Thursday, December 23, 2010

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.

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.


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

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