Demetrios L. Kouzoukas

Earlier today, #CMS issued a Final Rule to bolster non-discrimination regulations in federally-funded programs including #MedicareAdvantage, Exchange, and #Medicaid. Before you brush this off as a routine #Compliance update, let’s explore these new rules a little more deeply. This FR strengthens rules requiring equal access for all, including language, literacy, race, color, nationality, sex, age, and disability to ensure beneficiaries access the benefits, services, health programs and activities they are rightfully entitled to. This applies to providers and payers, and tackles decision support tools, web content and mobile app accessibility, including for disabled persons, non-english speakers and no/low-literacy members. Every department is impacted by this rule, as is every vendor providing services to plans. CMS acknowledges compliance may be costly, will require fundamental changes to processes/activities and may result in insurors exiting the market. This FR builds on the 2024 FR requiring plans to communicate with members in their preferred language and alternate formats upon learning of them and the 2025 FR requiring plans to provide Notice of Availability in the 15 most common languages in members' state. Among other things, covered entities must now: - Designate a Section 1557 Coordinator - Develop, tailor and implement written P&Ps  - Provide required notices and assurances - Train employees on their role to ensure nondiscrimination - Modify/remediate any discriminatory practices What can you do right now? Begin by examining current state to help prioritize next steps: 1. Are internal programs/processes compliant with these rules?  Are your providers compliant? If not, how much will compliance cost?  2. Is #HEDIS & #PartD #Star measure noncompliance indicative of discriminatory practices? Are #CAHPS, #HOS & #memberexperience surveys highlighting issues where discriminatory activities are masked as #StarRatings weakness? 3. Is every vendor, FDR & supplier compliant with these rules? Are they using any black box algorithms, intervention targeting logic, predictive models, hardware/software, etc which could be discriminatory? If not currently compliant, can they become compliant? Can you wait on their timeline to become compliant? How much will compliance cost? 4. Where can you reduce costs to pay for the increased health expenses which will result from expanded access to benefits and services as equal access for all is operationalized? 5. Are #VBC and risk-contracts masking discriminatory practices by passing decision-making to a different legal org? Is your FDR oversight adequate to find and remediate discrimination by delegates? 6. If your operations are not product-tailored, are any processes or activities “quietly discriminatory” by letting low-literacy, non-english speakers or disabled persons look like they are non-responsive, un-/under-engaged or opt-outs? #ThisIsCahps. #ThisIsHOS. This is #HealthEquity & #HEI. ⭐

56

8 Comments

The Medicaid Leadership Exchange podcast shares insights on how states are working to achieve better outcomes for individuals served by Medicaid, and creative approaches used to address #healthdisparities. Via CHCS and NAMD - https://hubs.la/Q02DVp3g0

10

Great commentary and details to be considered from post by Deborah Williams Too few probably understand what you've posted, the other major part of the problem. Commercial insured populations (employers & employees) pay the price for government policy failures that represent major hits on company bottom lines or lead to more individual bankruptcies today. #employeebenefits #employers #commerialinsurance #epcouncil.org

1