Medicare Plan providers face unique and difficult challenges. They serve a large and incredibly diverse population and attend to a wide variety of challenges in operating in today’s Medicare market.
Decoding and applying the lexicon of compliance requirements issued by Medicare is one such challenge. The 2016 Medicare Marketing Guidelines, which affect Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, Employer/Union-Sponsored Group Health Plans, Medicare-Medicaid Plans and Section 1876 Cost Plans – is 125 pages long. That’s a lot of regulatory code to consider, interpret and implement.
These regulations require that the plan also complies with the Rehabilitation Act of 1973, specifically sections 504 and 508 with respect to their member communication programs. The impact of this is that Medicare Plan providers must distribute plan information in various formats to meet unique needs presented by the disabilities of members.
The laws mentioned above boil down to two categories of actions taken to satisfy them: Alternate format availability and digital format accessibility.
Alternate Format Availability
According to the member marketing guidance, the definition of alternate formats is those formats “used to convey information to individuals with visual, speech, physical, hearing and intellectual disabilities (e.g., braille, large print, audio).”
Appendix 2 of the 2016 Medicare Marketing Guidelines states: All Plans/Part D Sponsors must ensure effective communication with individuals with disabilities and to provide auxiliary aids and services, such as alternate formats (e.g., braille, audio, large format), to individuals with disabilities to ensure an equal opportunity to access the agencies’ programs.
Digital Asset Availability
Further, according to HHS guidelines, Section 508 of The Rehabilitation Act requires that “Web sites and associated content created with federal funding, whether internal or external, government or contractor-hosted, are accessible to persons with disabilities.”
Appendix 2 further states that: All Plans/Part D Sponsors must have an internet website that is compliant with web-based technology and information standards for people with disabilities as specified in section 508 of the Rehabilitation Act.
On the face of it, creating fully accessible documents might not look all that challenging. After all, creating a document with large print, or even creating an audio version of that document for the vision-impaired isn’t too terribly difficult. The challenges can really loom, however, when working to deploy accessible documents on a large scale. The “laws of unintended consequences” can present themselves causing budget overruns, errors and compliance risks.
Medicare Plan providers communicate with an audience that is large by definition. Creating specific versions of individual member communications selectively for small segments of those audiences can be tedious and cost-prohibitive. As the needs for these types of fulfillments are exceptional in nature, effective workflow and supporting systems are needed to render them successfully. Even ostensibly simple accessibility changes, like providing large-print formats, can lead to unforeseen issues. As an example, increasing the font size on a document template can completely rearrange its layout, especially if the document contains images. This can force providers to create individual templates that correspond with each font size.
Editing the content of documents, whether that entails translating into foreign languages or simply adding content specific to those with certain disabilities, can trigger mistakes that can be far-reaching and expose plans to the penalties of non-compliance. Digital accessibility – most often in the form of PDF documents – are susceptible to the same issues. While most everyone has viewed a PDF document, few are experts in how to create and manipulate them for audible presentation. This can lead to documents that are confusing to those relying upon them for information.
Ensuring that member communications stay within the bounds of compliance regulations and satisfy the needs of the intended members can hit a plan’s managerial resources hard. With key staff availability at a premium, this is a task that most plans can’t afford to skip, but can’t afford to get it wrong.
The Alternative Solutions
Medicare Plan communications are high volume – and volume requires manpower. Technological advancements, however, have bred solutions that reduce the need for manpower, lower the overall costs of plan communications and help Medicare plan providers stay compliant.
Full-service communication platforms, like ABG Communication’s BridgeSuite, provide a centralized system through which plan administrators can create, edit and distribute member communications – as well as create versions of documents that fulfill all accessibility regulations and requests put forth by CMS and other government entities. These technological platforms eliminate the need for in-house experts and empower plans to execute the right communications at the right time, error-free.
ABG services include document template development that creates a PDF that complies CMS requirements as well as large print and braille document fulfillment and version-controlled online document template editing.
The Bottom Line
Ensuring compliance and meeting the needs of plan members are absolutely essential to the success of any Medicare Plan provider. Accomplishing these tasks with limited manpower and shrinking budgets requires the identification of new efficiencies and processes. Whether that means rethinking operations, reorganizing personnel, adapting new technologies or all of the above, Medicare Plan providers must identify new ways of doing business to survive in the modern healthcare climate.