Managed Care Contract Negotiations
Sep 07

Three steps to deal with plan requirements for translation services

Here are three steps to deal with the plan’s requirements for members with limited English proficiency (LEP):

Step #1: Clarify legal obligations. Review the federal regulations and guidance to confirm that you know the extent of your legal obligations to provide translation services to LEP patients. You may want to enlist the aid of an experienced attorney to do so since the guidance now allows providers some flexibility, says says Michael Schaff, Esq., an attorney at Wilentz Goldman & Spitzer in Woodbrige, NJ.

Also, check your state law. Some states also impose requirements on providers to offer translation services, which may be stricter than what HHS requires. For example, the New Jersey Department of Health and Senior Services has strict requirements on hospitals to provide translators between a patient and hospital personnel, says Schaff. “You don’t want to challenge a plan about overbroad translation requirements and then discover that the plan’s requirements aren’t overbroad but do conform with the law,” Schaff says.

Step #2: Check plan requirements. Make sure you know what the plan imposes on you regarding translation services. The requirement may be in your contract; more likely it will be in the plan’s policies and procedure manual, says Schaff. If you can’t find written confirmation of the plan’s requirements, you should ask the plan directly.

Ideally, the plan’s requirements won’t be broader than what the law requires. That means that either the plan doesn’t have specific requirements on translation services or includes the requirements generally as part of your overall obligation to comply with all applicable laws. “Then the requirements conform to the law but don’t go further,” says Maria K. Todd, MHA, PhD, vice president, HealthPro Consulting, Inc. in Brooklyn.

Step #3: Contact plan about discrepancies. If the plan requires you to comply with requirements beyond what the law requires of you, ask the plan to change its contract or policy manual to be in line with the law. Many plans will back down and change those requirements that go too far, especially if you’re a larger provider with leverage or if the plan hadn’t realized that the requirements were overbroad, says Schaff. “Even if you’re a small provider, you have nothing to lose by bringing it up,” he notes.

This tip was excerpted from HCPro’s monthly newsletter, Managed Care Contracting & Reimbursement Advisor. For more information, click here.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →