Health literacy glossary
Plain definitions of the terms used in health literacy, language access and the rules for health documents.
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- Adverse benefit determination
- A Medicaid managed care plan’s decision to deny, reduce, suspend or end a service, or to deny payment. The plan must send a written notice that explains the decision and the reasons for it, and that meets the plain-language rules for enrollee materials.
- Source: 42 CFR 438.400 and 438.404
- Read the CMS-0057-F guide
- Alternative formats
- Other ways to provide the same written information, such as large print, braille, audio or an accessible electronic file, for people who need them.
- Source: 42 CFR 438.10 (Medicaid managed care information requirements)
- Read the 42 CFR 438.10 guide
- CAHPS
- Consumer Assessment of Healthcare Providers and Systems: surveys that ask patients and plan members about their experience of care, including how well information was explained. HCAHPS is the hospital version.
- Source: CMS, Consumer Assessment of Healthcare Providers & Systems
- CDC Clear Communication Index
- A research-based tool from CDC with items on the main message, calls to action, language, numbers and risk. A score of 90 or higher passes.
- Source: CDC, the Clear Communication Index
- CLAS Standards
- The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, published by the HHS Office of Minority Health.
- Source: HHS Office of Minority Health, Think Cultural Health: CLAS
- Health literacy (organizational)
- The degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
- Source: Healthy People 2030, Health Literacy
- Health literacy (personal)
- The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
- Source: Healthy People 2030, Health Literacy
- HEDIS
- The Healthcare Effectiveness Data and Information Set: NCQA’s performance measures for health plans, many of which depend on members acting on a letter or reminder.
- Source: NCQA, HEDIS
- Lay summary
- A summary of a clinical trial’s results written for people without specialist knowledge. The EU Clinical Trials Regulation requires one for trials it covers.
- Source: Regulation (EU) No 536/2014, Annex V
- Limited English proficiency (LEP)
- Describes a person whose primary language for communication is not English and who has a limited ability to read, write, speak, or understand English.
- Source: 45 CFR 92.4 (Section 1557 definitions)
- Read the Section 1557 guide
- Machine translation
- Automated, text-based translation without the assistance of or review by a qualified human translator. Under Section 1557, it must be reviewed by a qualified human translator when the text is critical to a person’s rights, benefits or meaningful access, when accuracy is essential, or when the text is complex or technical.
- Source: 45 CFR 92.4 and 92.201(c)(3)
- Read the Section 1557 guide
- Materials critical to obtaining services
- Under Medicaid managed care rules, at a minimum: provider directories, enrollee handbooks, appeal and grievance notices, and denial and termination notices. They must be available in the prevalent non-English languages and carry taglines.
- Source: 42 CFR 438.10 (Medicaid managed care information requirements)
- Read the 42 CFR 438.10 guide
- MLR review
- Medical, legal and regulatory review: the sign-off a pharmaceutical or device company’s materials go through before they are used.
- N-PLAT
- IHA’s plain-language assessment of the text and design of health materials. HealthLiteracyCopilot scores documents against its criteria.
- More on N-PLAT
- Notice of availability
- Under Section 1557, a notice that language assistance and auxiliary aids and services are free. It goes in English and at least the 15 languages most commonly spoken by people with limited English proficiency in the state, with certain notices and communications.
- Source: 45 CFR 92.11 (notice of availability)
- Read the Section 1557 guide
- PEMAT
- The Patient Education Materials Assessment Tool from AHRQ. It scores how understandable and how actionable a print or audiovisual material is, as two percentages.
- Source: AHRQ, the Patient Education Materials Assessment Tool
- More on PEMAT
- Plain language
- Writing that is clear, concise, well-organized, and follows other best practices appropriate to the subject or field and intended audience. This is the definition in the Plain Writing Act of 2010.
- Source: Plain Writing Act of 2010 (plainlanguage.gov)
- Prevalent language
- In Medicaid managed care, a non-English language that the state determines is spoken by a significant number or percentage of potential enrollees and enrollees with limited English proficiency.
- Source: 42 CFR 438.10 (Medicaid managed care information requirements)
- Read the 42 CFR 438.10 guide
- Readability formula
- A calculation from sentence length and word length (syllables or letters) that estimates how hard a text is to read, often as a school grade. It does not measure meaning, layout or whether the reader can act.
- How the readability formulas work
- Readily accessible
- In Medicaid managed care, electronic information and services that comply with modern accessibility standards such as Section 508, Section 504 and WCAG 2.0 AA and successor versions.
- Source: 42 CFR 438.10 (Medicaid managed care information requirements)
- Star Ratings
- CMS’s 1-to-5-star quality ratings for Medicare Advantage and Part D plans. Some measures come from member surveys about their experience.
- Source: CMS, Part C and D Performance Data
- Tagline
- A short statement in a non-English language that tells the reader translation or interpretation is available and how to ask for it. In Medicaid managed care, taglines on materials critical to obtaining services must be in a conspicuously visible font size.
- Source: 42 CFR 438.10 (Medicaid managed care information requirements)
- Read the 42 CFR 438.10 guide
- Teach-back
- Asking people to explain in their own words what they need to know or do, then clarifying and checking again.
- Source: AHRQ, Health Literacy Universal Precautions Toolkit, 2nd edition, Tool 5
- WCAG
- The W3C Web Content Accessibility Guidelines. The ADA Title II and HHS Section 504 web rules adopt WCAG 2.1 Level AA.
- Source: W3C, WCAG 2.1
- Read the ADA Title II and Section 504 guide
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