Health insurers and HMOs have a limited time to review the new federal meaningful access rules and amend plan documents accordingly. However, many payors still have not revised their plans to include the required language, and others might not be aware the rules apply to them.

The New Requirements

In May 2016, the U.S. Department of Health and Human Services published final meaningful access rules with the aim to reduce discrimination, including that based on gender identity, and increase access to interpretation services for consumers with limited English proficiency. The rules provide that payors must:

  • Take action internally to prohibit discrimination based on race, color, national origin, sex (including gender identity), age, or disability in providing any aid, benefit, or service.
  • Include notices on significant documents to inform enrollees that:
  1. The issuer does not discriminate on the basis of race, color, national origin, sex, age, or disability;
  2. The issuer provides auxiliary aids and services to individuals with disabilities to provide meaningful access to health services;
  3. The issuer provides free translation and interpretation services for individuals with limited English proficiency to provide meaningful access to health services;
  4. How to obtain auxiliary aids and translation services;
  5. How to contact an employee responsible for compliance;
  6. The availability of a grievance process and how to file a grievance; and
  7. How to file a discrimination complaint with the Department of Health and Human Services, Office of Civil Rights.

All significant payor publications intended for enrollees, applicants, and members of the public must contain the notices listed above. “Significant publications” is not defined by the rules, but they generally are presumed to include policies, member guides, important notices about benefits, and similar information.

The rules indicate that larger size documents such as policies must include (1) a non-discrimination statement and (2) notices in at least the top 15 languages spoken in the state indicating that free translation services are available. Smaller size documents such as tri-fold brochures must include (1) a non-discrimination statement and (2) notices in at least the top 2 languages spoken in the state indicating that free translation services are available.

Sample notices are available in appendices A and B to the final rules.

Who Must Comply

The rules apply to health care plans or programs receiving any federal financial assistance, such as advance premium tax credits through a health insurance exchange, federal payments made to Medicare Advantage plans, and premiums or rates paid to Medicaid managed care plans. It is important to note that the rules’ reach is broad. If a payor offers just one policy that receives federal financial assistance, the rules apply not only to that specific policy but also to all other products offered by the payor whether or not those other products involve any federal financial assistance.

The rules also apply beyond payors. Third-party administrators must comply if they are engaged by a payor that receives federal financial assistance. Likewise, Medicare and Medicaid providers including physicians, hospitals, and skilled nursing facilities, are also subject to the rules as applicable.

Deadline to Comply

The anti-discrimination requirements became effective on July 18, 2016. The notice requirements are generally applicable on October 17, 2016, but where payors must modify their policy documents or plan designs, the compliance deadline is January 1, 2017. Any payors that have not filed amended policy documents with regulators for the 2017 plan year should do so this fall.