Oral, Linguistic, and Culturally Competent Services
Guides for Managed Care Plans
care, two guides offer approaches to defining cultural needs in managed care and
developing appropriate services for them. The Centers for Medicare & Medicaid Services (CMS) commissioned both guides, which were developed by a
contractor of the Agency for Healthcare Research and Quality
Download summaries of both guides below; PDF files of the full guides may be downloaded from the CMS website.
Disparities and Improvement of Cultural and Linguistic Competence
In recent decades, there has been increasing recognition of the prevalence of racial and ethnic disparities in health care delivery and outcomes in the United States. Culturally and linguistically diverse groups and individuals of limited English proficiency (LEP) typically experience less adequate access to care, lower quality of care, and poorer health status and outcomes.
The Institute of Medicine's recent report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, states that: "Racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patient's insurance status and income, are controlled."
The recent Commonwealth Fund report, Diverse Communities, Common Concerns: Assessing Health Care for Minority Americans, provides similar insights. Policymakers, Federal health care agencies, civil rights/advocacy groups, researchers, and health care payers and administrators, among others, represent key stakeholders with an interest in understanding the reasons for such disparities and designing methods to reduce or eliminate them. Research suggests a probable link between these disparities and the need for improved cultural and linguistic competence in the provision of health care services. It is difficult to reduce health care disparities without first improving the cultural and linguistic competence of the health care services provided. (Select for definitions of cultural and linguistic competence.)
2003 CMS Project for M+COs
Each year, CMS identifies a topic for a national quality assessment and performance improvement (QAPI) project that Medicare+Choice Organizations (M+COs) must conduct to comply with program requirements. In 2003, M+COs have a choice of conducting a QAPI project that addresses either clinical health care disparities or provision of culturally and linguistically appropriate services (CLAS). M+COs may seek assistance in developing and conducting projects that focus on clinical health care disparities from their State Quality Improvement Organizations.
To help M+COs conduct projects that address CLAS, CMS arranged for a contractor from AHRQ's Integrated Delivery System Research Network to develop two guides for managed care plans. Select to access summaries of each guide: