This CMS standard, AA05, provides:

The MAO ensures that all services, both clinical and non-clinical, are accessible to all members and are provided in a culturally competent manner, including those with limited English proficiency or reading skills and those with diverse cultural and ethnic backgrounds.

The Basics

The URAC standard to implement this is URAC MAP-NM 16.  It requires that your organization makes sure that services provide through its health plan are provided in a culturally competent way to all consumers.  This requires your organization to implement a strategy of outreach to those with limited language skills and diverse backgrounds, both cultural and ethnic.

Your organization should have P&Ps specifically addressing this issue, so be sure to familiarize yourself with those P&Ps.  

Management Tips

It will be incumbent on you to take care that your policies and procedures around meeting the service needs of your consumers who have limited English proficiency, or are from other cultures or ethnic backgrounds.  This will require a knowledge of the demographics of your consumer population, and the capacity for flexible response across the full array of diversity that population presents to your organization.  Your policy and procedure, as will a supporting documents, should demonstrate that you have researched your population and implemented systems to adapt to your consumers' diverse characteristics.  Your policies and procedures should also address this requirement in your provider network.  In this context, the "network adequacy" includes providers who are capable of delivering services to your diverse consumer population.

In addition, your customer service staff will need to be trained on how to handle calls from non-English-speaking members.  They will need to be fully capable of dressing issues such as literacy, multiple languages, or blindness.

URAC Accreditation Tips

For the desktop review, you should submit the applicable policies and procedures, and as well as any language from the provider manual that addresses cultural competence.  In addition, you should submit a list of employees who might service translators, as well as a list of interpretive accommodations available to the hearing-impaired.  Samples of non-English consumer-focused educational materials would be good to submit, as well.

The on-site review will involve interviews of customer service staff members to assess their familiarity with your policies and procedures are in cultural competency.  In addition, the reviewer will examine documents such as evidence that your staff has been trained in cultural competency.  In addition, the reviewer is likely to say when you provide a directory in an effort to find providers who speak languages other than English.

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