This advisory summarizes the most recent guidance released by the Department of Health and Human Services (HHS) listing the counties where certain notices are subject to the additional requirement that they be provided in a "culturally and linguistically appropriate manner." The counties include numerous ones in California, Florida, Georgia, New Jersey, New York, North Carolina, Oregon, Texas and Virginia and a number of other states and Puerto Rico where more than 10% of the population is literate only in Spanish. 

Two provisions of the Patient Protection and Affordable Care Act (PPACA) require that relevant notices to be provided in a "culturally and linguistically appropriate manner" – (1) the enhanced internal claims and appeals requirements and external review procedures; and (2) the summary of benefits and coverage. In order to satisfy this requirement, certain accommodations are necessary where notices are sent to an address in a county where 10% or more of the population is literate only in the same non-English language:

  • English versions of notices must include a statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the plan or issuer.
  • Upon request, notices must be provided in any applicable non-English language.
  • Oral language services (such as a telephone customer assistance hotline) that include answering questions in any applicable non-English language and providing assistance with filing claims and appeals (including external review) in any applicable non-English language.

The 10% threshold is based on U.S. Census data and is updated annually. The Department of Health and Human Services has issued an updated list of the counties where 10% or more of the population is literate only in the same non-English language. The updated list can be found at the following website: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/2009-13-CLAS-County-Data_12-05-14_clean_508.pdf

Employers with employees in the counties listed first need to arrange for translation services for the statement to be placed on the English version of the various notices and for the notices themselves, if requested. In addition, arrangements will need to be made to provide the oral, non-English language service to assist with questions and the filing of claims.

There are a few counties in Arkansas, Arizona and California where arrangements need to be made for non-English languages other than Spanish.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.