Servicing Members With Limited English Proficiency

Cultural Competency, as defined by the Pennsylvania Department of Public Welfare (DPW), is the ability of individuals to understand the social, linguistic, moral, intellectual, and behavioral characteristics of a community or population, and translate this understanding systematically to enhance the effectiveness of healthcare delivery to diverse populations.

Further, Section 601 of Title VI of the Civil Rights Act of 1964 states that:
No person in the United States shall, on the grounds of race, color or national origin, be excluded from participation in, be denied of, or be subjected to discrimination under any program or activity receiving federal financial assistance.

A form of discrimination against a recipient of Medical Assistance funds on the basis of national origin may be discriminatory actions against those of Limited English Proficiency (LEP). Therefore, these recipients must be allotted equal access to all services and benefits of Keystone Mercy Health Plan.

Recipients of federal financial assistance would include the Pennsylvania Medical Assistance Program, and by extension, Medical Assistance Managed Care Organizations, i.e., Keystone Mercy Health Plan and their participating providers.

Title III of the Americans with Disabilities Act (ADA) states that public accommodations must comply with basic non-discrimination requirements that prohibit exclusion, segregation, and unequal treatment of any person with a disability. Public accommodations (such as health care providers) must specifically comply with, among other things, requirements related to effective communication with people with hearing, vision, or speech disabilities, and other access requirements.

Communication, whether in written, verbal, or "other sensory" modalities is the first step in the establishment of the patient/practitioner relationship. The key to ensuring equal access to benefits and services for LEP and sensory impaired members is to ensure that our providers can effectively communicate with these members. Keystone Mercy participating providers are obligated to offer translation services to LEP members, and to make reasonable efforts to accommodate members with other sensory impairments.

If a Keystone Mercy Health Plan member requires or requests translation services because they are either a non-english speaking or a limited English speaking member, or, the member has some other sensory impairment, the provider has a responsibility to make arrangements to procure translation services for those members, and to facilitate the provision of health care services to such members.

In order to be in compliance with federal law and state contractual requirements, Keystone Mercy Health Plan and its participating providers have an obligation to provide interpreter services to LEP members and to make reasonable efforts to accommodate members with other sensory impairments.

Providers who are unable to arrange for translation services for an LEP member should contact Keystone Mercy Health Plan's Member Services 1-800-521-6860 - TTY line is 1-800-684-5505, who will assist with locating a professional interpreter that communicates in the member's primary language. 

Enhancing Services for Members with Limited English Proficiency

Keystone Mercy Health Plan is committed to working with our provider community to enhance services and communication with our members who are of Limited English Proficiency (LEP). Our goal is to be sure that members with Limited English Proficiency or sensory impairments will experience few barriers in their ability to communicate with Keystone Mercy or our participating physicians. The following initiatives help ensure that members with Limited English Proficiency can properly access and utilize their Keystone Mercy benefits.

• Correspondence and printed materials, such as denial letters, member newsletters, and plan brochures, contain a tagline in the four languages spoken by 5% or more of our membership. Currently these languages are Spanish, Russian, Cambodian, and Vietnamese. The tagline advises members to call Member Services for a translation of the materials.
• Interpreter services are handled either through bi-lingual Member Services Representatives, or our contracted AT&T Language line.
• Members who are hearing impaired may call our TDD/TTY number, 1-800-684-5505. Members with visual impairments may request materials in large print, Braille, or audio tape.

If you have questions or concerns regarding the provision of services to members with Limited English Proficiency, call our Member Services Department 24 hours a day, 7 days a week at 1-800-521-6860.

Providing Interpreter Services for Members with Limited English Proficiency

Keystone Mercy Health Plan and its participating practitioners continually strive to meet the needs of our culturally diverse membership.

On a quarterly basis, Keystone Mercy Health Plan offers its participating providers an article on the provisions regarding Cultural Competency. This quarter's topic addresses the use of friends and/or family members providing interpreter services for our members with Limited English Proficiency (LEP).

Keystone Mercy Health Plan, including participating providers, could be held liable under Title VI of the Civil Rights Act of 1964 if they require, suggest, or encourage members with LEP to use friends, minor children, and/or family members as interpreters. Doing so could result in any or all of the following situations:

• A breach in confidentiality, or reluctance on the part of the member to reveal personal information
• The member could be placed in a serious or even life threatening situation
• The person called upon to assist may not be competent to act as an interpreter and may lack familiarity with specialized medical terminology

A family member or friend may be used as an interpreter if:

• Requested by the LEP member; and
• The use of such a person(s) would not compromise the effectiveness of services or violate member confidentiality; and
• The member has been previously advised that an interpreter is available to them through the facility at no cost

Keystone Mercy Health Plan encourages all of our participating providers to do their part in striving to meet the needs of our culturally diverse membership. Any practitioner with a question regarding the provision of services to members with Limited English Proficiency may contact our Member Services Department at 1-800-521-6860.