Linguistic Competency Clause Samples

Linguistic Competency. 2.8.9.1. The STAR+PLUS MMP must demonstrate linguistic competency in its dealing, both written and verbal, with Enrollees and must understand that linguistic differences between the Provider and the Enrollee cannot be permitted to present barriers to access and quality health care and demonstrate the ability to provide quality health care across a variety of cultures. 2.8.9.2. The STAR+PLUS MMP must arrange and pay for Competent Interpreter services, including written, spoken, and sign language interpretation, for Enrollees or LARs, as applicable, to ensure effective communication regarding treatment, medical history, or health condition. The STAR+PLUS MMP must maintain policies and procedures outlining the manner in which Enrollees, or LARs, as applicable, and Enrollee’s Providers can access Competent Interpreter services including written, spoken, and sign language interpretation when the Enrollee is receiving services from a Provider in an office or other location, or accessing Emergency Services. 2.8.9.3. Over-the-phone interpretation (OPI), including three-way calls facilitated between the STAR+PLUS MMP, Provider and telephone interpreter, must not require advance notification by the Enrollee, LAR, or Provider. Upon a Provider, Enrollee, or LAR’s request, in-person interpreters for scheduled appointments shall be arranged as quickly as possible, with “rush” appointments available for Urgent Conditions. For routine care, in-person requests will be scheduled according to the requested date and time, or upon the next availability of the interpreter for the requested language, including American Sign Language (ASL). If an in-person interpreter is not available for the requested date and time, the STAR+PLUS MMP must notify and coordinate with the Provider and Enrollee, and offer alternative interpretation options, such as OPI, video remote interpretation, or the earliest availability of the in-person interpreter. Enrollees may select an in-person interpreter whether they require ASL, or another language. The STAR+PLUS MMP may recommend, but not require, an advance notice timeframe for arranging an in-person interpreter. The STAR+PLUS MMP must make a good faith effort to arrange an in-person interpreter when one is requested, regardless of an advance notice requirement.

Linguistic Competency. The demonstration that an entity or individual has the capacity to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency (LEP), those who have low literacy skills or are not literate, and individuals with disabilities that require communication accommodations.‌

Linguistic Competency. The CICO must demonstrate linguistic competency in its dealing, both written and verbal, with Enrollees and must understand that linguistic differences between the Provider and the Enrollee cannot be permitted to present barriers to access and quality health care and demonstrate the ability to provide quality health care across a variety of cultures. Access for Enrollees with Disabilities The CICO and its Providers must comply with the ADA (28 C.F.R. § 35.130) and Section 504 of the Rehabilitation Act of 1973 (Section 504) (29 U.S.C. § 794) and maintain capacity to deliver services in a manner that accommodates the needs of its Enrollees. The CICO and its Providers can demonstrate compliance with the ADA by conducting an independent survey/site review of facilities for both physical and programmatic accessibility. Physical and telephonic access to services must be made available for individuals with disabilities and fully comply with the ADA. The CICO must reasonably accommodate persons with disabilities and ensure that physical and communication barriers do not inhibit individuals with disabilities from obtaining services from the CICO. The CICO must have policies and procedures in place demonstrating a commitment to accommodating the physical access and flexible scheduling needs of Enrollees, in compliance with the ADA. This includes the use of TTY devices for the deaf and hard of hearing, qualified American Sign Language (ASL) interpreters, and alternative cognitively accessible communication for persons with cognitive limitations.

Linguistic Competency. The ICO must demonstrate linguistic competency in its dealing, both written and verbal, with Enrollees and must understand that linguistic differences between the provider and the Enrollee cannot be permitted to present barriers to access and quality health care and demonstrate the ability to provide quality health care across a variety of cultures. The ICO must have the capacity to meet the needs of the linguistic groups in its Service Area. The following must be available: The provision of care, including twenty-four (24) hour telephone access and scheduling appointments, by providers who are fluent in both English and the language spoken by the Enrollee, or through translation services performed by individuals who are: Trained to translate in a medical setting; Fluent in English; and Fluent in the Enrollee’s language; Linguistically appropriate pharmacy, specialty, behavioral health, and LTSS providers. Access for Enrollees with Disabilities The ICO and its providers must comply with the ADA (28 C.F.R. § 35.130) and Section 504 of the Rehabilitation Act of 1973 (Section 504) (29 U.S.C. § 794) and maintain capacity to deliver services in a manner that accommodates the needs of its Enrollees. The ICO and its providers can demonstrate compliance with the ADA by conducting an independent survey or site review of facilities for both physical and programmatic accessibility. Physical and telephone access to services must be made available for individuals with disabilities and fully comply with the ADA. The ICO must reasonably accommodate persons with disabilities and ensure that physical and communication barriers do not inhibit individuals with disabilities from obtaining services from the ICO. The ICO must have policies and procedures in place demonstrating a commitment accommodating physical access and flexible scheduling needs of Enrollees, in compliance with the ADA. This includes the use of TTY devices for the Deaf and hard of hearing, qualified American Sign Language (ASL) interpreters and alternative cognitively accessible communication for persons with cognitive limitations. Enrollee Services Enrollee Service Representatives (ESRs) The ICO must employ ESRs trained to answer Enrollee inquiries and concerns from Enrollees and Potential Enrollees, consistent with the requirements of 42 C.F.R.§§ 422.111(h)(1) and 423.128(d)(1). ESRs must be trained to answer Enrollee inquiries and concerns from Enrollee...

Linguistic Competency. The demonstration that an entity or individual has the capacity to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons with LEP, persons who have low literacy skills or are not literate, and persons with disabilities who require communication accommodations. Living Independence for the Elderly (LIFE) — A comprehensive service delivery and financing program model in certain geographic areas of the Commonwealth (which is known nationally as the Program of All-Inclusive Care for the Elderly) that provides comprehensive healthcare services under dual capitation agreements with Medicare and the MA Program to individuals age 55 and over who are NFCE. Lock-In — The restriction of a Participant who is involved in fraudulent activities or who is identified as abusing MA services to one or more specific Providers to obtain all of his or her services in an attempt to appropriately manage care. Long-Term Services and Supports (LTSS) — Services and supports provided Market Share — The percentage of Participants enrolled with a particular CHC- MCO when compared to the total number of Participants enrolled in all the CHC- MCOs within a CHC zone. Marketing — Any communication from the CHC-MCO, or any of its agents or independent contractors, with a potential Participant who is not enrolled in the CHC-MCO, that can reasonably be interpreted as intended to influence that individual to enroll in the CHC-MCO or to disenroll from or not enroll in another CHC-MCO. Marketing Materials – Any materials that are produced in any medium by or on behalf of the CHC-MCO that can reasonably be interpreted as intended to be Marketing. Master Provider Index (MPI) — A component of the Department’s MMIS, which is a central repository of Provider profiles and demographic information that registers and identifies Providers uniquely within the Department. Medical Assistance (MA) — The Medical Assistance Program authorized by Title XIX of the SSA, 42 U.S.C. §§ 1396 et seq., and regulations promulgated thereunder, and 62 P.S. §§ 441.1 et seq. and regulations at 55 Pa. Code Chapters 1101 et seq.

Linguistic Competency. 2.11.11.1. The Contractor must demonstrate linguistic competency in its dealing, both written and verbal, with Enrollees and must understand that linguistic differences between the provider and the Enrollee cannot be permitted to present barriers to access and quality health care and demonstrate the ability to provide quality health care across a variety of cultures.