The Departments of Labor and Health and Human Services, and the IRS (“the Agencies”) have issued Frequently Asked Questions About Affordable Care Act (“ACA”) and Consolidated Appropriations Act, 2021 Implementation (“FAQs”) Part 63 updating the requirements for providing notices in a “linguistically appropriate manner.”
The ACA requires group health plans and health insurance issuers to provide certain services and notices in a “culturally and linguistically appropriate manner.” Specifically, they are required to provide: (1) oral language services (such as a telephone assistance hotline) that include answering questions and providing assistance with filing claims and appeals in any “applicable” non-English language; (2) certain notices in any applicable non-English language, upon request; and (3) in the English versions of all notices, a statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the plan or issuer (so-called “taglines”).
For this purpose, a language is an “applicable” non-English language if at least 10% of the population residing in the participant’s or beneficiary’s county are literate only in the same non-English language, as determined by the United States Census Bureau.
The Summary of Benefits and Coverage (“SBC”), a uniform explanation of benefits and coverage, which is distributed to plan participants, beneficiaries, and other individuals eligible to enroll in the plan, is one of the notices subject to these rules. To help plans meet this requirement, written translations of the SBC template, taglines, sample language and its uniform glossary have been made available by the Agencies in various non-English languages.
Contemporaneously with the issuance of FAQs Part 63, the Agencies announced that 2023 Culturally and Linguistically Appropriate Services County Data Guidance (“CLAS Guidance”) is available at: https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/clas-county-data-2023.pdf. The CLAS Guidance sets forth an updated list of all counties in which 10% or more of the population is literate only in the same non-English language. This list identifies the languages that meet the 10% threshold for each county and the percentage of that county’s population who are literate only in that language.
The CLAS Guidance also includes sample taglines stating how to access the language services provided by the plan or issuer in each of the languages that meet the 10% threshold. Group health plans and health insurance issuers are required to provide SBCs as well as claims and appeals notices in a manner that is consistent with the new guidance effective for plan years (or, in the individual market, policy years) beginning on or after January 1, 2025.
The Agencies also stated that they plan to update the following documents in the future to reflect the updates in the 2023 guidance:
- SBC template and sample completed SBCs in English (with updated taglines in applicable non-English languages)
- Additional translated versions of the SBC and the uniform glossary; and
- Model notices for internal claims and appeals and external review (with updated taglines in applicable non-English languages).
FAQs Part 63 is available at: https://www.cms.gov/files/document/faqs-part-63.pdf