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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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The Office of Minority Health (OMH) under the US Department of Health and Human Services has developed a set of national standards for health care organizations to offer Culturally and Linguistically Appropriate Services (CLAS).  
While the CLAS standards are primarily directed at health care organizations; individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.  
The 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows:  
CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7).
CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).
CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
 
Standard 1
Health care organizations should ensure that health care consumers receive from all staff member's effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.  
Standard 2
Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.  
Standard 3
Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.  
Standard 4
Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each health care consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.  
Standard 5
Health care organizations must provide to health care consumers, in their preferred language, both verbal offers and written notices informing them of their right to receive language assistance services.  
Standard 6
Health care organizations must assure the competence of language assistance provided to limited English proficient health care consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the health care consumer).  
Standard 7
Health care organizations must make available easily understood health-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.  
Standard 8
Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.  
Standard 9
Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, satisfaction assessments, and outcomes-based evaluations.  
Standard 10
Health care organizations should ensure that data on the individual health care consumer's race, ethnicity, and spoken and written language are collected in health records, integrated into the organization's management information systems, and periodically updated.  
Standard 11
Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.  
Standard 12
Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and health care consumer involvement in designing and implementing CLAS-related activities.  
Standard 13
Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by health care consumers.  
Standard 14
Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.  
 
The OHM offers a toolkit to aid providers in the practical application of the Cross-Cultural Clinical Practice Guidelines. It introduces the basic fundamentals of cross-cultural practice and offers steps and processes essential to delivering quality care to culturally diverse populations.  
 
This document provides links to other web sites. We make these links available for the sole purpose of providing general educational information on health care related issues. We cannot guarantee the quality, accuracy, truthfulness, or reliability of information presented on these web sites. These links do not constitute or imply endorsement by us of such web site or of any views or opinions expressed in the web site.  
 
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