this new information from the Census will directly impact how they operate their business. 

With the passing of the Centers for Medicare & Medicaid Services (CMS) 10% Translation Rule, health plans that sell products in either Medicare or Medicaid are required to provide all their materials in an alternative language if over 10% of their population in a specific area speaks that language as their primary. CMS and other regulatory bodies are not only requiring this, but also heavily enforcing it – with increased auditing and secret shopper activities ensuring the available and accurate translation of these materials.

While the Rule has been in effect for a few years now, a recent study by the National Senior Citizens Law Center (NSCLC) found that many Medicare Advantage plans and Medicare Part D plans are not publishing marketing materials in Spanish as required by CMS under their provider contracts.

This study shows just how widespread non-compliance of translated marketing materials is. To make matters worse, this study does not take into account the compliance requirements for pre enrollment, post enrollment and mandated communications – which means the likelihood of non-adherence or inaccuracies in these materials is most likely even greater than reported in this study. This should be alarming for any health plan, as any inaccurate or missing translated materials could have devastating effects on their ability to market themselves if CMS enforces penalties against them.

As the population of the United States continues to change, the number of areas with required translation needs and the number of languages that will be required will continue to grow. With these changing demographics, the need for accurately translated member communications - including marketing, pre enrollment, post enrollment and mandated communications - will continue to be a driving component to the viability of a health plan.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Mandated Member Communications: It’s the Most Wonderful Time of the Year?

“It’s the most wonderful time of the year

with the kids jingle belling and 

everyone telling 

you’ll be of good cheer

It’s the most wonderful time of the year.”

Let me be the first to say that it’s pretty clear Andy Williams did NOT work at a health plan!!

While he is singing about parties for toasting and marshmallows for roasting, the rest of us are neck deep in the enrollment season and the stress, long hours and craziness that go hand-in-hand with this supposed “most wonderful time of year”.

Health plans are in the middle of orchestrating a successful enrollment season. With three major communication initiatives occurring, plans must create, produce and distribute Agent/Broker Communications, Pre-Enrollment materials and Post-Enrollment materials accurately, on time and within compliance. Any mistake made along the way can have a devastating effect on the plan’s ability to attract or retain members. Because of this, plans have a laser focus on these activities ensuring they are executed flawlessly.

Often lost amongst all these activities is another major initiative that needs to be handled with kid gloves: Preparing and executing mandated post enrollment communications. While these communications often fly below the radar during this time of year, they can have a major impact on a business if they are not handled properly. With changing regulations, new exhibits and addendum, and increased monitoring by regulatory bodies, failure to adhere to the requirements can lead directly to penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

While the other communications rightfully get most of the attention and resources, don’t let mandated member communications be the straw that breaks the camel’s back. Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process, and with the enactment of the Affordable Care Act and tightening regulatory guidelines, the process has only been compounded. Worse, failure to comply with strict service level agreements and deadlines can result in penalties, including monitoring, fines, and the risk of contract non-renewal. Taking the proper time will build positive momentum and will ensure that all your other enrollment activities were not for naught.

And you know what, if all of these communications are executed properly, this year’s enrollment season could very well end up being "the most wonderful time of year" for your plan.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Mandated Member Communications in Healthcare: An Introduction

Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process. The enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process. Worse, failure to comply with strict service level agreements and deadlines can result in penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

Today, this blog is commencing a series on the topic of mandated member communications, including the different types that currently (and potentially) could exist, as well as new methods for companies to improve their process for staying compliant.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact her at Pamela.Argeris@merrillcorp.com.