What Do Good Regulations Look Like?

| | Evidence Based Medicine, Utilization Review

Graphic For Karas May 2016 Article

As workers’ compensation professionals, regulations play a big part in how we conduct day-to-day business. Regulations help guide us in many areas of utilization review. For example, regulations tell us which treatments require preauthorization, mandated response timeframes, which treatment guidelines we must use and what to include in response letters. If you handle claims in several states, the number of requirements to know and comply with can be staggering.

With so many requirements to follow, I believe the most important part of any regulation is that it be clear (i.e., written in plain language). Here are my thoughts on using plain language in regulations.

Plain language means keeping topics simple and organized. Informative headings (often in the form of questions), personal pronouns, active verbs and limited levels of paragraphs are helpful. For example, which sentence would you rather read?

1. “She nodded her head in agreement.” This example uses personal pronouns (“she” and “her”).

2. “The woman was observed moving her head in an up and down manner that appeared to signal her acquiescence.”

The first sentence is simple, uses personal pronouns and active verbs, and is easy to read – the second sentence, not so much. Good regulations have similar traits.

The plain language initiative is nothing new. It has been around since the 1970s. According to the Plain Language Action and Information Network (PLAIN), in 1977, the Federal Communications Commission issued rules for Citizens Band Radios. The rules were formatted as short questions and answers and used personal pronouns, the active voice and clear instructions.

On March 23, 1978, President Jimmy Carter’s Executive Order (EO) 12044 called for improving government regulations by making them “cost-effective and easy-to-understand by those who were required to comply with them.” In 1998, a President Clinton Presidential Memorandum required all federal employees to write regulations and public communications in plain language by January 1, 1999.

Obviously, plain language has been a federal goal for some time, and many agencies have embraced it. The Department of Education, for example, funded the Document Designed Project, and the SEC’s Chairman, Arthur Levitt, was an early advocate for plain language (see the SEC Handbook). But it isn’t just the federal government that values the benefits of plain language; the private sector has also contributed to the undertaking. URAC’s V 3.0 Core 40 requires some URAC accredited companies to address health literacy by ensuring consumer materials are in plain language, measuring the extent of plain language and providing health literacy training to employees.

So what are some of the plain language tactics that make the regulations readable?

1. A well-organized table of contents and limited subdivision levels – a listing provides white space that separates the various conditions and inclusion of key words and topics give readers a road map to easily identify the provisions that matter to them. Subdivision paragraphs should be limited to three designated levels and simple levels clarify relative importance, allow pinpoint citations, simplify revisions, and take up little or no extra space.

2. Short sentences – readable sentences should be simple, active, affirmative and declarative. The U.S. National Archives provides three techniques for short, clear sentences:

   a. Average sentences to 15 words

   b. Put two or more complications qualifications after the main clause

   c. Keep subjects and verbs together and compound verbs together

3. Using the active voice – With the active voice, the subject of a sentence performs or causes the action expressed by the verb, putting the doer before the verb. This eliminates confusion by forcing the writer to name the actor in a sentence and makes clear to the reader who is required to perform a duty. Writing directly to ‘you’ for whoever must comply helps assist in writing in the active voice.

4. An emerging trend in plain language writing is to use “must” in place of “shall” to command some type of immediate action. In addition, “will” is preferred when using language to command action to be performed at a future date.

Everyone can benefit from clear and straight-forward regulations, and plain language practices are helping make them a reality. In my day-to-day duties, plain language in regulations makes my job much easier and more enjoyable and enables me to provide better service.

Kara White, Regulatory Manager at UniMed Direct