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HPG Style GuideHighPoint Global, LLC

Revised Date: January 21, 2014

HPG Style Guide

Table of ContentsIntroduction...................................................................................................................................1

How to Use This Style Guide......................................................................................................2

Abbreviations.................................................................................................................................3

Including Acronyms, Initialisms, and Contractions....................................................................3

Acronyms and Initialisms...........................................................................................................3

General Guidance..................................................................................................................3

Content Team........................................................................................................................ 4

Training Team........................................................................................................................ 4

Calendar Abbreviations..............................................................................................................5

Contractions...............................................................................................................................5

Geographic and Postal Abbreviations........................................................................................5

Formatting..................................................................................................................................... 5

508.............................................................................................................................................5

Alt Text Formatting................................................................................................................6

Figures....................................................................................................................................... 7

Headings.................................................................................................................................... 7

Instructional Text.......................................................................................................................8

Lists............................................................................................................................................ 8

Acronym Lists.............................................................................................................................9

Bulleted Lists..............................................................................................................................9

Numbered Lists........................................................................................................................10

Spacing.....................................................................................................................................10

Titles........................................................................................................................................ 10

Titles of Documents.............................................................................................................10

Other Titles.......................................................................................................................... 10

Screenshots..........................................................................................................................10

Scripting Terms........................................................................................................................10

User Interface Components.....................................................................................................11

URLs and Web Addresses........................................................................................................ 11

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be

disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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HPG Style Guide

Grammar......................................................................................................................................12

Active and Passive Voice..........................................................................................................12

Adjectives................................................................................................................................ 12

Clauses.....................................................................................................................................13

Gender Neutrality....................................................................................................................13

Misplaced Modifiers................................................................................................................ 14

Parallel Construction................................................................................................................14

Pronouns..................................................................................................................................15

Pronouns and Their Antecedents.........................................................................................15

Nominative and Objective Pronouns...................................................................................15

Relative Pronouns................................................................................................................15

Using the Pronoun “You”.....................................................................................................16

Prepositions.............................................................................................................................16

Verbs........................................................................................................................................17

Transitive and Intransitive Verbs.........................................................................................17

Agreement...........................................................................................................................17

Mood................................................................................................................................... 18

Sequence of tenses..............................................................................................................18

Word Usage............................................................................................................................. 19

Names and Terms........................................................................................................................19

Documents...............................................................................................................................19

Job Titles.................................................................................................................................. 20

Medical Terms......................................................................................................................... 20

Organizational Titles................................................................................................................21

Governmental Bodies..........................................................................................................21

Institutions, Companies, and Associations...........................................................................22

Websites and Email Addresses................................................................................................22

Numbers, Dates, and Times.........................................................................................................22

Figures or Words......................................................................................................................22

Money......................................................................................................................................23

Percentages............................................................................................................................. 23



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Phone Numbers.......................................................................................................................23

Health Insurance Marketplace Call Center..........................................................................23

SHOP PAS (Premium Aggregation System) Call Center........................................................23

Medicare..............................................................................................................................23

Dates........................................................................................................................................24

Time......................................................................................................................................... 24

Punctuation................................................................................................................................. 25

Apostrophe.............................................................................................................................. 25

Colon........................................................................................................................................25

Comma.....................................................................................................................................26

Series Comma......................................................................................................................26

Commas with Appositives....................................................................................................26

Commas with Parenthetical and Descriptive Phrases..........................................................27

Commas with Independent Clauses.....................................................................................27

Commas with Dependent Clauses.......................................................................................27

Em Dash ( — ) and Hyphen......................................................................................................28

Em Dash ( — )...................................................................................................................... 28

Hyphen.................................................................................................................................28

Compounds Formed with Prefixes.......................................................................................28

Compounds Formed with Specific Terms.............................................................................29

Compound Modifiers...........................................................................................................29

Other Compounds................................................................................................................30

Parentheses............................................................................................................................. 31

Quotation Marks......................................................................................................................31

Semicolons...............................................................................................................................31

Slashes..................................................................................................................................... 32

Referring to the Public.................................................................................................................32

Rules that Work for Both Marketplace and Medicare.............................................................32

Content................................................................................................................................ 32

Training................................................................................................................................32

Marketplace.............................................................................................................................33



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Content................................................................................................................................ 33

Training................................................................................................................................33

Medicare..................................................................................................................................33

Content................................................................................................................................ 33

Training................................................................................................................................34

HPG A to Z....................................................................................................................................35

Appendix A: Acronyms.................................................................................................................72

Appendix B: Plain Language Guidelines.......................................................................................82

A.1 Confusing Plurals...........................................................................................................82

A.2 Everyday Words and Simple Verbs................................................................................83

A.3 Unnecessary Words.......................................................................................................85

A.4 Redundant Words or Phrases........................................................................................86

A.5 Language & Terms: DOs................................................................................................87

A.6 Language and Terms to Use Cautiously.........................................................................89

A.7 Short, Simple Words......................................................................................................92

Appendix C: Script Writing Dos and Don’ts..................................................................................92

Communication Guidelines......................................................................................................92

Script Messaging......................................................................................................................95

Messages For Multiple Audiences...........................................................................................96

Notations................................................................................................................................. 96



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HPG Style Guide

INTRODUCTIONHighPoint Global created this style guide to promote consistency in usage and style in all written and electronic documents and materials produced for the Centers for Medicare & Medicaid Services.

Please review the information in this reference guide and focus on the areas most applicable to your writing assignments.

This is a living document. The editors will review and update this guide throughout the contract as we receive feedback from the branch, project leadership, and other stakeholders.

In creating this guide, we have turned to recognized authorities in grammar, word usage, and style, principally those listed below, in addition to following the preferences of our client. In many cases, the icon of the resource that guided a particular decision follows the entry.

Centers for Medicare & Medicaid Services (CMS)

U.S. Department of Health and Human Services (HHS) Web Style Guide or the HHS Style Guide

Merriam-Webster Dictionary (If Merriam-Webster lists more than one spelling for a word, use the first entry listed.)

Government Printing Office Style Manual

National Institutes of Health Plain Language Guidelines

Healthcare.gov 2.0 Learn Document

Chicago Manual of Style

Garner’s Modern American Usage



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http://plainlanguage.nih.gov/CBTs/PlainLanguage/login.asp

http://www.gpo.gov/fdsys/pkg/GPO-STYLEMANUAL-2008/pdf/GPO-STYLEMANUAL-2008.pdf

http://www.merriam-webster.com/

http://execsec.od.nih.gov/help/terms/documentprep.pdf

http://www.hhs.gov/web/policies/webstyle.html#exceptions

HPG Style Guide

How to Use This Style GuideThe HPG Style Guide is divided into 3 principle sections: The first section of headings comprises the style and grammar points that we commonly deal with in creating and editing documents. The topics are in alphabetical order, beginning with Abbreviations and ending with Referring to the Public.

The second section is an alphabetical listing of terms, commonly used acronyms, and other style points that don’t necessarily fall easily into the first section. These terms appear as they would be used, so if a word is lowercase, such as “gold plan,” it will appear lowercase in the A to Z listing. If a term does not have a definition, we are still working on it.

The third section comprises 3 appendices: a broader list of acronyms widely used by Medicare and Marketplace; Plain Language Guidelines, which is an abbreviated version of the full-length federal guidelines; and Script Writing Dos and Don’ts, a document created specifically for Marketplace.

This style guide is a living document, and we will update it regularly. We are currently working on a change-management process that will, we hope, be transparent and easy to understand. Until that change process is created, feel free to email any of the editors with your suggestions and requests.



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ABBREVIATIONS

Including Acronyms, Initialisms, and Contractions

This section explains how and when to use abbreviations. The HPG Style Guide, following HHS guidelines, advocates sparing use of abbreviations, acronyms, and initialisms.

HPG A to Z lists some common abbreviations not singled out here. For a complete explanation on various types of abbreviations, refer to the Chicago Manual of Style, Chapter 10, Overview.

Acronyms and Initialisms

By definition, acronyms are words created by the first letter or letters of a term that can be pronounced: COBRA for Consolidated Omnibus Budget Reconciliation Act and CHIP for Children’s Health Insurance Program. Initialisms are also abbreviated forms of longer terms, but they cannot be pronounced: PPO for preferred provider organization and SSN for Social Security number. For purposes of this style guide, these terms are interchangeable.

The Acronyms appendix lists terms widely used throughout HPG. The complete list of accepted CMS abbreviations is at www.cms.gov/apps/acronyms; HHS ones are at www.HHS.gov/az.

General Guidance

If the term is used only once in a document, do not include the acronym. If an acronym is warranted, put it in parentheses after the term the first time the term

appears. Make sure that your definition of each acronym is capitalized correctly — in text and in

charts. You will find correct capitalization in the acronym appendix. If the acronym isn’t widely accepted or understood, don’t use it at all. Using ‘s to convey ownership in an acronym is OK since you pronounce the s’s. Abbreviations pronounced as words (true acronyms) are not preceded by “the” (e.g.,

SHOP is one of the Marketplace types). Abbreviations pronounced letter by letter are usually preceded by “the,” as in “the CSR” and “the EJT.” Letter-by-letter abbreviations of institution names usually take an article if they would take an article when fully written out. For example, the Affordable Care Act becomes the ACA. The Centers for Medicare & Medicaid Services is an exception to this rule. CMS does not take an article.



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http://www.HHS.gov/az

http://www.cms.gov/apps/acronyms

HPG Style Guide

When an abbreviation/acronym begins with B, C, D, G, J, K, P, Q, T, U, V, W, Y, or Z, the indefinite article “a” is used. When an abbreviation/acronym begins with A, E, F, H, I, L, M, N, O, R, S, or X is used, the indefinite article “an” is used.

When you are writing out Alt text for 508 compliance, avoid using acronyms. Don’t assume everyone knows what the acronym is. For example, to some, AMA means

the American Medical Association; to others, it is the American Management Association. At the same time, use common sense.

If your deliverable is aimed at CMS staff, you do not need to spell out Centers for Medicare & Medicaid Services first before referring to CMS. CMS staff know what CMS means.

Do not use periods with acronyms: HIPAA not H.I.P.A.A.

Content Team

CSR NOTEs: After first reference, place the acronym in parentheses without quotation marks. Use the acronym for subsequent references.

READs: Limit use to common Marketplace and Medicare acronyms, such as CHIP, SHOP, and COBRA. Because customer service representatives will read this section of a script to callers, acronyms should be called out using an “or” or “also known as” statement.

o Correct: “Your children may be eligible for coverage through the Children’s Health Insurance Program, known as CHIP.”

o Incorrect: “Your children may be eligible for coverage through the Children’s Health Insurance Program (CHIP).”

o Correct: “You can contact your local State Health Insurance Assistance Program, also known as SHIP, to set up an appointment that is convenient for you.”

o Incorrect: “You can contact your local State Health Insurance Assistance Program (SHIP), to set up an appointment that is convenient for you.”

Training Team

Training materials follow the rules in the General Guidance section; however, there are some exceptions:

In eLearning modules, redefine Affordable Care Act (ACA) on each page of the module. Do not define it as an acronym when it’s only used once on a page.

In instructor guides, define the acronym the first time it’s used on an instructor guide page and then again the first time it’s used on a participant guide page. Treat these as separate documents.



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HPG Style Guide

Always define the acronym for the Children’s Health Insurance Program (CHIP) on the first and only reference.

Calendar Abbreviations

Spell out all months.

Contractions

Informal language is OK in the deliverables, so using contractions is OK.

Let’s get started. Patients can’t do that.

Geographic and Postal Abbreviations

For a further information on geographic abbreviations, refer to the U.S. Government Printing Office Style Manual. But when in doubt, spell it out.

Use 2-capital-letter state postal abbreviations for addresses but do not use these abbreviations for anything else. Use one space between the state and the ZIP code.

o New York, NY 10001o San Francisco, CA 94109

In all other instances, spell out state names completely. A comma must immediately follow the combination of a city and state name when the sentence continues. o The secretary will stop in Santa Fe, New Mexico, to talk about prevention.

A list of all state postal code abbreviations is available at StateAbbreviations.us. When referring to the United States as a noun, spell it out. When using United States as

an adjective, use U.S., which must include periods.

FORMATTING

508

Complying with 508 does not require using specific language. For example, both “click” and “type” are perfectly acceptable in terms of 508 compliance. As we create documents, we should consider how the JAWS reads them. JAWS understands most symbols (saying “percent”



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when it sees %, for example), but it does not do as well with abbreviations. Use abbreviations sparingly and do not use abbreviations for months at all. To streamline JAWS reading, put only one space after a period.

Alt Text Formatting

When Alt text is required for images and tables, use the language and formatting detailed in this table.

Type Approved Alt Text Formatting*

Element IconsDo not write out the name of decorative icons — such as Group Activity icon, Tip icon, icon, and Key Point icon — in Alt text. Instead, replace the name of the icon with double quotations marks: “”. The JAWS reader recognizes “” as the symbol for a decorative image.

Screenshots

Alt text conveys meaningful information in the description of an image. For consistency, use this formatting: “Screenshot of the [insert screen name] with a red box highlighting [description of image].” Replace “a red box” with another appropriate description as necessary.

Examples: Screenshot of the Contacts screen showing the options described above. Screenshot of the Contacts screen with a red box highlighting the Next

button. Screenshot of the Pick applet.

Agenda Table This table contains the agenda for this guide.

Tables

This table describes the content of a [fill in the name of the appropriate icon or reference source].

Examples: This table describes the content of a group activity. This table describes the content of an NGD activity and a note. This table lists contact information for [fill in the appropriate name].



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Type Approved Alt Text Formatting*

Miscellaneous Graphics

Some documents contain pictures and other graphic images, which also require Alt text descriptions.

Examples: Image of 2 people sitting at a desk. Graphic of the 5 step process.

Note: Change content within brackets to match the document, citing the table, image, or other appropriate item.

Note: In a PDF, Alt text is called a table summary.

Figures Always use a colon after the figure number: Figure #: instead of Figure #., or Figure #, or

any other variation to identify figures. Figure captions are set in italics and treated stylistically like headings, described below.

Figure 1: Please Use the Appropriate Style and Set All Captions in Headings Case

When making reference to a figure within text, put the reference in parentheses and place it adjacent to the description, as shown below. Do not capitalize “see” or “refer to” and do not put a terminal period after the figure number.

Click the Claims Meeting Part A Deductible button (see Figure 7) to view a beneficiary’s Part A deductible information.

Headings

Capitalize the first and last words in titles and subtitles, and capitalize all other major words.

Capitalize auxiliary (helping) verbs.o CMS Can Helpo Procedures You Should Follow

Lowercase the articles “the,” “a,” and “an.” Lowercase prepositions, regardless of length, except when they are used adverbially or

adjectivally (Look Up) or when they compose part of a Latin expression used adjectivally or adverbially (De Facto).

Lowercase the conjunctions “and,” “but,” “for,” “or,” and “nor.”



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Lowercase “to” not only as a preposition but also as part of an infinitive (to Run), and lowercase “as” in any grammatical function.

Limit use of articles, such as “the” and “a.” Do not put a terminal period at the end of headings.

Instructional TextFor consistency throughout Marketplace documents, use the following terms when speaking to consumers about how to navigate a website or complete an online form.

Use “select” instead of “click.” Use “link” instead of “hyperlink.” Use “press” instead of “hit” when referring to using keys on a keyboard. Use “enter” instead of “type.”

Medicare does not have similar language constraints; however the terms used should be consistent within any given document.

Lists

Lists should be consistent in style and format. The following conventions apply to all lists, including those in PowerPoint presentations. Bulleted lists and numbered lists do have a few requirements of their own, listed below.

Capitalize the first word of each listed item. Unless it is in a heading, do not capitalize the word “list” itself.

o the Data Navigator listo the CMS contact list

Rules for punctuation of lists are as follows: o Use a period (or other appropriate closing punctuation) at the end of each item that

comprises a complete sentence (or a series of such sentences). o Do not use periods at the end of listed items that comprise phrases or single-word

items. o Use periods at the end of all list items if there is at least one complete sentence

within that bulleted list for the purpose of consistency. To make a list, you need at least 2 items. If you find you have only one, roll the

information back into the preceding paragraph. Or take a look at the information: Can you make 2 points from the information contained in the single point and will this provide more or less clarity?

Use parallel construction in lists (i.e., begin each item with the same word tense or phrase construction). Each item in the example below begins with a verb:



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Example:

Prior to submitting an application, a state must complete the following tasks:

● Attend design reviews.

● Complete a Blueprint Application.

● Attest to the completed, submitted Blueprint.

Acronym ListsAcronym lists at the beginning of documents should be in alphabetical order by acronym rather than by term. Spell out terms as they would appear in text not in headline style with initial caps.

HHA: home health agency HSA: health savings account

Bulleted Lists Align the bulleted list directly under the first letter of the first word of the preceding sentence or upper level bulleted list.

When the bulleted list contains headers, bold the header and use a colon to separate the header and the description/additional information.

Example:

There are 3 scenarios in which you may complete the PDF application:

Completing a New PDF Application: A consumer who has not yet begun the application process calls, and you are directed by your supervisor to use the PDF application.

Finding and Completing an Existing, Incomplete PDF Application: A consumer who began a PDF application and then had to hang up before completing it calls back, and you are directed by your supervisor to finish completing the PDF application with the consumer.

Completing an Application Online Using an Existing, Incomplete PDF Application: A consumer who began a PDF application and then had to hang up before completing it calls back, and you are directed by your supervisor to finish completing the PDF application online.

Numbered ListsUse numbered lists when you are directing readers to follow items in a sequential order that reflect steps or that show how items have relative importance and priorities.



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When formatting a numbered list, put a period after the number, as shown below. Don’t use parentheses numbering your list.

Get health insurance in the following 3 easy steps:

1. Set up an account.2. Fill out the online application, which is at no cost to you.3. Compare your options.

SpacingUse only one space after punctuation, including periods. Eliminating extra spaces helps avoid design problems and comports with 508.

Titles

Titles of Documents `

Content teams for Marketplace and Medicare bold script titles.

Training teams for Marketplace and Medicare italicize script titles.

Other Titles

Books and government manuals, such as Medicare & You are italicized.

Screenshots

In text that references screenshots, match the language of the screenshot in both capitalization and spelling, even if it’s wrong. For example, per CMS, we use 2 words for “user name;” however, if you see it as “username” in a screenshot, use 2 words in text that references that specific screenshot.

Scripting Terms

Scripting terms, such as “applet,” “icon,” “form,” and “list,” are not capitalized, although the item the term refers back to is.

the Reference Materials applet the IT Help Desk list



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HPG Style Guide

User Interface ComponentsUser interface components are clickable objects that appear in an application (buttons, fields, links, radio buttons, screen names, tabs, and view names). When writing instructional text in which you tell the reader to select user interface components, use the rules below.

Match spelling and capitalization in the user interface, even if it’s wrong. For example, if a field is named “Zip Code field,” when you refer to it, use that spelling rather than “ZIP.”

Bold the name of the user interface component. For example, “In the First Name field, enter your name and then select the Save button.”

Exception: Web chat and email scripting use quotation marks, rather than bold, on user interface items, and written correspondence uses neither quotations nor bold.

Applets are mini applications and, as such, are not components on the user interface. Do not bold applet names. For example, “NGD contains a Contacts applet.”

Keyboard keys, such as Ctrl, Enter, and Alt, are NOT user interface components and are not bold. Match the capitalization used on the keyboard.

Just as you would in other references, put script names in italics when they are user interface components.

URLs and Web Addresses

To create live links in running text, use the default Word formatting, which will make them blue and will underline them. Links in buttons and bars, however, do not need to be underlined. Do not italicize links and do not put them in bold.

If you are making a reference to a website but have no need of a live link or a specific URL, such as all READ text, do not use “www” before the address. Use this style in scripts: Visit HealthCare.gov for more information. If you are directing someone to a specific URL, use the entire link, beginning with “http://.”

Note: CMS has issued a list of must-use URLS, which must be printed exactly as CMS requests. This supersedes anything outlined in the style guide.

When directing people to online information, say, “You can find more information about the Marketplace at HealthCare.gov.” Do not say “on HealthCare.gov.”



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GRAMMAR

Active and Passive Voice

In active voice, the subject acts. In passive voice, the subject is acted upon. In active voice, the subject is always clear. In passive voice, the subject is not always identified.

Passive: The handbook was given to employees by the director.Active: The director gave the handbook to employees.

Passive: Attendees will be provided the webinar presentation in one week.Active: CMS will provide the webinar presentation to attendees in one week.

Although Plain Language guidelines and HPG style advocate active voice, passive voice is sometimes unavoidable and, occasionally, more to the point, We may not always know who is performing the action.

Passive: Mr. Bradford was prescribed 5 different medications and called the pharmacist to ask about drug interactions.

In this instance, we don’t know if a single doctor or several doctors prescribed the medications, but that isn’t the point. The point is that Mr. Bradford is concerned about drug interactions.

If you don’t know who is performing the action, check with a subject matter expert before defaulting to passive voice.

Adjectives

Adjectives are words that modify nouns and pronouns; they describe something. They rarely present a problem outside of their use as compound modifiers, which are usually hyphenated.

Low-income family Part-time employee Long-term contract

For a full discussion of compound modifiers, refer to Hyphen (Compounding) in the Punctuation section.



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One particular adjective — “only” — can also cause trouble, mainly by being misplaced in the sentence. Look at how placement of “only” changes the meaning of this sentence.

The beneficiary only asked about using a cane.The beneficiary asked about using only a cane.

In the first sentence, the beneficiary asked just one question, which was about using a cane. In the second sentence, he asked about using just a cane (instead of, perhaps, a walker).

Clauses A clause includes a subject and a verb and can be either independent — in that it can stand on its own and make sense — or dependent (subordinate) — in which it relies on another part of the sentence or the independent clause to make sense.

Example: The attendees returned to the plenary session after they completed their feedback forms.

In this sentence, “The attendees returned to the plenary session” is the independent clause; the writer can insert a period after this clause to make a complete, simple sentence. “…after they completed their feedback forms” is the dependent or subordinate clause. It contains a subject (they) and a verb (completed), but because of its beginning adverb (after), it cannot stand on its own and needs context to be a complete sentence.

Gender Neutrality

All the documents we create need to be gender neutral. To achieve gender neutrality, you may use “he or she” and “him or her,” but doing so can be awkward and even cumbersome (When the beneficiary calls, ask him or her questions before looking up his or her answers). It is equally acceptable to resolve the problem by using “they” or “them,” even if the subject is singular. This use of a plural pronoun referring back to a singular subject is gaining wide usage in both spoken and written word.

When the caller asks about the program, tell them it is available in their state. If a beneficiary calls in with a complaint, ask them probing questions.

You will run no risk of being misunderstood, and you will be using perfectly acceptable grammar.



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HPG Style Guide

Misplaced Modifiers

Words, phrases, and clauses that describe other words, phrases, and clauses are modifiers. Place a modifier next or closely to the word, phrase, or clause it describes for clear, logical understanding. The following sentence’s modifier is misplaced.

Misplaced modifier:

Prescriptions, services, or supplies are on your Explanation fo Benefits (EOB) that you did not receive.

In the above example, it appears that “you” did not receive the Explanation of Benefits. The sentence is clarified below.

Correctly placed modifier:

Prescriptions, services, or supplies that you did not receive are on your Explanation of Benefits (EOB).

Other examples of misplaced modifiers:

Misplaced: Having walked home, the rain stopped just as she arrived. Corrected: She walked home and, just as she arrived, the rain stopped.

Misplaced: There are 4 lesson plans for the participants, each shown on the screen.Corrected: There are 4 lesson plans, each shown on the screen, for the participants.

Parallel Construction Words, phrases, and clauses are parallel when the elements functionally match.

Parallel items in a series: CMS posts webinar presentations, user group documents, and CMS links to SERVIS each week.

Parallel phrases: Companies frequently ask questions about completing grant applications, submitting required evidence, and testing portal functions.

Parallel clauses: During a design review, a state must provide supporting documentation before moving onto testing files; it must upload testing files before seeking Marketplace approval; and it must provide a detailed Declaration Letter after the governor has



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attested to the completed activity areas.

Pronouns

Pronouns and Their AntecedentsA pronoun is a word used as a substitute for a noun or another pronoun.

The antecedent of a pronoun must be unambiguous. Avoid drafting confusing sentences such as the following.

Unclear: After the instructors review the new procedures with the students, they will go to lunch. (Who will go to lunch: the instructors, the students, or both?)

Better: After the instructors review the new procedures with the students, the students will go to lunch.

Nominative and Objective PronounsThe form of a pronoun depends on its function within a sentence. When used as the subject of a verb, a pronoun must be in the nominative case (I, you, he, she, it, we, they, and who). As the object of a verb or preposition or as the subject of an infinitive, a pronoun must be in the objective case (me, you, him, her, it, us, them, and whom). Confusion rarely occurs unless the pronoun is coupled with another noun or pronoun. And substituting “I” for “me” is the most common error, although “who” and “whom” are also problematic.

“Andrea gave the book to me,” slips effortlessly off the tongue. Adding another object to the preposition “to” may cause trouble.

Correct: Andrea gave the book to Skip and me. Incorrect: Andrea gave the book to Skip and I.

Correct: Whom did you give the book to?Incorrect: Who did you give the book to?

Occasionally, the uncertain writer will avoid both “I” and “me” by incorrectly substituting the reflexive pronoun “myself.”

Relative PronounsThe relative pronouns — who, whom, whose, which, and that — introduce adjective clauses and are usually necessary to the understanding of the sentence. You can occasionally drop “that” without confusion: He picked up the report [that] you completed. But not always. In this



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sentence, the reader has to circle back and mentally insert “that” for clarity: He requested the report be presented at the morning meeting.

Using the Pronoun “You”

Pronouns help the audience picture themselves in the text and relate better to your documents. More than any other single technique, using “you” pulls users into your document and makes it relevant to them. When you use “you" to address users, they are more likely to understand what their responsibility is. (Note: In training materials, “you” refers to the CSR, not the consumer.)

Instead of: The agency requires all applicants to provide copies of their tax returns.Use: You must provide copies of your tax return.

Be sure to define “you” clearly by any of the following methods:

State in the beginning of the document who the user is: “This training provides you, the CSR, with knowledge on the Affordable Care Act.”

Define “you” in the Definitions section — “You” means the customer service representative.

If you address different users in different parts of the document, define “you” in each context: “How do people or families apply for health insurance? If you are a person, you must apply… If you are a family, you must apply …”

Prepositions Although convention dictates that you avoid ending sentences with prepositions, it’s better to end a sentence with a preposition than to contort your sentence to avoid the ending preposition. Neither Chicago, Garner’s, nor Merriam-Webster’s voices any objection to the terminal preposition. Compare these sentences and it’s easy to see why the terminal preposition has a solid place in our language:

Give them what they asked for. Give them that for which they asked.

Prepositions and prepositional phrases can increase sentence length. Often the object of the preposition (typically a noun) can be used as an adjective to the word that preceded the prepositional phrase.



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Instead of: She thought the title of the book was intriguing.Use: She thought the book’s title was intriguing.

Instead of: We delivered the monthly metrics report for the month of January.Use: We delivered January’s monthly metrics report.

Note: Do not capitalize prepositions used in titles (documents, sections, etc.). Refer to the Heading subsection in Formatting for more details.

VerbsFor a sentence to be a sentence, it has to have a verb. For the most succinct explanation of verbs and the problems they present, refer to Garner’s Tenses entry. Beyond active and passive voice, addressed above in its own section, HPG verb guidelines are here.

Transitive and Intransitive VerbsTransitive verbs can take an object.

I dropped the cup. Mrs. DuPont phoned the CSR.

An intransitive verb cannot take an object (although it may be followed by a prepositional phrase that acts as an adverb).

He skis. He skis in Vermont. (Prepositional phrase answers where he skis.)

AgreementA verb must agree with its subject in person and in number. Subject-verb agreement doesn’t often present a problem unless the subject is connected to a misleading phrase, such as “as well as” or “together with.”



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HPG Style Guide

Correct: Aspirin, together with his other medications, controls the pain.Incorrect: Aspirin, together with his other medications, control the pain.

Correct: Jeremy, as well as Sydney, is planning a vacation.Incorrect: Jeremy, as well as Sydney, are planning a vacation.

Collective nouns, notably “none” can also cause some confusion. “None” can mean “not one,” which takes the verb “is,” or “not any,” which takes the verb “are.” Other collective nouns, such as “team,” usually take a singular verb.

MoodMood classifies verbs according to whether the writer intends the verb to express fact, command, or hypothesis. Do not switch moods in midsentence.

Indicative MoodIndicative mood is the most commonly used mood because it expresses facts, questions, assertions, and explanations.

She took notes in class. Are you going to the show?

Imperative Mood Scroll down for more information. Evacuate the building!

Subjunctive MoodSubjunctive is commonly used to express doubts, demands, suggestions, and wishes.

If I were rich, I’d buy a condo in Paris. I recommend that you take the medicine at once.

Although the subjunctive is often introduced with “if,” use the indicative if the statement might be true but the writer doesn’t know.

“If the supplier will not repair the beneficiary’s equipment, escalate the claim.”

Sequence of tensesGarner states: “The sequence of tenses refers to the relationship of tenses in subordinate clauses to those in principals clauses.” Sequencing rarely presents a problem if the action in the principal clause and subordinate clause occur in the same time period (past, present, or future).

He walked home after he saw the movie. I am going home after I finish the project.



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HPG Style Guide

Problems begin to arise with the subjunctive and with indirect discourse or reporting.

When the writer is reporting something that someone said, a present tense verb shifts to past tense.

When indirectly reported, “I am driving home” becomes, “She said that she was driving home.”

To avoid problems when mingling tenses, take your lead from the tense of the principal clause. If the principal clause is in the present, present perfect, or future, the subordinate clause has a present-tense verb.

Correct: She will go to the movie after it opens in her town.Incorrect: She will go to the movie after it will open in her town.

When the principal clause is in the past tense or past perfect tense, the subordinate clause takes a past-tense verb.

Correct: We drove home after the movie was over.Incorrect: We drove home after the movie had been over.

The ongoing or truth rule in sequencing tenses: When a subordinate clause states an ongoing or general truth, it should be in the present tense regardless of the tense of the principal clause.

The beneficiary told the CSR that she needs a respirator.

The action (“beneficiary told”) happened in the past, but the beneficiary’s need for a respirator is ongoing, requiring a present tense verb.

Word UsageChoosing the right word increases the precision of your writing. Avoid incorrectly substituting similar words that have slightly different meanings; using nouns incorrectly as verbs and vice versa; and using outdated terminology. If you have questions about a particular word, consult HPG A to Z or email an editor.

NAMES AND TERMS

DocumentsINFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been

publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure

may result in prosecution to the full extent of the law.19

HPG Style Guide

Follow the Chicago Manual of Style guidelines for capitalization of titles of works — general principles. Titles mentioned or cited in text and notes are usually capitalized headline-style. See Formatting for a description of this style.

Capitalize acts, treaties, and government programs in their complete and accepted titles. Lowercase these terms in their generic forms.

Affordable Care Act, the act Bill of Rights Food Stamp Act of 1964; food stamps Title 9 the Fourth Amendment, the amendment

Job Titles

Preceding an individual’s name, job titles are capitalized. Otherwise, they are lowercase, unless you are referring to the incumbent President and Vice President of the United States, which are always capitalized. Lowercase “presidency” and “presidential.”

John Kerry is the secretary of state. Secretary of State John Kerry will speak at commencement.

Ben Lanius is the president of HPG. HPG President Ben Lanius interviewed the job candidate.

There are also some CMS-specific requests that vary from broadly accepted rules. Always capitalize the following:

Navigator and Data Navigator Web Chat CSR

Military titles are lowercase unless preceding the name of an individual. Example: The general who leads the Joint Chiefs of Staff is General Martin Dempsey.

Medical Terms Medical terms, including diseases, conditions, and equipment, do not need to be capitalized; however, proper nouns associated with them always are. When in doubt, refer to Medline Plus, the National Institutes of Health’s dictionary, created by the National Library of Medicine in collaboration with Merriam-Webster.

Parkinson’s disease



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http://www.nlm.nih.gov/medlineplus/

HPG Style Guide

type 1 diabetes rheumatoid arthritis respirator wheelchair diphtheria, tetanus, and pertussis vaccine

Organizational Titles

Governmental BodiesCapitalize “administration” when referring to the federal executive branch serving under a specific president.

The Obama Administration followed the Bush Administration.

Do not capitalize words such as “federal,” “state,” or “nation” if used generically and not part of a proper noun or title. “Federal Government,” however, is always capitalized.

Some federal regulations focus on the nation’s public lands. The Federal Government administers the national parks.

The state-owned park was near the lake. The biggest state is Alaska.

Capitalize “federal,” “state,” or “nation” when they are part of a title.

The Federal Elections Commission The State Department employees The Navajo Nation The State of New York

Do not capitalize the word “state” when it refers back to the proper name of a state previously mentioned. Note: Four states are commonwealths and should be called such when using the official name: the Commonwealth of Kentucky, the Commonwealth of Massachusetts, the Commonwealth of Pennsylvania, and the Commonwealth of Virginia.

He spoke at the State of Washington’s centennial this summer. He had been to the state many times in the past.

The Commonwealth of Kentucky proposed the legislation. As a state, Kentucky is known for its horse farms.

Do not capitalize the words “congressional,” “members,” “government,” “department,” “agency,” “local,” and “nation,” except in titles.

The U.S. Department of Health and Human Services is the largest domestic agency.



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HPG Style Guide

The department held a discussion on the energy crisis, and several members of Congress attended the event.

The senators called for a congressional investigation into 2federal agencies.

Lowercase “program” or other common nouns in second references.

The Children’s Health Insurance Program offers low-cost health insurance plans for children up to the age of 18 in families who earn too much income to qualify for Medicaid. In some states, the program may have a different name.

Institutions, Companies, and AssociationsCapitalize these names, as well as the departments within them. Lowercase them when used generically.

Service Employees International Union, the union Northwestern University, the university Siemens Medical Solutions, Siemens, the company

Websites and Email Addresses

Capitalize principal words in CMS URLs (e.g., HealthCare.gov, InsureKidsNow.gov). Capitalize Federal Government acronyms used in URLs (e.g., CMS.gov, HHS.gov, and

IRS.gov). When directing people to the Twitter account, say @HealthCareGov. Capitalize proper names in email addresses: [email protected]

If you are uncertain about which words to capitalize, refer to the website itself.

NUMBERS, DATES, AND TIMES

Figures or WordsWrite out numerals 0 and 1 (i.e. zero and one).

Use the numeric digit for numerals 2 and greater, unless the number starts the sentence:

Of all states populating the Blueprint Application, only 18 have attested to completion. Twenty states applied for the new status.

Write “million” and “billion.” Do not list a long string of numbers, except for emphasis.



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HPG Style Guide

Correct: The sun is 93 million miles from Earth.Incorrect: The sun is 93,000,000 miles from Earth.

Avoid ordinal numbers if possible. When using them, spell them out: first, second, fifth, twentieth.

MoneyWhen writing dollar amounts use the dollar sign followed by the number. If the dollar amount is even, do not add “.00.”

Examples:

The claim was for $78.46.

You can claim up to $90 on that form.

PercentagesUse the numeric digit in front of the percentage symbol unless the numeric value begins a sentence. When the numeric value begins a sentence, spell out the numeral and the word “percent.” Do not put a space between the number and the percent symbol.

Examples:

Attendance from May to January increased 7%.

Seventy-five percent of the conference attendees provided favorable feedback.

Phone NumbersThe phone number format is X-XXX-XXX-XXXX, which uses dashes to separate phone numbers but does not use parentheses.

Health Insurance Marketplace Call Center1-800-318-2596 — Telephone Inquiries

1-855-TTY-HEAL (1-855-889-4325)

SHOP PAS (Premium Aggregation System) Call Center 1-800-706-7893 — General Inquiries

1-800-706-7915 — TTY

Medicare



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HPG Style Guide

1-800-MEDICARE (1-800-633-4227)

1-877-486-2048 — TTY

Dates

Write the full month, numeric date, and 4-digit year. Do not use st, th, or nd with dates. In change logs, document footers, reports, and other similar documents, it is acceptable to use this format: XX/XX/XXXX.

Also refer to En Dash

CMS hosted a spring conference May 23 - 24, 2012. November 16, 2012, was the application deadline.

When both the date and the year are used, the year is set apart with commas.

When including a month and a day in a sentence, write the cardinal number (January 1, January 2, January 3), not the ordinal number (January 1st, January 2nd, January 3rd).

On Tuesday, November 6, 2013, the Colts won the game. They agreed that January 2010 was a good month. They believed February 3 was a bad day (not “February 3rd”). The House voted on July 2, 2011, to pass the legislation. The campaign ran from March 6, 2012, to April 15, 2013. The abbreviated campaign ran from March 6 to April 15, 2011. The 3 months in question were March, April, and May 2012.

Time

Use a hyphen to show a span of time; use lowercase letters with periods for a.m. and p.m.; and capitalize time zones. If the beginning and end times both occur in the morning (or both occur in the afternoon) use the a.m. or p.m. after the end time only:

The webinar aired from 4:00 - 5:00 p.m., Eastern Time (ET). Each conference day’s schedule is 9:00 a.m. - 4:30 p.m., ET.

Per CMS, do not use “standard” or “daylight savings time” in time designations.



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HPG Style Guide

PUNCTUATION

Apostrophe

Use apostrophe “s” (’s) to convey ownership in singular words, including those ending in an s. (Reading aloud, note that you pronounce the s’s in Kansas’s.)

Each application’s narrative includes an itemized statement. Kansas’s governor signed the legislation. CMS’s database administration

Use only the apostrophe if the word is plural.

All states’ Navigators must complete a certification test. All the patients’ appointments were canceled.

Use an apostrophe to set aside a quotation within a quotation.

The customer service representative said, “Refer to Medicare & You, where it says, ‘If you don’t agree with your late enrollment penalty, you can ask for a review or reconsideration.’”

If a name is used as an adjective, it is not in the possessive form and doesn’t take an ’s.

CMS regulations cover many situations. Iowa legislators voted on the bill.

A noun preceding a gerund (verb ending in -ing) takes the possessive case:

The patient complained about Dr. Miller’s continuing the treatment.

Colon

The most frequent use of a colon is at the end of a sentence to introduce a list or series of items.

The provider offers 3 pieces of durable medical equipment: wheelchairs, walkers, and canes.

Writers occasionally make the mistake of separating the verb and its object with a colon.

The provider offers: wheelchairs, walkers, and canes.



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HPG Style Guide

Avoid these unnecessary colons.

Colons may also precede quotations and questions.

On page 82, Medicare & You states: “You generally must stay enrolled for the calendar year.”

The caller wanted to know one main thing: When does coverage begin? CMS promised 3 things: CMS will return Progress Letters within one week; CMS will

provide flexibility with consultations; and CMS will help each state with grant applications.

Capitalize the first word after a colon only if it is a proper noun or the start of a complete sentence.

Use one space after a colon, not 2 spaces.

Colons follow the salutation in a letter or email.

To Whom It May Concern: Dear Mr. Valdez:

Comma

Series Comma

HHS and the U.S. Government Printing Office Style Manual use the series comma (also called the serial comma or the Oxford comma). The series comma calls for putting a comma before the conjunction (and, but, or, nor, so, yet) in a series of 3 of more.

Each participant will receive a syllabus, notebook, and pen. The initiative will improve health care access, quality, and affordability.

Commas with Appositives

Commas set off words or phrases in apposition (a noun or noun phrase followed by another noun or noun phrase that refers to the same thing) or in contrast.

The agent, a CSR from Rhode Island, handled the disgruntled caller. The main office, not the suburban branch, hosted the visiting delegation. Jean’s sister, Joyce, was the eldest. (Jean had one sister.) But Jonathan’s brother Moses

Taylor was appointed. (Jonathan had more than one brother.)



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HPG Style Guide

Commas with Parenthetical and Descriptive Phrases

Use commas to set off parenthetic words, phrases, or clauses. For example:

Jefferson, who was then secretary of state, favored locating the capital in Washington. Their high morale, he suggested, might have caused them to put success of the team

above the reputation of the college. It was obvious, however, that he did not receive the answer he had hoped for. (Note:

When used as a conjunctive adverb (an adverb that connects 2 clauses), “however” is preceded by a semicolon and followed by a comma: The teams obtained documentation available on the VistA website, such as training manuals, installation guides, and technical manuals; however, they did not receive the additional IT documents that they requested.)

Commas with Independent ClausesIndependent clauses joined by conjunctions are separated by a comma, which goes before the conjunction.

Example: He thought the building was empty, but he saw lights on the third floor.

Commas with Dependent Clauses

A comma must follow a dependent clause that precedes a main clause.

Example: If you don’t file the paperwork on time, you won’t receive your benefits.

If the dependent clause follows the main clause, the 2 are separated by a comma only if the clause is nonrestrictive, meaning that it is not essential to the meaning of the main clause.

Restrictive: We will work if you pay us.

Nonrestrictive: I’d like to get your address now, if you don’t mind.

Writers sometimes mistakenly separate the parts of a compound predicate.

Correct: The agency published the regulation and will closely monitor its effect on access to health care.

Incorrect: The agency published the regulation, and will closely monitor its effect on access to health care.



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HPG Style Guide

Em Dash ( — ) and HyphenPut a space on both sides of a dash in all uses.

The following subsections provide additional details regarding the difference between em dashes, en dashes, and hyphens.

Em Dash ( — )Use the em dash to denote an abrupt change in thought in a sentence or an emphatic pause.

Example: We will fly to Paris in June — if I get a raise.

Smith offered a plan — it was unprecedented — to raise revenues.

When a phrase that otherwise would be set off by commas contains a series of words that must be separated by commas, use dashes to set off the full phrase.

Example:

He listed the qualities — intelligence, humor, conservatism, independence — that he liked in an executive.

To create an em dash (—) in Word, type 2 hyphens and include a space before and after the hyphen; Word will generate the em dash automatically.

Hyphen

Use hyphens to indicate a range of inclusive numbers or dates.

Example: CMS hosted a spring conference May 23 - 24, 2012. Each conference day’s schedule was 9:00 a.m. - 4:30 p.m., EST. Follow steps 1 - 3.

While hyphens serve other uses, such as showing the division of a word between 2 lines, usage issues arise most often with the hyphen as joiner: compounding. A compound word is a union of 2 or more words, either with or without a hyphen. Use hyphens in compound words to avoid ambiguity or to form a single idea from 2 or more words. General rules are laid out here. You may also turn to Merriam-Webster’s to see whether a particular word is a closed compound, open compound, or hyphenated compound. The Chicago Manual of Style, Sixteenth Edition, section 7.85, delineates broad rules of usage, beyond the ones shown below.

Compounds Formed with Prefixes



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HPG Style Guide

Compounds formed with prefixes are generally closed, unless closing the compound would create double identical vowels or triple consonants: coinsurance, proactive, interstate, multivitamin, autoimmune, but pre-emergent, shell-like, anti-inflammatory.

Compounds Formed with Specific TermsWhen in doubt about a specific word, defer to Merriam-Webster’s. Some words formed with terms such as “wide,” “on,” and “like” have compounds commonly spelled both open and closed. For example:

worldwide, system-wide online, on-target childlike, flu-like

Other terms have more generally applied rules.

all: When used as an adverbial phrase, spell open (all along, all over); when used as an adjectival phrase, hyphenate (all-out effort, all-encompassing regulation).

free: Generally hyphenate. The athletes are drug-free. It is a toll-free number.

full: Hyphenate before a noun: a full-sized load.

near: Spell open as a noun form and hyphenate as an adjective form: a near miss, a near-death experience.

self: Hyphenate as both a noun and an adjective: self-analysis, self-explanatory.

Compound ModifiersUse a hyphen between 2 words that form a compound modifier when that modifier immediately precedes the noun it modifies. When a compound follows the noun it modifies, hyphenation is usually unnecessary.

Compare

The well-read child spoke often.

The child who was well read spoke often.

Compare

The professor asked an open-ended question.

The question was open ended.

Adjectives with “well,” such as “well-made,” are hyphenated.



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HPG Style Guide

Two adjectives that precede a noun and act as a single idea, as well as adverbs — except those ending in “ly” —are usually hyphenated,

on-site storage, storage on site high-value items, items of high value service-disabled veteran-owned

Compounds created by adverbs ending in “ly” are spelled open: a federally approved plan, an easily understood policy, a generally accepted rule.

Compounds created by the adverbs more, less, most, least, and very are generally spelled open, unless spelling them open creates some ambiguity.

the most educated man the least qualified applicant a more thorough exam

Other Compounds

Use a hyphen for 2-thought compounds.

Serio-comic Socio-economic

Compound nationalities should be spelled open whether used as a noun or an adjective.

Mexican American French Canadian imports

Other examples of properly hyphenated terms include:

Wall-to-wall Off-the-shelf technologies Enterprise-level processes

When using a compound modifier in a title, always capitalize both words.

Course-Complete Survey Employer-Based Insurance Benefits



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HPG Style Guide

Parentheses

If the parenthetical content is not a complete sentence, do not capitalize the first word and use a period outside the closing parenthesis.

The application includes 13 modules (including partnership activities).

When a phrase placed in parentheses (this is an example) might normally qualify as a complete sentence but is dependent on the surrounding material, do not capitalize the first word or end with a period.

When introducing a list, place the colon outside the closing parenthesis.

Marketplace conference attendees include (in alphabetical order):

Quotation MarksUse quotation marks when you are quoting someone, when you use a word as a word, and when you are designating an article title.

The woman said, “I can have the paperwork to you by Friday.” The term “benefit” can mean many different things to consumers. He wrote “New Studies on Hypertension” for a medical journal.

With rare exceptions, punctuation belongs inside the quotation mark, even where the quotation mark sets off only part of a sentence.

She said, “I will.” She said, “I will,” every single time. She said, “Do you think I will?” Exception: Did she really say, “I will”?

SemicolonsUse the semicolon to separate items in a complex series when the items already contain internal punctuation. For example:

The sites are as follows: Dallas, Texas; Erie, Pennsylvania; and St. Cloud, Minnesota. The patient talked to the doctor about a series of seizures, which he had weeks before;

his prescription drugs, including Lipitor and Plavix; and his upcoming cancer screening. Jose Smith, of Chicago, is a Navigator for the Marketplace run by Illinois; Jane Brown, of

Kansas, is the Marketplace CEO and relies on Jose’s Navigator plan; and Sam Alvarez, of



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HPG Style Guide

Denver, uses a combination of Jose and Jane’s efforts in reports to the Colorado governor.

Use a semicolon to link 2 independent clauses not joined by a conjunction to signal a closer connection between them than a period would.

Example: The Marketplace run by Colorado completed its application on November 15, 2012; the Marketplace run by Maryland completed its application just a day later.

A semicolon is often used before “however,” “therefore,” “indeed,” and similar terms.

Example:

Tell the participants that this lesson covers many of the fields found in Next Generation Desktop (NGD); however, in some cases, it may not explain every field in each applet.

Do not capitalize the first word after a semicolon unless it is a proper noun or pronoun.

Slashes

Do not use a space before or after a slash. For example, CMS/OC is correct, and CMS / OC is incorrect.

REFERRING TO THE PUBLICCMS has specific requirements about referring to the general public, and those requirements are not the same for Marketplace and Medicare.

Rules that Work for Both Marketplace and Medicare

Content

To make scripting more personal, use “you” instead of “consumer” or “beneficiary” in the READ. For example, “You may be eligible for financial assistance.”

Training

The rules for training vary between Medicare and Marketplace and are explained below.

Marketplace

ContentINFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been



HPG Style Guide

The term “consumer” is appropriate in the CSR note and when speaking in broad terms in the READ. “Consumer” is also the term Marketplace.CMS.gov and HealthCare.gov use most often in the context of the ACA. Consumers are eligible for Marketplace coverage or currently have insurance. In limited circumstances, use “eligible consumers.” For example, “On January 1, 2014, every health insurance plan in the Marketplace is open to every eligible consumer, regardless of pre-existing conditions.” Do not use “constituents,” “clients,” “beneficiaries,” “callers,” and “individuals.”

Use “individual” to refer to the mandate, but use “people” for those who are not eligible for health insurance through the Marketplace. For example, “The Affordable Care Act requires most people to maintain health insurance.” Also, “People who are not eligible for Marketplace coverage are not required to pay a fee.”

The terms “employees” and “employers” can be used in SHOP scripts and other scripts that touch on employer-based insurance.

Training

Use “consumers” instead of “constituents,” “clients,” “beneficiaries,” “callers,” “people,” “individuals,” “employees” (can use for SHOP modules), or “employers” (can use for SHOP modules). This is also the term most often seen on Marketplace.CMS.gov and HealthCare.gov in the context of the ACA. Note: Medicare uses “beneficiary.”

When referring to people who have health insurance, they are “consumers” (person is insured = consumer); however, when we are referring to people without insurance or are in the process of applying for and enrolling in health insurance, then “people” is OK (person is uninsured = people). Additionally, if it is unclear whether the person has insurance, use “people.” You can also use “eligible person.”

Medicare

“Beneficiary” refers to the individual receiving Medicare. Do not use “beneficiary” in Medicare READ language; use “people with Medicare.” The shortened version, “bene,” is strictly reserved to internal communications. Both “consumer” and “beneficiary” are appropriate in the CSR NOTEs and when speaking in broad terms in the READ.

Content

Use “person with Medicare.”

Training

You may use “caller” or “beneficiary.” “Bene” is reserved strictly for internal documents.



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HPG Style Guide

HPG A TO ZTerms below are listed case sensitive as each would appear within a sentence.

NUMBERED TERMS80/20 Rule (Medical Loss Ratio or MLR)

The 80/20 Rule, sometimes known as the Medical Loss Ratio or the MLR, requires insurance companies to spend at least 80% of premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs. If an insurer uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

AAAaccount (online)

An online profile you can create within health care sites to track your information and keep a record of your claims and records. This uses your personally identifiable information (PII) to maintain legitimacy and accuracy.

actuarial value (AV)

The actuarial value of a health insurance policy is the percentage of the total covered expenses that, on average, the plan would cover. For example, a plan with a 70% actuarial value means that, on average, consumers would pay 30% of the cost of health care expenses through features like deductibles and coinsurance. The amount consumers pay would vary substantially by the amount of services they use.

advance premium tax credit (APTC)

Do not use “advanced” premium tax credit. People purchasing health coverage through a Marketplace may be eligible for APTC and cost-sharing assistance based on their income. The Marketplace may determine that a tax filer is eligible for APTC for a benefit year if:

Household income is between 100% and 400% of the federal poverty level. The tax filer, his or her spouse, or anyone claimed as a personal exemption deduction is

enrolled in a Marketplace plan. Anyone the tax filer claims as a personal exemption deduction is not eligible for minimal

essential coverage outside the individual market.



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HPG Style Guide

Non-tax filing applicants must provide the tax filer’s Social Security number to be eligible for APTC, and the tax filer or his or her spouse must have complied with the income tax return-filing requirements for that year.

Advanced Resolution Center (ARC)

affect/effect /impact

“Affect” the verb means to influence:

The snowstorm affected travelers throughout the Midwest. Cigarette smoke affects my breathing.

“Affect” is rarely used as a noun in contemporary usage. It means a person’s expression or demeanor.

She exhibited a disinterested affect.

“Effect” the noun means “the result of”:

The effect of the snowstorm was widespread. Cigarette smoke has an effect on my breathing.

The verb “impact” means “to strike with a blow” or “to pack firmly together.” Do not use “impact” as a verb in place of “affect.”

Affordable Care Act (ACA)

Also known as Obamacare; Health Reform; Patient Protection and Affordable Care Act (PPACA). The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, collectively known as the ACA, make up the health care reform legislation signed into law on March 23, 2010. The ACA requires people not covered by employer- or government-sponsored insurance plans to maintain minimal essential health insurance coverage or pay a fee. The ACA reforms certain aspects of the private health insurance industry and public health insurance programs, and increases insurance coverage for those with pre-existing conditions.

Note: The Affordable Care Act is the legislation that led to the establishment of the Health Insurance Marketplace, or the Marketplace. Use “the Affordable Care Act” or “the ACA” only when referring to this legislation. Use “the Health Insurance Marketplace” or “the Marketplace” to describe the program constructs and activities resulting from the implementation of the ACA.

agency

Lowercase, unless used as part of an agency’s name

agent partner

Lowercase, unless referring to the Agent Partner search screen in Next Generation Desktop



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HPG Style Guide

agents and brokers

States have flexibility to use agents and brokers to enroll qualified people in a Marketplace plan through the Marketplace and to assist people applying for advance premium tax credit and cost-sharing reduction. Agents or brokers can also help consumers navigate through the agent’s or broker’s website, and negotiate or sell coverage to consumers from a health insurance company outside the Marketplace.

a lot

Always 2 words; never “alot.”

already/all ready

“Already” applies to time, and “all ready” refers to preparation.

Are you already done writing those notes? Are you all ready to go?

American Indian and Alaska Native

When referring to indigenous Americans, use “American Indian” or, where applicable, “Alaska Native.” Do not use “Indian,” “Native American,” “Alaskan,” or “Eskimo.”

and/or

Avoid this term. “And” serves most circumstances when a writer might be tempted to use “and/or.”

annual limits

A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan.

appeal

A request for your health insurance company to review a decision or a grievance again.

appeals process

In the Marketplace, if your claim is denied or your health insurance coverage canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the company does not change its decision, you have the right to take your appeal to an independent third party for review, also known as an external review.

For a complete explanation of the appeals process for a Medicare claim determination, visit: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedicareAppealsProcess.pdf.

application



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http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedicareAppealsProcess.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedicareAppealsProcess.pdf

HPG Style Guide

Like form, applet, and similar terms, application is generally lowercase.

assister

Use “assister” not “assistor” when describing an application assister or in-person assister.

association health plan

Health insurance plans that are offered to members of an association. These plans are marketed to individual association members, as well as small businesses. How these plans are structured, whom they sell to, and whether they are state-based or national associations determine whether they are subject to state or federal regulation, or both, or are largely exempt from regulations.

autoenroll/autoenrollment

One word.

autopopulate

One word.

BBBbeneficiary

Beneficiary refers to the individual receiving Medicare. Do not use beneficiary in Medicare READ language; use “people with Medicare.” The shortened version, “bene,” is strictly reserved to internal communications.

benefit

The money or services provided by an insurance policy. In a health plan, benefits are the health care you get.

birth date

Two words

biweekly

No hyphen; not bi-weekly

bronze plan



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HPG Style Guide

The bronze plan is a Marketplace plan that covers 60% of the total plan benefit cost; typically, it is the least expensive (lowest premium) plan offered by an insurance company.

CCCcallback/call back

One word as a noun and 2 as a verb.

call centers

The Marketplace will assist consumers by providing access to service information via a toll-free call center. Each state has flexibility in structuring its call center to meet its population’s needs, including establishing core competencies for handing off calls, designing “referral routes” to established information sources, and setting call center specific performance standards.

caller

While it is common to use this term on the Medicare side, do not use this in Marketplace documents. Use “consumer” or “people” instead.

canceled

Use the single “l” rather than “ll” when forming the past tense.

care coordination

Not “coordination of care,” “coordination of services,” “service coordination,” or “coordination”

caseworker

One word.

catastrophic plan

Catastrophic plans protect against major medical out-of-pocket expenses and include coverage of 3 primary care visits. These plans have high deductibles and lower premiums. Consumers are eligible to enroll in a catastrophic plan if they are under 30 years of age before the beginning of the plan year, if they cannot afford minimum essential health insurance, or if they are eligible for a hardship exemption.



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HPG Style Guide

CCO Learning

Formerly called Learning Central.

Center for Medicaid and CHIP Services (CMCS)

CMCS is responsible for developing and implementing national policies governing Medicaid and Children’s Health Insurance Program (CHIP). CMCS works closely with states and the Center for Consumer Information and Insurance Oversight (CCIIO) to implement the Marketplace’s eligibility and enrollment functions.

Centers for Disease Control and Prevention (CDC)

Headquartered in Atlanta, the CDC is dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability.

Centers for Medicare & Medicaid Services (CMS)

The federal agency that runs Medicare, Medicaid, Children's Health Insurance Program, and the Marketplace run by the Federal Government

certified application counselors (CACs) and in-person assistance counselors

This group of facilitators assists consumers with filling out and submitting the application for a health plan, comparing and selecting a Marketplace plan, and enrolling in health coverage. There is no cost to the consumer for using the services of a CAC or in-person assistance counselor.

check box

Two words

child care

Two words

Children’s Health Insurance Program (CHIP)

All states provide coverage for children through Medicaid and CHIP. States may have a name other than CHIP for the programs that cover children.

In Marketplace Content, on the first and only reference to the program, include “known as CHIP” in the READ. In Marketplace Training, on the first and only reference, always include “(CHIP).”



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HPG Style Guide

claim

A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered.

COBRA (Consolidated Omnibus Budget Reconciliation Act)

COBRA gives workers and their families who lose their health benefits due to job loss, reduction in hours worked, transition between jobs, death, divorce, etc., the option to continue group health benefits provided by their group health plan for limited period of time, usually 18 months. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.

Never spell out in Medicare scripts.

code numbers

When embedded in text, code numbers appear in quotation marks. Example: Some common revenue codes are “1024” and “1025.”

coinsurance

One word. Coinsurance is your share of the costs of a health care service or medical device after you pay your deductible.

composed of/comprise

A medication may be “composed of” or may “comprise” a number of ingredients. A medication is not “comprised of” ingredients. Replace “comprised of” with a grammatical substitute. See also Include.

Correct: The team comprises [is made up of, is composed of, consists of] customer service representatives, team leaders, and managers.

Incorrect: The team is comprised of customer service representatives, team leaders, and managers.

Contact Center Operations (CCO)

Consumer Assistance Program (CAP)

Programs designed to help consumers with health insurance problems.



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HPG Style Guide

continuous /continual

“Continuous” means occurring nonstop without interruption. “Continual” means frequently occurring.

Tinnitus caused continuous ringing in her ears. Your continual interruptions make it difficult for me to complete my work.

copay/copayment

One word, no hyphen

cost-sharing reduction (CSR)

Do not refer to this term by its acronym if CSR is already being used in the same document for “customer service representative.” A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the silver plan category.

A tax filer is eligible for CSR for the benefit year if the tax filer:

meets the eligibility requirements for enrollment in a Marketplace plan meets the requirements for APTC has household income below 250% of the federal poverty level is enrolled in a Marketplace plan with a certain level of coverage

coverage/insurance

Use “coverage” instead of “insurance” when referencing Marketplace products.

Example: You can get health coverage through the Marketplace.

cross-reference

Whether it is a noun or verb, it is always hyphenated.

CSR NOTE

This is an internal term that provides instructions to the CSRs within the scripts.

customer service representative (CSR)

Lowercase except Phone CSR and Web Chat CSR INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been



HPG Style Guide

DDDdatabase

One word

Data Navigator

The Data Navigator, sometimes referred to as Navigator, is an easy-to-use, menu-driven search tool that makes the data and information resources of CMS more easily available. Use the Data Navigator to find data and information products for specific CMS programs, such as Medicare and Medicaid, or on specific health care topics or settings-of-care. The Navigator displays search results by data type, making it easier to locate specific types of information (e.g., data files, publications, and statistical reports).

deductible

Your deductible is the amount you owe for covered health care services before your insurance plan begins to pay.

For example, if your deductible is $1000, your plan will cover costs only once you have paid $1000 for health care services. The deductible may not apply to all health care services and depends on your health insurance provider’s requirements.

Defense of Marriage Act (DOMA)

Passed in 1996, DOMA is a federal law that allows states to refuse to recognize same-sex marriages. In 2011, the Obama Administration concluded that the law is unconstitutional and said that it will uphold the law but will no longer defend it in court. In 2013, the Supreme Court overturned the proversion of the law that defined “marriage” only as a union between one man and one woman as husband and wife.

dependents

Dependents are family members such as spouses, children, and partners.

Diff Doc

Like Word, Diff Doc is a specific program and should be capitalized.

disenroll/disenrollment

One word



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HPG Style Guide

drop-down

Hyphenate as an adjective.

dual eligible

Two words, no hyphen

EEEEasy Pay

Always capitalize

e.g. /i.e.

e.g. means “for example” and is the abbreviation for the Latin term “exempli gratia.” Use e.g. when referring to a subset within or a sample of a larger group. Use a comma after the term. Do not italicize the term.

CMS hosted a dinner for some of the early innovator states (e.g., Oregon, Maryland, and Connecticut).

i.e. means “that is” or “that is to say” or “in other words” and is the abbreviation for the Latin term “id est.” Use a comma after the term. Do not italicize the term.

CMS met with the 2 conditionally approved marketplaces run by the state (i.e., Arkansas and Delaware).

If you can’t remember the difference between the 2 terms, imagine that i.e. means “in essence” and e.g. sounds like “egg sample.”

Note: It is redundant to begin a phrase with e.g. and end it with etc.

eLearning module

eligible/eligibility

eligibility results

Do not use “eligibility determination” unless absolutely necessary to avoid confusion. It is OK, however, to say “the Marketplace will make a determination on eligibility.”



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HPG Style Guide

email

One word, lowercase, no hyphen

employer-based

Do not use “work-based.”

employer-shared responsibility

If an employer with at least 50 full-time equivalent employees doesn't provide affordable health insurance and an employee uses a tax credit to help pay for insurance through a Marketplace, the employer must pay a fee to help cover the cost of the tax credit.

employer-sponsored

Do not use work-based.

end-stage renal disease

Lowercase and always hyphenate “end-stage.”

enrollment eligibility

These are requirements that a consumer must meet to be able to purchase health insurance through the Marketplace:

Must live in the United States Must be a U.S. citizen or lawfully present in the United States for the entire time you

plan to be covered by health insurance Can’t be currently incarcerated

ensure/insure/assure

“Ensure” means make certain. “Insure” means to cover with insurance or agree to provide compensation for damage. “Assure” means to inform confidently or remove doubt from someone's mind.

Example: Mike wanted to ensure that he protected his house from disasters. He bought a homeowners policy that insured his house against fire, flood, theft, and earthquakes. He assured his wife that the policy was affordable.



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HPG Style Guide

essential health benefits (EHB)

EHB is a core package of items and services that must be offered by any Marketplace plan, including items and services such as outpatient care, emergency services, hospitalization, maternity and newborn care, prescription drugs, laboratory services, children care services such as oral and vision care, preventive services, mental health and substance use disorder services, and rehabilitative and habilitative services and devices.

essential job training (EJT)

et cetera (etc.)/et alia (et al.)

“Etc.” and “et al.” are often used in text when the writer hasn’t taken the time to be precise. Use them only when there really are too many items to innumerate.

Lazy usage: The bakery sells pies, cakes, etc.

More precise: The bakery sells an array of goods, including pies and cakes.

If you use etc. and et al., follow these rules of punctuation.

If the sentence were a question, etc. and et al would appear with both a period and a question mark: “…etc.?”

If within parenthesis, etc. and et al. still contain the period; however, any additional punctuation that might be required appears after the parenthesis: (. . . et al.).

If at the end of a sentence, do not use double periods: “…etc. The next sentence…”

exception (Medicare prescription drug coverage)

A type of Medicare prescription drug coverage determination. A formulary exception is a drug plan decision to cover a drug that’s not on its drug list or to waive a coverage rule. A tiering exception is a drug plan decision to charge a lower amount for a drug that’s on its nonpreferred drug tier. You must request an exception, and your doctor or other prescriber must send a supporting statement explaining the medical reason for the exception.

excluded services

Health care services that your health insurance or plan doesn’t pay or cover.

exemption/exceptions (individual mandate)

Exemptions and exceptions release an individual from the obligation to pay a fee if they don’t maintain minimum essential coverage. You cannot apply for exemptions at this time.



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HPG Style Guide

Exemptions to the individual mandate include:

Religious conscience: You are a member of a religious sect that is recognized as being morally opposed to accepting any health insurance benefits.

Health care sharing ministry: You are a member of a recognized health care sharing ministry.

Indian tribes: You are a member of a federally recognized Indian tribe. No filing requirement: Your household income is below the minimum threshold for filing

a tax return. To find out if you have to file a federal tax return, contact the IRS. Short coverage gap: You went without coverage for less than 3 consecutive months

during the year. Hardship: A Health Insurance Marketplace has certified that you have suffered a

hardship that makes you unable to obtain coverage. Unaffordable coverage options: You can’t afford coverage because the minimum

amount you must pay for the premiums is more than a specified percentage of your household income.

Incarceration: You are currently in a jail or correctional facility. Not lawfully present: You are neither a U.S. citizen nor an alien lawfully present in the

U.S.

external review

A request for an independent review organization to review a benefit determination made by your health insurance company.

Extra Help

Uppercase when referring to the low-income subsidy program.

FFFfederal

Lowercase (adj.), unless “Federal Government.”

Federal Government

Always capitalize.



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HPG Style Guide

federally approved program

No hyphen

federal poverty level (FPL)

The Federal Government’s working definition of poverty that is used as the reference point to determine the number of people with income below poverty and the income standard for eligibility for public programs. The Federal Government uses 2 different definitions of poverty. The U.S. Census poverty threshold is used as the basis for official poverty population statistics, such as the percentage of people living in poverty. The poverty guidelines, released by the U.S. Department of Health and Human Services, are used to determine eligibility for public programs and subsidies.

Federally Facilitated Marketplace

This term has been replaced by Marketplace run by the Federal Government.

fee

Use “fee” to describe the tax imposed for not purchasing insurance. Do not use “penalty” or “assessment.”

fewer/less

Use “fewer” when referring to a group of distinct elements. Use “less” when referring to an aggregate.

Fewer people are dying of strokes. Please use less vinegar in that dressing. Less fat, fewer calories

final rule

Lowercase.

fits your budget

CMS prefers the term “fits your budget” to the term “affordable.”

flexible spending account (FSA)

Also known as flexible savings or flexible spending arrangements, these are arrangements you set up through your employer to pay for many of your out-of-pocket medical expenses with tax-



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HPG Style Guide

free dollars. These expenses include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices. You decide how much of your pre-tax wages you want taken out of your paycheck and put into an FSA. You don’t have to pay taxes on this money. Your employer’s plan sets a limit on the amount you can put into an FSA each year.

If you don’t spend your FSA funds by the end of the plan year, you can’t carry them over, or use them, for expenses in the next year. There is an exception to this rule if your employer’s FSA plan permits you to use unused FSA funds for expenses incurred during a grace period of up to 2.5 months after the end of the FSA plan year.

flip chart

Two words.

follow-up

Hyphenated as a noun.

free

Use “free or low-cost plans.” Do not use “no-cost or low-cost plans.”

full-time equivalent (FTE)

You are considered FTE employee if you generally work 30 or more hours per week on average.

GGGGeneral Medicare

Use this term only when referring to the line of business.

gold plan

The gold plan is a Marketplace plan that covers 80% of the total plan benefit cost.

go/no-go

grandfathered plan

An individual or group health plan that was purchased on or before March 23, 2010.



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HPG Style Guide

HHHhandout

One word

he/she

Do not use this terminology. See Gender Neutrality in Grammar.

health care

Two words unless referring to the name of an agency.

health care provider

A person or organization that’s licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.

health coverage

Use “coverage” instead of “insurance” when referencing Marketplace products.

health insurance

Health insurance protects consumers from the high costs of medical care for serious illness and injury. No one plans to get sick or hurt, but most people need treatment for an illness or injury at some point, and health insurance helps consumers pay for these costs. Health insurance also helps consumers pay for the cost of the routine care needed to stay healthy by covering the cost of many preventive services, such as vaccines and screenings.

health insurance claim number (HICN)

The Social Security Administration assigns health insurance claim numbers to individuals to identify them as Medicare beneficiaries.

health insurance company

Do not use “issuer,” “health insurance provider,” or “health insurer.”

Health Insurance Marketplace

Training: Always use full name upon first reference. Use Marketplace thereafter.



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HPG Style Guide

Content: Do not use “Health Insurance Marketplace” in any instance in scripts. Always use “Marketplace.”

Each state must establish and operate a Marketplace where people and small-business employees can purchase health insurance coverage. The marketplaces increase access to coverage by creating a single point of access for consumers to receive eligibility determinations for enrollment in the Marketplace. A Marketplace by definition can encompass multiple vendors, so we always say “Marketplace,” singular.

health insurance plan

A health insurance plan is the agreement between a consumer and an insurance company to pay for certain medical services. Health insurance plans provide coverage for medical care, and may include dental and vision, depending on the plan selected. Each plan specifies the exact services covered and the consumer’s financial responsibility.

health insurance through the Marketplace

The new Health Insurance Marketplace offers consumers a choice of affordable health insurance plans that cover a comprehensive set of services to purchase. Note that open enrollment begins on October 1, 2013.

health maintenance organization (HMO)

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

health savings account (HSA)

A medical savings account available to taxpayers who are enrolled in a high deductible health plan. The funds contributed to the account aren't subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical expenses. Unlike a flexible spending account (FSA), funds roll over year to year if you don't spend them.

help desk

Two words; lowercase

HHS Operating Divisions and Staff Divisions

Abbreviate by saying OpDivs and StaffDivs.



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HPG Style Guide

high-risk pool

Hyphenated term. State programs designed to provide health insurance to residents who are considered medically uninsurable and are unable to buy coverage in the individual market. High-risk pools operate in many states but vary by eligibility, cost-sharing requirements, availability of premium subsidies, and funding sources.

HIPAA

Health Insurance Portability and Accountability Act. Enacted in 1996, HIPAA combines a range of regulations that include those protecting personal health information and prohibiting pre-existing condition exclusions when workers are moving from one job to another.

HIPAA eligible individual

Your status once you have had 18 months of continuous creditable health coverage. To be HIPAA eligible, at least the last day of your creditable coverage must have been under a group health plan; you also must have used up any COBRA or state continuation coverage; you must not be eligible for Medicare or Medicaid; you must not have other health insurance; and you must apply for individual health insurance within 63 days of losing your prior creditable coverage. When you're buying individual health insurance, HIPAA eligibility gives you greater protections than you would otherwise have under state law.

home health

Lowercase unless it is part of a proper name, as in Home Health Agency.

Home Health Agency

Always capitalize

home page

Two words, lowercase.

IIIicebreaker

One word

if/whether

“If” specifies a condition. “Whether” introduces an indirect question concerning alternatives.



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HPG Style Guide

I do not know whether John will arrive on Tuesday or Wednesday. If he can do it, let him.

imply/infer

Although related, these 2 words refer to different ends of the communication process. When speaking or writing, you can “imply” something beyond what your words state directly; the person listening to you or reading your writing can then “infer” your indirect message.

incarcerated

Do not use “prison,” “jail,” or “imprisoned.”

include

The standard usage of “include” introduces a nonexhaustive list. Dinner includes dessert. When introducing a complete list, use “consists of” or some similar term.

Correct: The doctor saw 3 patients, including Ms. Owen.

Incorrect: The doctor saw 3 patients, including Mrs. Sveum, Ms. Owen, and Mr. Spires.

individual mandate

Under the ACA, consumers are required to obtain health insurance or pay a fee imposed for not purchasing insurance. When describing this fee, do not use penalty, responsibility payment, or annual payment.

in regard to/in regards to (with regard to/with regards to)

The correct forms are “in regard to” and “with regard to.”

insurance affordability program (IAP)

A health insurance option designed to reduce the cost of health insurance.

Internal Revenue Service (IRS)

Internet

Always capitalize.

it’s/its

“It’s” is a contraction of “it is.” (It’s a fine day outside.)



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HPG Style Guide

“Its” is the possessive form of “it.” (The dog is wagging its tail.)

JJJJAWS

An internal-use only term standing for Job Access with Speech, a program that converts text to speech for the visually impaired.

job-based

Do not use “work-based.”

KKKkeyword

One word

LLLlawfully present

Do not use “lawful permanent resident,” “legal permanent resident,” or “legally present.”

lay/lie

“Lay” (past tense and past participle form, “laid”) is a transitive verb; people lay things on the table or floor.

“Lie” (past tense, “lay”; past participle, lain) is an intransitive verb; things and people lie on the table or on the couch.

I am going to lie down for a nap; I lay down for a nap yesterday; I have lain down for a nap every afternoon.

The man lays the paperwork on the table; the man laid the paperwork on the table; the man has laid the paperwork on the table.



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HPG Style Guide

licensed insurance agent

To the extent permitted by a state, licensed insurance agents may enroll consumers in coverage through the Marketplace. Under state law, health insurance companies will compensate licensed insurance agents. Federal and state training and certification will apply.

licensed insurance broker

To the extent permitted by a state, licensed insurance brokers may enroll consumers in coverage through the Marketplace. Under state law, health insurance companies will compensate licensed insurance brokers. Federal and state training and certification will apply.

life cycle

Two words, no hyphen

lifetime limits

A cap on the lifetime benefits that you may get from your insurance company.

local system administrator

Lowercase.

Log in/Login (log on)

Log in (2 words) is a verb. Login (one word) is a noun.

Example: To log in to the program, enter your user name and password on the login screen.

long-term/short-term

Always hyphenate as an adjective.

long-term care

A variety of services that help people with their medical and nonmedical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care is custodial care. Medicare doesn’t pay for this type of care if this is the only kind of care you need.



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HPG Style Guide

long-term hospital care

Acute care hospitals that provide treatment for patients who stay, on average, more than 25 days. Most patients are transferred to one of these facilities from an intensive or critical care unit. Services provided include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.

lower costs

Use this phrase when describing the advanced premium tax credit (APTC). Do not use “premium savings” or “premium discount.”

MMMmail-order

Always hyphenate as an adjective: mail-order prescription.

Marketplace

Always capitalize. The Marketplace is a new way to get health coverage. In the Marketplace, people (through the individual Marketplace) and small businesses (through the SHOP Marketplace) can compare health insurance plans, get answers to questions, determine eligibility for financial assistance, and enroll in health insurance.

Marketplace plan(s)

Marketplace plans are health insurance plans offered to people and small businesses getting health coverage through the Marketplace. Health insurance providers must meet a set of minimum requirements to offer insurance in the Marketplace, but states have flexibility to require additional Marketplace plan standards beyond those outlined in the ACA.

Note: Do not use Qualified Health Plan or QHP.

Marketplace run by the Federal Government

This Marketplace is created and administered by the Federal Government.

Marketplace run by the Federal Government and state

A Marketplace run by the Federal Government and state enables the state and HHS to work together to operate a Marketplace. Although the Federal Government has ultimate authority and accountability in this type of Marketplace, the state has the opportunity to operate some



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HPG Style Guide

Marketplace functions while the Federal Government operates other Marketplace functions. There are 2 distinct models for a Marketplace run by the Federal Government and state:

Plan Management Partnership Consumer Assistance Partnership

In these models, states can decide to operate the plan management functions, the consumer assistance functions, or both. For some states, a Marketplace run by the Federal Government and state may facilitate a future transition to a Marketplace run by the state. A Marketplace run by the Federal Government and state must be fully operational by January 1, 2014.

Marketplace run by the state

A Marketplace run by the state in which it operates all Marketplace activities; however, the state may use the Federal Government’s services for APTC and CSR determinations, exemptions, risk adjustment, and reinsurance programs. The Federal Government encourages states to establish a Marketplace run by the state, which must have been approved by January 1, 2013, and fully operational by January 1, 2014. A Marketplace run by the state functions similarly to a Marketplace run by the Federal Government. A Marketplace run by the state processes a consumer’s application and offers health coverage for them to enroll in if they are eligible. All health coverage offered by a Marketplace run by the state must cover essential health benefits that include preventive services (including vaccines), screenings, hospital stays, and prescription drugs.

Marketplace Terminology

Do not use “Exchange” or “Exchange Marketplace.”

Note: Per the client, use “Health Insurance Marketplace” on first reference and use “Marketplace” thereafter within training documents. Use “Marketplace” on first reference in scripts.

Avoid making distinctions between marketplaces (see below) and if you use the terms “marketplaces” at all, it must be lowercase. When you do make distinctions between the marketplaces, use the following terms:

Marketplace run by the state (previously State-based Marketplace) Marketplace run by the Federal Government (previously Federally-facilitated

Marketplace) Marketplace run by the state and Federal Government (previously Marketplace)



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HPG Style Guide

Marketplace website

Consumers can access and compare Marketplace plan information through the Marketplace website at HealthCare.gov, including:

Premium and cost-sharing information via an electronic calculator Summary of benefits and coverage Level of coverage (bronze, silver, gold, or platinum) A provider directory Navigation and consumer help information Ratings, ratios, survey results, financial data, and eligibility determinations

Medicaid

Medicaid is composed of state-operated programs that offer health insurance for most adults under 65 with individual incomes up to about $15,000. Jointly funded by the Federal Government and the states, Medicaid is the primary health insurance program for low-income and high-need populations. Medicaid covers nearly 60 million Americans, including 9 million low-income Medicare beneficiaries (i.e., dual eligible) and 8 million people with disabilities. The program also provides health coverage to one in 3 children and one in 4 poor nonelderly adults, and it covers one in 3 births. The ACA established a national floor for Medicaid coverage at 133% of the FPL. This will expand Medicaid coverage, and the Federal Government will finance 100% of this expansion from 2014 to 2016, phasing down funding to 90% by 2020. Currently, state reimbursement rates from the Federal Government range between 50% and 76%. In June 2012, the Supreme Court overturned the mandatory Medicaid expansion included in the ACA.

Medicaid expansion

Effective January 1, 2014, states may expand Medicaid to include additional low-income people. The extent of Medicaid expansion in many states is still undetermined.

Medicare

Medicare is a federal program for all people 65 or older, people under 65 with certain disabilities, and people of all ages with end-stage renal disease.

Medicare-approved

Always hyphenate as an adjective.



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HPG Style Guide

Medicare Summary Notice (MSN)

If you have Original Medicare, you'll get a Medicare Summary Notice in the mail every 3 months for Medicare Part A and Part B-covered services. The notice shows all your services or supplies that providers and suppliers billed to Medicare during the 3-month period, what Medicare paid, and what you may owe the provider.

minimum essential coverage (MEC)

MEC is the type of coverage a person must have to meet the individual mandate requirement.

multi-

Compounds formed with multi are usually closed: multistate, multilevel, and multiyear.

Refer to Merriam-Webster dictionary because some terms are closed, where others are hyphenated. For example, “multivitamin” and “multi-tax.”

multistate plan

A multistate plan is a health insurance plan offered in more than one state. The plan meets a federal standard to give you access to high quality and affordable health care.

NNNNA

Use NA; do not spell out “not applicable.”

National Government Services (NGS)

Next Generation Desktop (NGD)

nationwide

One word, no hyphen

Navigator

Always capitalize.

Navigators work with consumers and provide assistance at no cost to the consumer in eligibility, enrollment, and other Marketplace functions by explaining program specifications appropriate to the population’s needs and in a variety of venues. They help consumers with



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HPG Style Guide

Marketplace services from application to Marketplace plan selection and any referrals along the way.

no cost to the consumer

Use this phrase anywhere we mention filling out an application or when a consumer receives assistance with the application (also known as consumer assistance).

noncovered

One word, no hyphen

non-Medicare

Always hyphenated

non-preferred

Always hyphenated

nonprofit

One word, no hyphen

Notice of Proposed Rulemaking (NPRM)

A notice of proposed rulemaking, also known as a proposed rule, is a public notice issued by an agency of the United States government when it seeks to add, remove, or change a rule or regulation as part of the rulemaking process. NPRMs are published in the Federal Register and typically allow 60 days for public comment and an additional 30 days for reply comments.

OOOOffice of Information Services (OIS)

OIS is responsible for the Marketplace’s information technology build. Working closely with CCIIO, OIS is building the Federal Data Services Hub (Hub) system and the system for a Marketplace run by the Federal Government.

offline

One word, no hyphen



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HPG Style Guide

OK

Use this spelling rather than “okay.”

ongoing

One word

online

One word, no hyphen

opt-out

Hyphenate as an adjective; spell open as a verb.

Original Medicare

Do not use Original Medicare Plan.

out-of-pocket costs (OOPC)

Your out-of-pocket costs are your expenses for medical care that are not covered by your insurance plan. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services. This also includes all costs for services that are not covered.

out-of-pocket limit/maximum

Hyphenate and use “maximum” for the Content team; hyphenate and use “limit” for the Training team.

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care that your health insurance or plan doesn’t cover. Some health insurance and plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums.

PPPPatient’s Bill of Rights

Capitalize.



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HPG Style Guide

percent

Use the symbol (%) rather than spelling out the word. When a sentences begins with a percentage, both the sign and the number are spelled out. “Fifteen percent of the students had perfect attendance.”

Physician Fee Schedule

Capitalize.

personal health information (PHI)

Any individually identifiable health information that is used or circulated by an entity that falls under the governance of HIPAA. The privacy-regulation safeguards mandated by HIPAA and the responsibility for maintaining them extends to third-party business partners.

personally identifiable information (PII)

PII is information that is used on its own or with other information to identify, contact, or locate a single person.

plan levels

The 4 plan levels are bronze, silver, gold, and platinum.

All plans are lowercase (e.g., bronze plan). Plan levels are not shown in quotes. Do not refer to these as “metal plans.”

platinum plan

The platinum plan is a Marketplace plan that covers 90% of the total plan benefit cost; typically, it is the most expensive (highest premium) plan offered by a health insurance company.

point of service plan (POS Plan) (POS)

A type of plan through which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans may require you to get a referral from your primary care doctor in order to see a specialist.

pop-up

Hyphenate as an adjective; spell open as a verb.



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pre-existing condition

A condition, disability, or illness (either physical or mental) that you have before you're enrolled in a health plan. Genetic information, without a diagnosis of a disease or a condition, cannot be treated as a pre-existing condition. This term is defined under state law and varies significantly by state.

preferred provider

A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers. If your health insurance or plan has a “tiered” network, you may have to pay more to see certain providers. Your health insurance or plan may have preferred providers who are also “participating” providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more.

preferred provider organizations (PPO)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

premium

Your premium is the amount due to your health plan to cover health care services. Payment may be made monthly, quarterly, or yearly, depending on your health insurance provider’s requirements.

President/president

Uppercase when referring to the President or Vice President of the United States; lowercase otherwise.

pre-tax

Hyphenate.

preventive

Do not use “preventative.”



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preventive services (prevention)

Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, and other health problems.

protected health information (PHI)

PHI is individually identifiable information, such as health records, health status, and health care payment information transmitted by electronic media, maintained in electronic media, or transmitted in any other form or medium.

provider-sponsored organization

Lowercase, unless referring to a specific Medicare Provider-Sponsored Organization

QQQQuick Letter

Capitalize.

RRRREAD

The READ is the internal term used for scripting that is read aloud by the customer service representatives.

reauthenticate

One word, no hyphen

re-enroll

Hyphenate.

reference materials

Lowercase, unless referring to the tab in NGD

regard to

Do not use regards to.



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Remittance Advice

Similar to the Medicare Summary Notice, Remittance Advice is the summary the doctor receives explaining Medicare reimbursement. Do not use Remittance Notice.

re-register

Always hyphenated

road map

Two words

role-play

Hyphenate.

SSSscorecard

One word

screenshot

One word

seasons

Seasons should be written lowercase: winter, spring, summer, and fall.

self-service

Hyphenate.

silver plan

The silver plan is a Marketplace plan that covers 70% of the total plan benefit cost.

site map

Two words.



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Small Business Health Options Program (SHOP)

A new program designed to simplify the process of finding health insurance for your small business.

Content: On first reference in READs, use “Small Business Health Options Program Marketplace, known as SHOP.”

Training: On the first reference, use “Small Business Health Options Program (SHOP) Marketplace.” Use just “SHOP” thereafter.

SmartScript

Spelled this way in NGD, this is a script with logic built into it. As users answer questions, the SmartScript guides them to the next correct scripting.

Social Security Administration (SSA)

Social Security number (SSN)

“number” is always lowercased.

Do not use made-up SSNs because they might be an actual SSN, which is PII. Instead, use an alternative form of hash marks (i.e., ###-##-####).

spot-check

Hyphenated as a verb.

stand-alone

Hyphenate when used as an adjective.

Standard Operating Procedure (SOP)

subcommittee

One word

Subsidiary Marketplace

An arrangement established for smaller service areas within a state. A state may have multiple subsidiary marketplaces, but they must not overlap or compete with each other. The goal is to create a localized approach to providing health insurance coverage.



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Supplemental Nutritional Assistance Program (SNAP)

Sometimes referred to as “food stamps”

TTTtaking

Use this word when referring to CSRs taking phone calls. Do not use “fielding.”

tax credit

Do not use “tax credit” to describe the advanced premium tax credit (APTC) in scripts on the individual Marketplace. Use “lower costs.”

You can use tax credit to describe the tax credit that small businesses participating in SHOP receive.

A tax credit is an amount that a person or family can subtract from the amount of income tax that they owe. If a tax credit is refundable, the taxpayer can receive a payment from the government to the extent that the amount of the credit is greater than the amount of tax they would otherwise owe.

taxpayer identification number (TIN)

A taxpayer identification number is a number used by the Internal Revenue Service in the administration of tax laws. Although there are several kinds of TINs, the most widely known one is the Social Security number.

third party

Do not hyphenate as an adjective.

Tier 1, Tier 2

Use Arabic numbers; do not use Roman numerals.

timeframe

One word

tool

Lowercase unless it is part of a specific tool title, like the Plan Compare Tool, Premium Estimation Tool, Lite Account Tool, and Quick Answer Tool.



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toolbar

One word, but “scroll bar” and “thread bar.

TRICARE

TRICARE is the health care program serving Uniformed Services members, retirees, and their families worldwide.

trustworthy

One word, no hyphen

UUUURL

All caps. Do not use “url.”

U.S. citizen

Do not use “national.”

U.S. Department of Health and Human Services (HHS)

The Department of Health and Human Services is the United States government's principal agency for protecting the health of all Americans and providing essential services.

user name

Two words, per HealthCare.gov. Note: This may appear as username on NGD documents and in various other materials.

VVVU.S. Deparmtnet of Veterans Affairs (VA)

The proper name is actually the U.S. Department of Veterans Affairs, changed from Veterans Administration when it became a cabinet-level position in 1989.

veterans health care programs

A program administered by Veterans Affairs that meets the minimum essential coverage standard under the health care law. Veterans and their beneficiaries who are enrolled in the



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veterans health care program, Civilian Health and Medical program (CHAMPVA), or the spina bifida health care program do not need to buy additional coverage through the Marketplace.

WWWWeb

Capitalize when referring to the World Wide Web or when part of the name of a tool. Lowercase in all other instances

web-broker

Hyphenate; web-brokers must comply with all agent and broker requirements and assist qualified people in enrolling in Marketplace plans through the Marketplace and in applying for APTC and CSR.

Web Chat/web chat

Capitalize when referring to the NGD module, to a Web Chat CSR, and in context of specific tools or buttons.

webinar

One word, lowercase.

webmaster

One word, lowercase. Do not use “Webmaster” or “Web master.”

website

One word, lowercase. Do not use “web site,” “Website,” or “Web site.”

Weekly Health Insurance Exchange Marketplace Update

Capitalize.

whether/if

“If” is conditional and “whether” presents an alternative or a possibility.

Example: You also learned how to ask probing questions to determine whether an inquiry was due to fraud.



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Example: You will now follow the CS Fraud script to determine whether the possible fraud situation in this scenario should be escalated.

which/that

Use “which” to introduce nonessential, or nonrestrictive, clauses. Use “that” to introduce essential, or restrictive, clauses. With “which,” you can drop the clause and not lose the meaning of the sentence. With “that,” the clause is essential to the reader’s understanding. Nonrestrictive clauses are always set apart with commas; restrictive clauses are not. If you see a sentence using “which” without a comma, it probably needs a comma or the word needs to be changed to “that.”

Restrictive: “Adam bought the biggest car that was blue.” In this sentence, Adam bought the biggest blue car, not necessarily the biggest of all the cars. Contrast that with its nonrestrictive counterpart.

Nonrestrictive: “Adam bought the biggest car, which was blue.” Here, it is clear that Adam bought the largest of all cars and it happened to be blue.

Restrictive: “We will test our new system that we completed in October”. In this sentence, we are testing only the new system that we completed in October. New systems may have been completed in other months, but the meaning here is restricted to the one completed in. Contrast that with the following:

Nonrestrictive: “We will test our new system, which we completed in October.” In this sentence, we are testing the new system. The phrase about its completion could be removed without muddling the meaning.

Tip: If you can drop the clause and not lose the meaning of the sentence, use “which” with a comma before and after the clause; otherwise, use “that.” Do not use commas with “that” clauses. Use the conjunction “that” to introduce a dependent clause if the sentence sounds or looks awkward without it. There are no hard-and-fast rules; when in doubt, use “that.”

who/whom

“Who” is grammatically the subject (never the object) of a sentence, clause, or phrase.

The customer service representative who answered the question will talk with his or her supervisor after the call.

Who is here from OC?

Use “whom” when a person is the object of a verb or preposition.

The state officer with whom we spoke was quite helpful.



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Whom do you wish to see?

workflow

One word.

workstation

One word.

XXXX-ray/x-ray

When used as a noun, X-ray is spelled with a capital X; as a verb, it is lowercase. Both are

hyphenated.

YYY

ZZZZIP code

ZIP is an acronym for “zone improvement plan.”



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APPENDIX A: ACRONYMSBelow is a list of acronyms used frequently by Medicare and Marketplace. For a full list of CMS-accepted acronyms, refer to http://www.cms.gov/apps/acronyms.

ABN Advance Beneficiary Notice of Noncoverage

ACA Affordable Care Act

Note: Can be referred to as the health care law. Do not use health reform. In titles, refer to it as “the Affordable Care Act” with “the” preceding the term.

ACH Automated Clearing House

ACO accountable care organization

ADAP AIDS Drug Assistance Program

ADMC Advance Determination of Medicare Coverage

ADS Automated Development System

AEP annual enrollment period

AFO ankle-foot orthotics

ALJ administrative law judge

ALS amyotrophic lateral sclerosis (Lou Gehrig’s disease)

ANOC Annual Notice of Change

APTC advance premium tax credit

Note: Do not use in Content and Training materials. Instead, use “lower costs.”

ARC Advanced Resolution Center

ASC ambulatory surgical center

AV actuarial value

BAH Booz Allen Hamilton

Also called Booz Allen.

BHP basic health plan

BIC beneficiary identification code

BiPAP bilevel positive airway pressure machines

BIU Benefit Integrity Unit

BPCI Bundled Payments for Care Improvement (initiative)



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CAC certified application counselor

CAHPS Consumer Assessment of Healthcare Providers and Systems

CAP Consumer Assistance Program

CBA competitive bidding area

CBIC Competitive Bidding Implementation Contractor liaison

CBP Competitive Bidding Program

CC Cost and Coverage

CCIIO Center for Consumer Information and Insurance Oversight

CCN claim control number

CCO Contact Center Operations

CCOG Contact Center Operations Group

CCP Coordinated Care Plan

CDC Centers for Disease Control and Prevention

CHAMPVA Civilian Health and Medical Program of the Department of Veterans Affairs

Note: Never spell out in Medicare scripts.

CHIP Children’s Health Insurance Program

CMCS Center for Medicaid and CHIP Services

CMN Certificate of Medical Necessity

CMS Centers for Medicare & Medicaid Services

COB coordination of benefits

COBC Coordination of Benefits Contractor

COBRA Consolidated Omnibus Budget Reconciliation Act


COLA cost of living adjustment

CO-OP Consumer Operated and Oriented Plan Program

Note: CO-OP was established by the ACA to foster the creation of qualified nonprofit health insurance providers that will offer competitive health plans in the individual and small group Marketplaces.

CORF comprehensive outpatient rehabilitation facility

CPAP continuous positive airway pressure



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CS Customer Service

C-SNP Chronic Special Needs Program

CSP consumer support program

CSR cost-sharing reduction

CSR customer service representative

CVI chronic venous insufficiency

CWF Common Working File

CWFDM Common Working File Data Mart

DDR Disclosure Desk Reference

Note: Refer to as 1-800-MEDICARE Disclosure Desk Reference.

DHS Department of Homeland Security

DIF DME Information form

DME durable medical equipment

DME MAC Durable Medical Equipment Medicare Administrative Contractor

DMEPOS durable medical equipment, prosthetics, orthotics, and supplies

DOD Department of Defense

DOMA Defense of Marriage Act

D-SNP dual eligible Special Needs Program

ECP electronic check processing

ECP electronic claims processing

EE Eligibility and Enrollment

EEG electroencephalogram


EGHP employer group health plan

EHB essential health benefits

Note: Do not make the acronym plural (i.e., EHBs) because the definition is already plural.

EJT essential job training

eMSN electronic Medicare Summary Notice

EOB Explanation of Benefits



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EOC Evidence of Coverage

EPO epoetin alfa

EPO exclusive provider organization

ERISA Employee Retirement Income Security Act

ESC employer-sponsored coverage

ESI employer-sponsored insurance

ESRD end-stage renal disease

FAQ frequently asked question

FDA Food and Drug Administration

FEHBP Federal Employees Health Benefits Program

FFS fee-for-service

FISS Fiscal Intermediary Shared [or Standard] System

FMAP federal medical assistance percentage

FMT Feedback Management Team

FOIA Freedom of Information Act

FPL federal poverty level

FQHC federally qualified health center

FSA flexible spending account

FTC Federal Trade Commission

FTE full-time equivalent

Note: The E does not stand for employee; therefore, FTE employee is correct.

FTI federal tax information

GEP general enrollment period

HCPCS Healthcare Common Procedure Coding System

HDHP high deductible health plan

HEAT Health Care Fraud Prevention and Enforcement Action Team

HEDIS Healthcare Effectiveness Data and Information Set

HHA home health agency



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HHABN Home Health Advance Beneficiary Notice of Noncoverage

Note: This form was recently discontinued, but this needs to be listed through the next round of A/B Tier 1 updates.)

HH PPS Home Health Prospective Payment System

HHS U.S. Department of Health and Human Services

Note: The acronym HHS is also used in reference to a state health department.

HIBC high-intensity behavioral counseling

HICN health insurance claim number

HIE Health Information Exchange Marketplace

Note: Information not Insurance.

HINN hospital-issued notice of noncoverage

HIOS Health Insurance Oversight System

HIPAA Health Insurance Portability and Accountability Act

HMO Health Maintenance Organization

HPG HighPoint Global

HRA health reimbursement account

HSA health savings account

HTKR Healthcare Training and Knowledge Resources

IAP insurance affordability program

ICN internal check number

IEP initial enrollment period

IEQ Initial Enrollment Questionnaire

IHS Indian Health Service

IME Indirect Medical Education

IPC in-person counselor

IPPB intermittent positive pressure breathing

IPPS Inpatient Prospective Payment System

IRE Independent Review Entity

IRS Internal Revenue Service

IFR inpatient rehabilitation facility



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IRMAA income-related monthly adjusted amount

IRP Inexpensive and Routinely Purchased

IRS Internal Revenue Service

ISG Internal Support Group

IT information technology

IVIG intravenous immunoglobulin

IVR interactive voice response

LC Learning Central; formerly Learning Management System.

LCD local coverage determination

LEP late enrollment penalty

LI NET Limited Income Newly Eligible Transition

LIS low-income subsidy

LOB line of business

LTC long-term care

LTR lifetime reserve days

MA Medicare Advantage Plan

Note: This is written MA Plan.

MAC Medicare Administrative Contractor

MADP Medicare Advantage Disenrollment Period

MAGI modified adjusted gross income

MAPCP Multipayer Advanced Primary Care Practice Demonstration

Note: This is written MAPCP Demonstration.

MA PDP Medicare Advantage Prescription Drug Plan

Note: In NGD, this is written MA-PDP. It may also appear as MA-PD Plan. While we match screenshots in NGD, the preferred usage is MA PDP.

MBD Medicare Beneficiary Database

MBP Medicare Beneficiary Portal

MBR Master Beneficiary Record

MCBS Medicare Current Beneficiary Survey

MCO managed care organization



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MEC minimum essential coverage

MENH Medicare Essentials New Hire

MHBP Mail Handlers Benefit Plan

MIPPA Medicare Improvements for Patients and Providers Act

MLR medical loss ratio

MM marketing misrepresentation

MP multiple plans

MRN Medicare Redetermination Notice

MS multiple sclerosis

MSA Medical Savings Account

MSN Medicare Summary Notice

MSP Medicare Secondary Payer

MSPRC Medicare Secondary Payer Recovery Contractor

MSPRP Medicare Secondary Payer Recovery Portal

NA not applicable

Note: Never spell out in Marketplace or Medicare scripts.

NAIC National Association of Insurance Commissioners

NASI National Academy of Social Insurance

NCD National Coverage Determination

NECC New England Compounding Center

NGA National Governors Association

NGD Next Generation Desktop

NGS National Government Services

NIST National Institute of Standards and Technology

NMO National Mail-Order Diabetic Supply Program

NPI National Provider Identifier

NPRM notice of proposed rulemaking

NPWT negative pressure wound therapy

OCR Office for Civil Rights

OEC Online Enrollment Center



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OEP open enrollment period

OIG Office of Inspector General

OIS Office of Information Services

OMB Office of Management and Budget

OMHA Office of Medicare Hearings and Appeals

OMO Office of the Medicare Ombudsman

OOP out of pocket

Note: Do not use in CMS TQC materials.

OOPC out-of-pocket costs

OPM Office of Personnel Management

OPPS Outpatient Prospective Payment System

OPT ocular photodynamic therapy

OSA obstructive sleep apnea

PACE Program of All-Inclusive Care for the Elderly

PAP Patient Assistance Program

PBM pharmacy benefit manager

PBP plan benefit package

PCIP Pre-Existing Condition Insurance Plan

PDP prescription drug plan

PEN parenteral and enteral nutrition

PET positron emission tomography


PFFS Private Fee-for-Service

PHI personal health information

PHI protected health information

PHR personal health record

PHSA Public Health Service Act

PIC Program Integrity Contractor

PII personally identifiable information

PMD power mobility device



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POD print on demand

POS point of service

PPACA Patient Protection and Affordable Care Act

Note: PPACA is not synonymous with the ACA and should only be used when specifically calling out the initial PPACA law signed on March 23, 2010.

PPO preferred provider organization

PPS prospective payment system

PSC Program Safeguard Contractor

PSO Provider-Sponsored Organization

QCM quality call monitoring

QDWI Qualified Disabled Working Individual

QI Qualified Individual

QIO Quality Improvement Organization

QMB Qualified Medicare Beneficiary

QME qualified medical expenses

RA risk adjustment

RAD respiratory assist device

RDS retiree drug subsidy

RFP request for proposal

RHC rural health clinic

RP Rights and Protections

RRB Railroad Retirement Board

RTP returned to provider

SDI State Department of Insurance

SEP special election period

SHIP State Health Insurance Assistance Program

SHOP Small Business Health Options Program

SLMB Specified Low-Income Medicare Beneficiary

SME subject matter expert

SMP Senior Medicare Patrol



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SNAP Supplemental Nutritional Assistance Program

Note: SNAP has also been referred to as “food stamps” on first occurrence.

SNF skilled nursing facility

SOP standard operating procedure

SPAP State Pharmaceutical Assistance Program

SSA Social Security Administration

Note: Do not use the acronym SSA for single streamlined application.

SSDI Social Security Disability Insurance

SSI Supplemental Security Income

SSN Social Security number

SSP system security plan

TANF Temporary Assistance for Needy Families

Tdap Combined tetanus, diphtheria, and pertussis vaccine used for those 11 and older. (DTaP is the version of the vaccine used on younger children and replaces DPT, which is no longer used in the U.S.)

TENS transcutaneous electrical nerve stimulator


TEP Transfer Enrollment Period

TIN taxpayer identification number

TOB type of bill

TPA third-party claims administrator

TQC training, independent quality assurance, and content development

TrOOP true out of pocket

TTT train-the-trainer

TTY teletype


UCID unique call identifier

UCMC Universal Content Management Contributor

UMWAUnited Mine Workers of America

URAC Utilization Review Accreditation Commission



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Note: Use only the acronym; do not use the full term in any context.

VA U.S. Department of Veterans Affairs

VCS virtual call center strategy

VHA Veterans Health Administration

The VHA is a division of the VA.

VPAP variable positive airway pressure

WCMSA Workers’ Compensation Medicare Set-Aside Arrangement

WHCRA Women’s Health and Cancer Rights Act

ZIP zone improvement plan

ZPIC Zone Program Integrity Contractor

APPENDIX B: PLAIN LANGUAGE GUIDELINESIn 2010, the White House mandated that all public-facing documents issued by a federal agency adhere to the National Institutes of Health (NIH) Plain Language Guidelines.

PlainLanguage.gov defines plain language as, “…communication your audience can understand the first time they read or hear it.” Language that is plain to one level of readers may not be plain to others, so keep in mind the resulting actions your audience should be able to do after reading a document that is in plain language:

The reader finds what he or she needs. The reader understands what he or she finds. The reader uses the information to meet his or her needs.

Writing techniques can help you adhere to plain language guidelines:

Structure the content and flow logically. Use personal pronouns regularly. Write in the active voice. Weed out wordiness through clear, concise, meaningful sentences. Substitute easily recognized everyday words for complex terms and phrases.

This appendix provides some key plain language guidelines. Refer to plainlanguage.nih.gov/CBTs/PlainLanguage/login.asp for additional help that is not provided here. The guidelines are available online or on the CMS SharePoint site in the same location as the CMS Style Guide.



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https://hello.bah.com/projects/cmstqc/Program%20Management/Forms/AllItems.aspx?RootFolder=%2Fprojects%2Fcmstqc%2FProgram%20Management%2FStyle%20Guide%20and%20Content%20Development%20Best%20Practices&FolderCTID=&View=%7B6CF809EF-CF2F-4F3A-BAE6-5659C16A67C3%7D

http://www.plainlanguage.gov/howto/guidelines/bigdoc/fullbigdoc.pdf

http://plainlanguage.nih.gov/CBTs/PlainLanguage/login.asp

HPG Style Guide

A.1 CONFUSING PLURALS

Confusing Plural Clearer Singular

People and organizations wishing to apply must file applications at no cost to the consumer with the appropriate offices in a timely manner.

You must apply at least 30 days before you need the certification, which is at no cost to you.

a. If you are a person, apply at the state office in the state where you reside.

b. If you are an organization, apply at the State office in the state where your headquarters is located.

In addressing a single person, you can avoid awkwardness by using you to address the user directly, rather than using him or her or his or her.

Confusing Plural Clearer Singular

The applicant must provide his or her mailing address and his or her identification number.

You must provide your mailing address and identification number.

A.2 EVERYDAY WORDS AND SIMPLE VERBS

Use everyday words and simple verbs.

Tip: Avoid using words of 3 or more syllables when a simpler alternative is available.

Use everyday words and simple verbs to describe an action (listed case sensitive as it would appear within a sentence)

Instead of: Try:

abide follow

anticipate expect

carry out a review review

commence start

comply follow



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Use everyday words and simple verbs to describe an action (listed case sensitive as it would appear within a sentence)

Instead of: Try:

conduct an analysis analyze

do an assessment assess

educate yourself inform yourself

ensure make sure

entity no suggested word; see note below*

gain an understanding understand

in accordance with according to, regarding

in regards in regard

invoke no suggested word; see note below*

present a report report

prior to before

provide assistance assist

shall

must for an obligation,must not for a prohibition,may for a discretionary actionshould for a recommendation

terminate end

utilize use

various several



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*To avoid using these words, it might be necessary to “write around” them. For example, this language in the second sentence of the paragraph does a nice job of writing around invoke. Similar language should be repeated in the next sentence.

“For religious institutions that offer health insurance to their employees, there is an exception to this rule. These religious institutions can choose whether or not to cover contraceptives in the health insurance they offer to their employees. However, even if your employer invokes this exemption, you can still buy contraceptive coverage directly from your health insurance company, and this insurance must also cover contraceptives at no additional cost.”

A.3 UNNECESSARY WORDS

Avoid unnecessary words. Watch out for of, to, on, and other prepositions. They often mark phases you can reduce to one or 2 words. Some of the most frequently encountered unnecessary words and phrases, with suggested improvements, follow:

Instead of…(listed case sensitive as it would appear within a sentence)

Try (listed case sensitive as it would appear within a sentence)

a number of several, a few, many

a sufficient number of enough

an amount of X X

as a result of because

at the present time now

at this point in time not

be responsible for must

certainly (eliminate this and most other intensifying modifiers, such as “very”)

first annual first or inaugural

for the purposes of to

in order to to



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in the event if

is able to can

on a monthly basis monthly

on the ground that because

prior to before

reason why reason

whether or not whether

A.4 REDUNDANT WORDS OR PHRASES

Avoid redundant words or phrases.



advance planning You cannot plan after the fact.

and also This is almost always redundant.

Both You can usually just say and.

but nevertheless One or the other is sufficient.

close scrutiny By definition, all scrutiny is close.

Either You can usually just say “or.”

eliminate altogether If some remains, it has not been eliminated.

in addition to … also They mean the same thing.



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major breakthrough A minor discovery is not a breakthrough.

new innovation Innovations are always new.

on the occasion whenEither “on the occasion of” or “when” will suffice. “When” has the advantage of being shorter.

partake in/of “take part in” or “participate in”

true fact If it is not true, it is not a fact.

Keep in mind to omit other types of redundant words.

Instead of: The X Department and the Y Department worked together on a joint project to improve …

Use: The X and Y Departments worked on a project to improve …

In this statement, you don’t need “joint” or “together.” Saying that X and Y worked on a project says it all. “Joint” and “together” are both redundant.

Other ways to omit unnecessary words include eliminating hidden verbs, using pronouns, and using active voice. See guidance on those 3 topics (Avoid hidden verbs, Use pronouns to speak directly to readers, and Use active voice) in the Plain Language Guidelines for more information.

A.5 LANGUAGE & TERMS: DOS

DO Say Here’s Why

Target messages to population as closely as possible, or use the generic “you.”

Consumers react most powerfully to statements where they can identify themselves specifically.

Use specific realistic/credible dollar figures whenever possible: “$0 premium,” “You could pay $142 each month.”

Consumers want to see hard numbers, since the concept of “affordable” is relative.

“The Marketplace gives you control over your health insurance options.”

Consumers like the idea of being able to have control over a process that is



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http://www.plainlanguage.gov/howto/guidelines/bigdoc/fullbigdoc.pdf

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DO Say Here’s Why

frequently out of their control.

“Information about prices and benefits is written in simple terms you can understand.”

Information presented in an accessible way decreases the amount of unknowns (and accompanying anxiety) involved in the process of buying insurance.

“By law, insurance plans won’t be able to deny coverage to people because of pre-existing or chronic conditions like cancer or diabetes.”

People like the idea that plans are high quality and treat people fairly.

“Plans must offer a comprehensive set of benefits (coverage for doctor visits, preventive care, hospitalization, prescriptions).”

Consumers want assurance that plans are high quality. This gives concrete examples of what will be covered.

“You could lower your monthly premiums right away.”

The reference to paying less right now immediately resonates. This message alone was strong enough to make most participants want to find out more.

“There’s help for working families.”Most people consider themselves to be included in “working families,” so they can feel this benefit may be for them.

“You could get a break on costs.”

“Break” makes people feel they uncovered a good deal through their own efforts. CMS uses this language. (Also listed in Commonly Used Terms and Phrases.)

“You can find coverage that fits your budget.

This language is viewed more favorably than “affordable.” CMS uses this language. (Also listed in Commonly Used Terms and Phrases.)

“Insurance,” when referring to the product that will be purchased.

“Coverage,” when referring to the general benefit of having health insurance vs. being uninsured.

“Insurance” does a better job communicating something you’d compare and choose or purchase.

“Coverage” is a bit “friendlier” and, for some, represents what you get after you get insurance.

“You can get help online, over the phone, or in person at no cost to you.”

Give consumers these 3 options wherever appropriate, including when talking about



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DO Say Here’s Why

enrolling online, over the phone, or in person, which is at no cost to the consumer.

Instead of “should,” use “can.” “Should” sounds too blunt.

A.6 LANGUAGE AND TERMS TO USE CAUTIOUSLY

Be Careful (listed case sensitive as it would appear within a sentence)

Here’s Why (listed case sensitive as it would appear within a sentence)

exchange People think “Exchange” is a place to trade or swap merchandise and don’t immediately associate it with health care.

simplifiedConsumers like the term, but many didn’t find it believable. Best when specifics are given such as “apples-to-apples” compare

any language that sounds like a sales pitch: too casual, over-promising, or hyperbolic (e.g., no hassle, every, all)

Consumers take buying insurance seriously and are uncomfortable with phrases that sound “sales-y” — this makes messages less credible.

affordable

“Affordable” is attention getting, but relative - consumers want to see hard numbers or context that makes it more meaningful.

messages that only mention “your family”Single and childless people have trouble identifying with messages exclusively about “family.”

financial assistance available This was well-liked by low-income people already enrolled in Medicaid, but not by others. The concept will need more exploration. Terms like “help” or “helping hand” often connote a handout and can create barriers to acceptance. Many consumers think “assistance” is for someone else, not for them, even when they are clearly eligible for a benefit. One term that has tested well elsewhere is “break” — it is common colloquially and



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seems to give people the feeling that they have uncovered a good deal through their own efforts.

even if you’ve been turned down before “Turned down” was associated with negative past experiences.

You may be surprised at the help you can get.

Consumers don’t want surprises; they want predictability.

low-cost plansParticipants with higher incomes and/or experience with insurance see references to “low-cost” plans as likely lower quality.

driving down costs

This can be a popular attention getter, but has issues much like “low-cost plans” above. People wonder how quality is being compromised.

Plans must meet basic federal cost and coverage standards.

People like the idea that plans are high quality and treat people fairly, but the word “basic” can be interpreted as minimal.

plans that fit every situation This was over-promising to some, and a generalization to others.

the same brand-name plans you knowMany consumers have had bad experiences with the brand-names before, and others felt this left out new players.

tax credits Should only be used in SHOP materials aimed at employers.

Families earning up to $92,000 can get help.

The $92K figure is too high for low-income consumers to relate to as a motivational message. However, context is important: once people have decided to learn more or apply, including specific figures can help people see where they fit in.

It’s hard to know where to start. Some people feel like they know where to start, but just can’t afford to.

one-stop shopping People appreciate that all the information



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is in one place, but balk at “one-stop shopping” as too trivial. Others saw it as related to “sleazy” sales techniques: “It’s something you’d expect from a used car lot.”

You don’t have to worry about the fine print.

This seems misleading to people who want to understand the details.

benefits

Benefits are a little more confusing than insurance or coverage. For some, they are what you get from an employer; they include health insurance and vacation time.

like Kayak or Orbitz

Many feel it trivializes the concept. Health insurance is a serious intangible product, and making a choice is more emotionally loaded than picking a hotel or airline ticket.

quality standardsGenerally unfamiliar to respondents. People make assumptions about what quality means and are often incorrect.

complaint MARKETPLACE CONTENT AND TRAINING ONLY

Per CMS, we should limit the use of the word “complaint.” In material that deals with HICS escalations, CSRs should tell consumers that they will escalate their “issue” or “request” — not “complaint.” In other materials, use “report an issue” or “If you have an issue with … ” rather than “report a complaint” or “If you have a complaint … ” You can use “complaint” when it cannot be avoided and also as a key word.

Note: This is not a global change; “complaint” still appears in a few scripts (Reporting Identity Theft; Privacy of



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Consumers’ Information) and some training material.

A.7 SHORT, SIMPLE WORDS

Kathy McGinty (www.plainlanguage.gov) offers tongue-in-cheek instructions for bulking up your simple, direct sentences.

There is no escaping the fact that it is considered very important to note that a number of various available applicable studies ipso facto have generally identified the fact that additional appropriate nocturnal employment could usually keep juvenile adolescents off thoroughfares during the night hours, including but not limited to the time prior to midnight on weeknights and/or 2 a.m. on weekends.

And the original, using stronger, simpler words:

More night jobs would keep youths off the streets.

In making your word choices, pick the familiar or frequently used word over the unusual or obscure. There are many lists of complex words and suggested substitutes, for example www.plainlanguage.gov/howto/wordsuggestions/simplewords.cfm.

APPENDIX C: SCRIPT WRITING DOS AND DON’TSThe Plain Writing Act of 2010 requires federal agencies to write “clear government communication that the public can understand and use.”2 CMS is therefore committed to using plain language in any document that provides information about any Federal Government benefit or service.3 CMS conducted meetings and trainings to further this goal.4 As a result, CMS increased its efforts to publish plain language materials on consumer products and on the web.5

Communication GuidelinesBe Clear

Write in a clear and succinct manner to ensure a listener/reader can quickly and fully comprehend the information.6

Avoid obscure or pretentious words to describe a simple idea. Use plain language. Keep sentences short. Avoid long introductions. Instructions should be simple, succinct, and clear.

Example: HPG and CMS flagged this sentence for being complex or too long:



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“A legal permanent resident is any noncitizen residing in the United States under legally recognized and lawfully recorded permanent residence as an immigrant.”

A clearer alternative might appear as follows:

“A legal permanent resident is any immigrant legally and permanently residing in the United States.”

Note: Do not use phrases such as “It is important to note that …” in the READ. A more useful alternative might be, “Please note….”

Seek Readability

Check the readability of your work using the Flesch Reading Ease test and the Flesch-Kincaid Grade Level test, both of which are integrated in Word. See footnote for Word instructions.7

The Flesch Reading Ease test rates text on a 100-point scale; the higher the score, the easier it is to understand the document. Aim for a score higher than 70.

The Flesch-Kincaid Grade Level test rates text on a U.S. grade-school level. The Content and Training teams aim for a score of 8.0 (eigth-grade reading level).

Tips to improve readability:

Use white space and other design features to make a document easier to read. Use bullets or a text box to help readers absorb the material. Use headings and subheadings to organize information. Isolate an idea for emphasis. Avoid writing in all capital letters. Avoid using words of 3 or more syllables when a simpler alternative is available.

Be Positive

Focus on telling the caller what he or she can do instead of what he or she cannot do.

Example: CMS requested that this sentence be revised:

“You cannot fill out or submit a Marketplace application at no cost to you on HealthCare.gov until open enrollment begins.”

A more positive alternative might be the following:

“You can fill out or submit a Marketplace application for free at HealthCare.gov as soon as open enrollment begins.”

Use Active Voice

Avoid passive voice. Active voice is clearer and often more succinct than passive voice. Using active voice also avoids confusion around the subject of an action. A passive construction occurs when you make the object of an action into the object of a sentence.8

Example:



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Passive Voice: The tree was pulled down. Active Voice: They pulled the tree down.

Note: You can tailor your grammar settings to catch some passive voice, although not all. Careful editing is necessary.

Use a Personable Tone

Keep the script tone relaxed, natural,9 conversational, friendly, and personal.

Focus on upbeat language in the greeting that communicates professionalism, knowledge, and openness.

Consider the target market and envision a normal conversation that you might have with a colleague, peer, or acquaintance. Using pronouns, such as “you” and “we,” helps the CSR focus on the customer and makes the customer feel acknowledged and appreciated. Consumers react most powerfully to statements in which they can identify themselves specifically.

Provide language to deal with objections. Acknowledge frustration, apologize for delay and confusion, and provide information that will help representatives know when the problem is beyond their scope.

Acknowledge the difficulty and complexity of the subject matter up front. Ask questions to gauge understanding. Summarize big-picture topics concisely and then ask probing questions to elicit more detailed questions. Avoid acronyms.

Use specific realistic/credible dollar figures whenever possible. Consumers want to see hard numbers because the concept of “affordable” is relative.

Example:

“Free” “You could pay $142 each month.”

Read Scripts Aloud

Read scripts aloud as you write them. Sometimes, what is written well is not easily spoken. Reading scripts aloud can help you identify grammatical issues and notice strings of words that can trip up a speaker, as well as recognize sentences that can be long or confusing.

Reading a script aloud also helps the writer confirm how long it takes to read a given script. Just because a script is 5 lines long does not mean it can be read in the appropriate amount of time.

Listen Actively

Encourage active listening.10 Ask open-ended questions, those that cannot easily be answered “yes” or “no,” to encourage discourse.

Get agreement from the customer. Feedback from the customer that the CSR is on the right track will reduce tension and confusion. Ask questions to confirm that the customer understands.



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Provide Alternate Resources

Provide alternate contact options. If the caller asks a question that is beyond the scope of the CSR’s abilities, make alternate sources of information available, such as federal websites and other information found in the Agent Partner Search. Encourage CSRs to catalog feedback on information that is not yet available.

Encourage the caller to call back or use other means of communication (web chat) to ask follow-up questions. Let him or her know that every effort will be made to ensure that his or her questions will be answered.

Make a list of pertinent keywords. Make a note of where the CSR can find supplemental information to explain the topic further.

Script MessagingThere are a number of important messages that we need to convey to consumers. Make sure that you are using them in your scripting.

Top Script Messages

Top script messages include:

You may be eligible for lower monthly premiums right away. You can see what your premium, deductibles, and out-of-pocket costs will be before you

decide to enroll. You can make apples-to-apples comparisons of costs and coverage between health

insurance plans.

Additional Affordability Messages

Cost is the top barrier for the uninsured, so affordability messages resonate deeply. For example:

Your life and family are unique. Find health insurance that fits the way you live at the Marketplace, and learn whether you can get a break on costs.

Pay less for health insurance right now. You may be able to get lower costs on your Marketplace plan.

Even working families can get help through the new Marketplace. Find out how you can get a health insurance plan that’s right for you at a price you can be comfortable with.

Additional Ease, Choice, and Control Messages

Beside affordability, top messages emphasize ease, choice, and control. These messages include:

When you shop at the Marketplace, everything you need is laid out for you. Information about prices and benefits is written in simple terms you can understand, so you don’t



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have to guess about your costs. You get a clear picture of what you’re paying and what you’re getting before you make a choice.

The Marketplace simplifies your search for health insurance by gathering all your options in one place. One application, one time, and you and your family can explore every qualified insurance plan in your area, along with any free or low-cost insurance programs you qualify for.

Choose a plan from the comfort of your home or anywhere you can access the web and sign up right online.

The Marketplace gives you control over your health insurance options, with plans to fit your personal situation and budget. Compare plans based on what’s important to you, and choose the combination of price and coverage you feel comfortable with.

Messages For Multiple AudiencesCMS has a psychographic segmentation scheme that categorizes people according to lifestyles and approach to health information. Three of CMS’s segments represent 90% of the uninsured (healthy and young; sick, active, and worried; and passive and unengaged). It is useful to identify messages that cut across all segments of society.

Two message concepts are both highly motivational and highly believable among all 3 uninsured CMS segments:

You can find out if you’re eligible for a free or low-cost health insurance premium. You can see what your premium, deductibles, and out-of-pocket costs will be before you

make a decision to enroll.

When developing scripts that will resonate with stakeholders, remember the client. Check relevant sources — including HHS, CMS, Booz Allen — as necessary.

Notations1 Read the HHS Style Guide for more complete guidelines. Available on SharePoint:

https://hello.bah.com/projects/cmstqc/Onboarding/Background%20and%20Primer/HHS%20Style%20Guide.pd.

2 The Plain Writing Act of 2010. Available at: http://www.gpo.gov/fdsys/pkg/BILLS-111hr946enr/pdf/BILLS-111hr946enr.pdf.

3 Plain Writing. Available at: http://www.medicare.gov/about-us/plain-writing/plain-writing.html.

4 Plain Writing at the Centers for Medicare & Medicaid Services: One Year Later: Available at: http://www.medicare.gov/files/cms-annual-plain-writing-report-2012.pdf.

5 Plain Writing at the Centers for Medicare & Medicaid Services: One Year Later: Available at: http://www.medicare.gov/files/cms-annual-plain-writing-report-2012.pdf.



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http://www.medicare.gov/files/cms-annual-plain-writing-report-2012.pdf

http://www.medicare.gov/files/cms-annual-plain-writing-report-2012.pdf

http://www.medicare.gov/about-us/plain-writing/plain-writing.html

http://www.medicare.gov/about-us/plain-writing/plain-writing.html

http://www.gpo.gov/fdsys/pkg/BILLS-111hr946enr/pdf/BILLS-111hr946enr.pdf

http://www.gpo.gov/fdsys/pkg/BILLS-111hr946enr/pdf/BILLS-111hr946enr.pdf



HPG Style Guide

6 PlainLanguage.gov. Available at: http://www.plainlanguage.gov/. See also: HHS Plain Language Guidelines, available at: http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html.

7 To access on word: Click “File” and “Options.” Click “Proofing” and make sure the “Show grammar with spelling” option is checked. Check the “Show readability statistics” option. Then, on the “Review” tab, click the “Spelling & Grammar” button. After spell check completes, the Flesch Reading Ease and Flesch-Kincaid Grade Level Statistics will appear in a Readability Statistics window.

8 University of North Carolina, The Writing Center, “Passive Voice.” Available at: http://writingcenter.unc.edu/handouts/passive-voice/.

9 How to Use Scripts to Ensure Consistency in Customer Service. Available at: http://www.evancarmichael.com/Business-Coach/4218/How-to-Use-Scripts-to-Ensure-Consistency-in-Custom er-Service.html .

10 Active Listening tips. Available at: http://www.studygs.net/lisening.htm.11 Section 508.gov. Available at: https://www.section508.gov/.



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https://www.section508.gov/

http://www.studygs.net/lisening.htm

http://www.evancarmichael.com/Business-Coach/4218/How-to-Use-Scripts-to-Ensure-Consistency-in-Customer-Service.html

http://www.evancarmichael.com/Business-Coach/4218/How-to-Use-Scripts-to-Ensure-Consistency-in-Customer-Service.html

http://writingcenter.unc.edu/handouts/passive-voice/

http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html

http://www.plainlanguage.gov/

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