most discussion among legal advocates for Medicaid beneficiaries. The concern is rooted in the fact that it is the wording of the regulation that will control, not the preamble or webinar statements. Moreover, the proposed regulation § 438.420 defines “timely appeal” but then does not use the term in the remainder of the rule. We are suggesting small clarifications to address possible confusion about the requirements for continued benefits. We also support the amendments made to clarify requirements for recoupment but are recommending some additional protections for people with disabilities and limited English proficiency. RECOMMENDATION: Definitions. As used in this section— Timely filinges means filing on or before the later of the following— Within 10 calendar days of the MCO, PIHP, or PAHP mailing the notice of adverse benefit determination. Before the date the adverse coverage determination is to take effect. (The MCO, PIHP, PAHP must mail an advance notice as required by § 438.404(c)(1)). (b) Continuation of benefits. The MCO, PIHP, or PAHP must continue the enrollee's benefits if all of the following occur: … (1) The enrollee or the provider timely files files the appeal timely; ….. (d) Enrollee responsibility for services furnished while the appeal is pending. … Such practices must be consistently applied within the State under managed care and FFS delivery systems. To recover costs from an enrollee who has LEP or has a disability that requires information provided in alternate formats, the MCO, PIHP, or PAHP may only recover the cost of the services furnished to the enrollee while the MCO, PIHP or PAHP appeal and State fair hearing are pending if the MCO, PIHP, or PAHP can document that it provided the enrollee with information about recovery in the enrollee's language or in an alternate format to meet the needs of an individual with a disability. New § 431.234 – De novo State fair hearing Under Goldberg, a constitutionally impartial hearing will not occur until the individual reached the state fair hearing level of appeal. See, e.g., Daniels v. Wadley, . To ensure this fairness, the state fair hearing needs to occur de novo. We recommend:
including specialized terminology, which can be demonstrated by taking a language proficiency examination. As a note, we reference “sign language interpreter” below rather than “American Sign Language” in recognition that some enrollees may need assistance in another country’s sign language. RECOMMENDATION: Amend subsection (h)(vii) as follows: (vii) The provider’s cultural and linguistic skills, including languages spoken by the provider or by skilled medical interpreter at the provider’s office. To include a provider’s language skills in the directory, the provider must demonstrate he/she: is proficient and able to communicate all healthcare information accurately in the non-English language or sign language for which the provider will provide services in a non-English language or sign language; and possesses proficiency in the non-English language or sign language for which services will be provided including knowledge of: specialized healthcare terms and concepts in both languages; and any particularized vocabulary and phraseology likely to be used by the limited English proficient person or person needing a sign language interpreter, such as regional usages of terms; If a provider only has conversational capabilities in a non-English language or sign language, the provider may not list that language in the provider directory. We appreciate inclusion of the term “skilled medical interpreter” as a method of identifying providers who can offer language services in their offices. We suggest, however, that HHS provide some explanation of what “skilled” means, either in this section or in the definitions section. First, we would recommend changing “skilled” to “competent”. To be an effective interpreter, an individual must possess the requisite knowledge, skills and abilities. Skills alone are insufficient. For example, in surveying the healthcare interpreter field to develop its certification examination, the Certification Commission for Healthcare Interpreters () identified 6 “skills” (including active listening, retaining information in short term memory, note taking) but over 20 “knowledge” domains and 20 “abilities”. (See, e.g., Job Task Analysis Study and Results, May 14, 2010, CCHI, , at 10-11). An individual could meet the skills required to be an interpreter but not have the knowledge or abilities so using the term “skilled” interpreter does not sufficiently capture the requirements for an effective interpreter. Second, given the overall lack of understanding of the knowledge, skills and abilities required of healthcare interpreters throughout the healthcare arena, we recommend