Background
Alignment Healthcare, a Medicare Advantage insurer, disputed its plan ratings after observing a marked decline in Spanish-language survey responses between 2023 and 2024. Alignment claimed the decline resulted from either a sampling error or a survey administration failure where Spanish-speaking members received English surveys despite requesting Spanish. Because Spanish speakers reported higher satisfaction rates in Alignment’s internal surveys, the alleged language mismatch significantly depressed the plans’ star ratings, which directly affect federal funding and enrollee selections. Alignment requested that CMS either suppress the survey results or mark the measures as unreliable.
CMS investigated Alignment’s concerns over several weeks of correspondence. CMS found that the proportion of Spanish-preferring enrollees in the sample matched the broader population, that Spanish-language survey responses occurred at rates higher than average for Medicare Advantage plans, and that the survey vendor attested to following all CMS protocols. CMS denied Alignment’s request. Alignment sued under the Administrative Procedure Act, and the district court granted summary judgment for CMS. Alignment appealed.
The Court’s Holding
The D.C. Circuit affirmed, holding that CMS did not act arbitrarily or capriciously in refusing to suppress the survey results. Even assuming Alignment’s interpretation of the CMS Protocols was correct—that vendors must send Spanish-only materials to identified Spanish-preferring enrollees—Alignment failed to show that the vendor violated this requirement. The court found the vendor’s “conservative approach” to matching Alignment’s language preference data with CMS’s sample file reasonable, using name and address components to confirm identity while declining to match records with conflicts. This conservative approach was consistent with the high rates of Spanish-language survey responses, which suggested the vendor successfully distributed Spanish surveys to those who preferred them.
The court further held that the CMS Protocols require Spanish-language surveys be “available” to Spanish speakers through multiple methods—mail pre-notification in English and Spanish with toll-free numbers, web surveys in both languages, and telephone options—not necessarily that Spanish-only materials be sent initially to all identified Spanish-preferring enrollees. CMS’s investigation was thorough and provided plausible explanations for the data fluctuations, including that some bilingual enrollees opt to complete surveys in English even when Spanish is available. Finding no evidence of protocol violation or survey administration error, CMS reasonably declined further action. The court also rejected arguments based on the nondelegation doctrine, finding CMS retained ultimate authority to determine whether survey results are sufficiently accurate for rating purposes.
Key Takeaways
- Agencies must follow their own procedural rules, but a challenger must prove actual violation of those rules; theoretical concerns about flexibility in data-matching approaches do not suffice.
- Courts defer substantially to agency expertise in technical matters like survey methodology, particularly where the agency has investigated thoroughly and offered reasoned explanations for its conclusions.
- CMS Protocols require Spanish-language survey accessibility through multiple channels but do not mandate initial distribution of Spanish-only materials to all identified Spanish-preferring enrollees.
- A plan’s failure to raise a Chenery objection in district court—that an agency’s decision cannot be affirmed on grounds the agency did not invoke—is forfeited on appeal absent exceptional circumstances.
Why It Matters
This decision clarifies the scope of CMS’s obligations under its survey administration protocols and significantly raises the bar for Medicare Advantage plans seeking to suppress or modify rating data. Plans must demonstrate concrete evidence of protocol violation, not speculative concerns about potential language-mismatch errors or data-matching variance. The ruling also confirms that CMS’s role is limited to reviewing the quality and reliability of results, not to micromanaging how vendors implement language preferences, as long as vendors take reasonable steps to make Spanish-language surveys accessible.
The decision has practical implications for future rating disputes: Alignment’s option to request “double-stuffed” mail packets containing both English and Spanish surveys illustrates CMS’s preferred path forward for plans concerned about language accessibility in future survey cycles. More broadly, the opinion exemplifies judicial deference to agency technical expertise and demonstrates that thorough agency investigation and reasoned explanation will typically survive APA arbitrary-and-capricious review, even where a challenger disputes the agency’s conclusion.