BILL NUMBER: SB 853	CHAPTERED
	BILL TEXT

	CHAPTER  713
	FILED WITH SECRETARY OF STATE  OCTOBER 9, 2003
	APPROVED BY GOVERNOR  OCTOBER 8, 2003
	PASSED THE SENATE  SEPTEMBER 11, 2003
	PASSED THE ASSEMBLY  SEPTEMBER 11, 2003
	AMENDED IN ASSEMBLY  SEPTEMBER 9, 2003
	AMENDED IN ASSEMBLY  SEPTEMBER 4, 2003
	AMENDED IN ASSEMBLY  JULY 15, 2003
	AMENDED IN ASSEMBLY  JULY 2, 2003
	AMENDED IN SENATE  APRIL 22, 2003

INTRODUCED BY   Senator Escutia
   (Coauthor:  Senator Perata)

                        FEBRUARY 21, 2003

   An act to amend Section 1367 of, and to add Sections 1367.04 and
1367.07 to, the Health and Safety Code, and to add Sections 10133.8
and 10133.9 to the Insurance Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 853, Escutia.  Health care language assistance.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care.  A willful violation
of the act is a crime.  Existing law provides for the regulation of
health insurers by the Department of Insurance.
   This bill would require the Department of Managed Health Care to
adopt, not later than January 1, 2006, regulations establishing
standards and requirements to provide health care service plan
enrollees with access to language assistance in obtaining health care
services.  Pursuant to the bill, the regulations would require
health care service plans and specialized health care service plans
to implement programs to assess enrollee needs, and to provide
translation and interpretation for medical services and translation
of vital documents to enrollees, and to report to the department
regarding internal policies and procedures related to cultural
appropriateness.  The bill would require the regulations to provide
that a health care service plan is in compliance with the
requirements if it is required to meet and meets the same or similar
standards, as imposed by  the Medi-Cal program.  The bill would
require the department to consider specified factors and to seek
public input.  The department would be required to regularly review
information regarding compliance and make recommendations for changes
and to report certain information biennially to the Legislature and
specified advisory committees.
   This bill would impose similar requirements on the Insurance
Commissioner and health insurers that contract with health care
providers for alternative rates of payment to ensure that insureds
have access to translated materials and language assistance in
obtaining health care services.
   This bill would require a contract between a health care service
plan and a health care service provider to ensure compliance with the
standards adopted by the board.
   By placing additional requirements on health care service plans,
the violation of which would be a crime, the bill would impose a
state-mandated local program.
  The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1367 of the Health and Safety Code is amended
to read:
   1367.  A health care service plan and, if applicable, a
specialized health care service plan shall meet the following
requirements:
   (a) Facilities located in this state including, but not limited
to, clinics, hospitals, and skilled nursing facilities to be utilized
by the plan shall be licensed by the State Department of Health
Services, where licensure is required by law.  Facilities not located
in this state shall conform to all licensing and other requirements
of the jurisdiction in which they are located.
   (b) Personnel employed by or under contract to the plan shall be
licensed or certified by their respective board or agency, where
licensure or certification is required by law.
   (c) Equipment required to be licensed or registered by law shall
be so licensed or registered, and the operating personnel for that
equipment shall be licensed or certified as required by law.
   (d) The plan shall furnish services in a manner providing
continuity of care and ready referral of patients to other providers
at times as may be appropriate consistent with good professional
practice.
   (e) (1) All services shall be readily available at reasonable
times to each enrollee consistent with good professional practice.
To the extent feasible, the plan shall make all services readily
accessible to all enrollees consistent with Section 1367.03.
   (2) To the extent that telemedicine services are appropriately
provided through telemedicine, as defined in subdivision (a) of
Section 2290.5 of the Business and Professions Code, these services
shall be considered in determining compliance with Section 1300.67.2
of Title 28 of the California Code of Regulations.
   (3) The plan shall make all services accessible and appropriate
consistent with Section 1367.04.
   (f) The plan shall employ and utilize allied health manpower for
the furnishing of services to the extent permitted by law and
consistent with good medical practice.
   (g) The plan shall have the organizational and administrative
capacity to provide services to subscribers and enrollees.  The plan
shall be able to demonstrate to the department that medical decisions
are rendered by qualified medical providers, unhindered by fiscal
and administrative management.
   (h) (1) Contracts with subscribers and enrollees, including group
contracts, and contracts with providers, and other persons furnishing
services, equipment, or facilities to or in connection with the
plan, shall be fair, reasonable, and consistent with the objectives
of this chapter.  All contracts with providers shall contain
provisions requiring a fast, fair, and cost-effective dispute
resolution mechanism under which providers may submit disputes to the
plan, and requiring the plan to inform its providers upon
contracting with the plan, or upon change to these provisions, of the
procedures for processing and resolving disputes, including the
location and telephone number where information regarding disputes
may be submitted.
   (2) A health care service plan shall ensure that a dispute
resolution mechanism is accessible to noncontracting providers for
the purpose of resolving billing and claims disputes.
   (3) On and after January 1, 2002, a health care service plan shall
annually submit a report to the department regarding its dispute
resolution mechanism.  The report shall include information on the
number of providers who utilized the dispute resolution mechanism and
a summary of the disposition of those disputes.
   (i) A health care service plan contract shall provide to
subscribers and enrollees all of the basic health care services
included in subdivision (b) of Section 1345, except that the director
may, for good cause, by rule or order exempt a plan contract or any
class of plan contracts from that requirement.  The director shall by
rule define the scope of each basic health care service that health
care service plans  are required to provide as a minimum for
licensure under this chapter.  Nothing in this chapter shall prohibit
a health care service plan from charging subscribers or enrollees a
copayment or a deductible for a basic health care service or from
setting forth, by contract, limitations on maximum coverage of basic
health care services, provided that the copayments, deductibles, or
limitations are reported to, and held unobjectionable by, the
director and set forth to the subscriber or enrollee pursuant to the
disclosure provisions of Section 1363.
   (j) A health care service plan shall not require registration
under the Controlled Substances Act of 1970 (21 U.S.C. Sec. 801 et
seq.) as a condition for participation by an optometrist certified to
use therapeutic pharmaceutical agents pursuant to Section 3041.3 of
the Business and Professions Code.
   Nothing in this section shall be construed to permit the director
to establish the rates charged subscribers and enrollees for
contractual health care services.
   The director's enforcement of Article 3.1 (commencing with Section
1357) shall not be deemed to establish the rates charged subscribers
and enrollees for contractual health care services.
   The obligation of the plan to comply with this section shall not
be waived when the plan delegates any services that it is required to
perform to its medical groups, independent practice associations, or
other contracting entities.
  SEC. 2.  Section 1367.04 is added to the Health and Safety Code, to
read:
   1367.04.  (a) Not later than January 1, 2006, the department shall
develop and adopt regulations establishing standards and
requirements to provide health care service plan enrollees with
appropriate access to language assistance in obtaining health care
services.
   (b) In developing the regulations, the department shall require
every health care service plan and specialized health care service
plan to assess the linguistic needs of the enrollee population,
excluding Medi-Cal enrollees, and to provide for translation and
interpretation for medical services, as indicated.  A health care
service plan that participates in the Healthy Families Program may
assess the Healthy Families Program enrollee population separately
from the remainder of its enrollee population for purposes of
subparagraph (A) of paragraph (1).  A health care service plan that
chooses to separate its Healthy Families Program enrollment from the
remainder of its enrollee population shall treat the Healthy Families
Program population separately for purposes of determining whether
subparagraph (A) of paragraph (1) is applicable, and shall also treat
the Healthy Families Program population separately for purposes of
applying the percentage and numerical thresholds in subparagraph (A)
of paragraph (1).  The regulations shall include the following:
   (1) Requirements for the translation of vital documents that
include the following:
   (A) A requirement that all vital documents, as defined pursuant to
subparagraph (B), be translated into an indicated language, as
follows:
   (i) A health care service plan with an enrollment of 1,000,000 or
more shall translate vital documents into the top two languages other
than English as determined by the needs assessment as required by
this subdivision and any additional languages when 0.75 percent or
15,000 of the enrollee population, whichever number is less,
excluding Medi-Cal enrollment and treating Healthy Families Program
enrollment separately indicates in the needs assessment as required
by this subdivision a preference for written materials in that
language.
   (ii) A health care service plan with an enrollment of 300,000 or
more but less than 1,000,000 shall translate vital documents into the
top one language other than English as determined by the needs
assessment as required by this subdivision and any additional
languages when 1 percent or 6,000 of the enrollee population,
whichever number is less, excluding Medi-Cal enrollment and treating
Healthy Families Program enrollment separately indicates in the needs
assessment as required by this subdivision a preference for written
materials in that language.
   (iii) A health care service plan with an enrollment of less than
300,000 shall translate vital documents into a language other than
English when 3,000 or more or five percent of the enrollee
population, whichever number is less, excluding Medi-Cal enrollment
and treating Healthy Families Program enrollment separately indicates
in the needs assessment as required by this subdivision a preference
for written materials in that language.
   (B) Specification of vital documents produced by the plan that are
required to be translated.  The specification of vital documents
shall not exceed that of the Department of Health and Human Services
(FIHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal
Register 52762 (August 30, 2000)), but shall include all of the
following:
   (i) Applications.
   (ii) Consent forms.
   (iii) Letters containing important information regarding
eligibility and participation criteria.
   (iv) Notices pertaining to the denial, reduction, modification, or
termination of services and benefits, and the right to file a
grievance or appeal.
   (v) Notices advising limited-English-proficient persons of the
availability of free language assistance and other outreach materials
that are provided to enrollees.
   (vi) Translated documents shall not include a health care service
plan's explanation of benefits or similar claim processing
information that is sent to enrollees, unless the document requires a
response by the enrollee.
   (C) (i) For those documents described in subparagraph (B) that are
not standardized but contain enrollee specific information, health
care service plans shall not be required to translate the documents
into the threshold languages identified by the needs assessment as
required by this subdivision, but rather shall include with the
documents a written notice of the availability of interpretation
services in the threshold languages identified by the needs
assessment as required by this subdivision.
   (ii) Upon request, the enrollee shall receive a written
translation of the documents described in clause (i).  The health
care service plan shall have up to, but not to exceed, 21 days to
comply with the enrollee's request for a written translation.  If an
enrollee requests a translated document, all timeframes and deadline
requirements related to the document that apply to the health care
service plan and enrollees under the provisions of this chapter and
under any regulations adopted pursuant to this chapter shall begin to
run upon the health care service plan's issuance of the translated
document.
   (iii) For grievances that require expedited plan review and
response in accordance with subdivision (b) of Section 1368.01, the
health care service plan may satisfy this requirement by providing
notice of the availability and access to oral interpretation
services.
   (D) A requirement that health care service plans advise
limited-English-proficient enrollees of the availability of
interpreter services.
   (2) Standards to ensure the quality and accuracy of the written
translations and that a translated document meets the same standards
required for the English language version of the document.  The
English language documents shall determine the rights and obligations
of the parties, and the translated documents shall be admissible in
evidence only if there is a dispute regarding a substantial
difference in the material terms and conditions of the English
language document and the translated document.
   (3) Requirements for surveying the language preferences and needs
assessments of health care service plan enrollees within one year of
the effective date of the regulations that permit health care service
plans to utilize various survey methods, including, but not limited
to, the use of existing enrollment and renewal processes, subscriber
newsletters, or other mailings.  Health care service plans shall
update the needs assessment, demographic profile, and language
translation requirements every three years.
   (3) Requirements for individual enrollee access to interpretation
services.
   (4) Standards to ensure the quality and timeliness of oral
interpretation services provided by health care service plans.
   (c) In developing the regulations, standards, and requirements,
the department shall consider the following:
   (1) Publications and standards issued by federal agencies, such as
the Culturally and Linguistically Appropriate Services (CLAS) in
Health Care issued by the United States Department of Health and
Human Services Office of Minority Health in December 2000, and the
Department of Health and Human Services (FIHS) Office of Civil Rights
(OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).

   (2) Other cultural and linguistic requirements under state
programs, such as Medi-Cal Managed Care Policy Letters, cultural and
linguistic requirements imposed by the State Department of Health
Services on health care service plans that contract to provide
Medi-Cal managed care services, and cultural and linguistic
requirements imposed by the Managed Risk Medical Insurance Board on
health care service plans that contract to provide services in the
Healthy Families Program.
   (3) Standards adopted by other states pertaining to language
assistance requirements for health care service plans.
   (4) Standards established by California or nationally recognized
accrediting, certifying, or licensing organizations and medical and
health care interpreter professional associations regarding
interpretation services.
   (5) Publications, guidelines, reports, and recommendations issued
by state agencies or advisory committees, such as the report card to
the public on the comparative performance of plans and reports on
cultural and linguistic services issued by the Office of Patient
Advocate and the report to the Legislature from the Task Force on
Culturally and Linguistically Competent Physicians and Dentists
established by Section 852 of the Business and Professions Code.
   (6) Examples of best practices relating to language assistance
services by health care providers and health care service plans,
including existing practices.
   (7) Information gathered from complaints to the HMO Helpline and
consumer assistance centers regarding language assistance services.
   (8) The cost of compliance and the availability of translation and
interpretation services and professionals.
   (9) Flexibility to accommodate variations in plan networks and
method of service delivery.  The department shall allow for health
care service plan flexibility in determining compliance with the
standards for oral and written interpretation services.
   (d) The department shall work to ensure that the biennial reports
required by this section, and the data collected for those reports,
are consistent with reports required by government-sponsored programs
and do not require duplicative or conflicting data collection or
reporting.
   (e) The department shall seek public input from a wide range of
interested parties through the Advisory Committee on Managed Health
Care or other advisory bodies established by the director.
   (f) A contract between a health care service plan and a health
care provider shall require  compliance with the standards developed
under this section.  In furtherance of this section, the contract
shall require providers to cooperate with the plan by providing any
information necessary to assess compliance.
   (g) The department shall report biennially to the Legislature and
the Advisory Committee on Managed Health Care, or other advisory
bodies established by the director, regarding plan compliance with
the standards, including results of compliance audits made in
conjunction with other audits and reviews.  The reported information
shall also be included in the publication required under subparagraph
(B) of paragraph (3) of subdivision (c) of Section 1368.02.  The
department shall also utilize the reported information to make
recommendations for changes that further enhance standards pursuant
to this section.  The department may also delay or otherwise phase in
implementation of standards and requirements in recognition of costs
and availability of translation and interpretation services and
professionals.
   (h) (1) Except for contracts with the State Department of Health
Services Medi-Cal program, the standards developed under this section
shall be considered the minimum required for compliance.
   (2) The regulations shall provide that a health plan is in
compliance if the plan is required to meet the same or similar
standards by the Medi-Cal program, either by contract or state law,
if the standards provide as much access to cultural and linguistic
services as the standards established by this section for an equal or
higher number of enrollees and therefore meet or exceed the
standards of the regulations established pursuant to this section,
and the department determines that the health care service plan is in
compliance with the standards required by the Medi-Cal program.  To
meet this requirement, the department shall not be required to
perform individual audits.  The department shall, to the extent
feasible, rely on audits, reports or other oversight and enforcement
methods used by the State Department of Health Services.
   (3) The determination pursuant to paragraph (2) shall only apply
to the enrollees covered by the Medi-Cal program standards.  A health
care service plan subject to paragraph (2) shall comply with the
standards established by this section with regard to enrollees not
covered by the Medi-Cal program.
   (j) Nothing in this section shall prohibit a government purchaser
from including in their contracts additional translation or
interpretation requirements, to meet linguistic or cultural needs,
beyond those set forth pursuant to this section.
  SEC. 3.  Section 1367.07 is added to the Health and Safety Code, to
read:
   1367.07.  Within one year after a health care service plan's
assessment pursuant to subdivision (b) of Section 1367.06, the health
care service plan shall report to the department, in a format
specified by the department, regarding internal policies and
procedures related to cultural appropriateness in each of the
following contexts:
   (a) Collection of data regarding the enrollee population pursuant
to the health care service plan's assessment conducted in accordance
with subdivision (b) of Section 1367.06.
   (b) Education of health care service plan staff who have routine
contact with enrollees regarding the diverse needs of the enrollee
population.
   (c) Recruitment and retention efforts that encourage workforce
diversity.
   (d) Evaluation of the health care service plan's programs and
services with respect to the plan's enrollee population, using
processes such as an analysis of complaints and satisfaction survey
results.
   (e) The periodic provision of information regarding the ethnic
diversity of the plan's enrollee population and any related
strategies to plan providers.  Plans may use existing means of
communication.
   (f) The periodic provision of educational information to plan
enrollees on the plan's services and programs.  Plans may use
existing means of communications.
  SEC. 4.  Section 10133.8 is added to the Insurance Code, to read:
   10133.8.  (a) The commissioner shall, on or before January 1,
2006, promulgate regulations applicable to all individual and group
policies of health insurance establishing standards and requirements
to provide insureds with appropriate access to translated materials
and language assistance in obtaining covered benefits.  A health
insurer that participates in the Healthy Families Program may assess
the Health Families Program enrollee population separately from the
remainder of its population for purposes of subparagraph (A) of
paragraph (3) of subdivision (b).  An insurer that chooses to
separate its Healthy Families Program enrollment from the remainder
of its population shall treat the Healthy Families Program population
separately for purposes of determining whether subparagraph (A) of
paragraph (3) of subdivision (b) is applicable and shall also treat
the Healthy Families Program population separately for purposes of
applying the percentage and numerical thresholds in subparagraph (A)
of paragraph (3) of subdivision (b).
   (b) The regulations described in subdivision (a) shall include the
following:
   (1) A requirement to conduct an assessment of the needs of the
insured group, pursuant to this subdivision.
   (2) Requirements for surveying the language preferences and
assessment of linguistic needs of insureds within one year of the
effective date of the regulations that permit health insurers to
utilize various survey methods, including, but not limited to, the
use of existing enrollment and renewal processes, newsletters, or
other mailings.  Health insurers shall update the linguistic needs
assessment, demographic profile, and language translation
requirements every three years.  However, the regulations may provide
that the surveys and assessments by insurers of supplemental
insurance products may be conducted less frequently than three years
if the commissioner determines that the results are unlikely to
effect the translation requirements.
   (3) Requirements for the translation of vital documents that
include the following:
   (A) A requirement that all vital documents, as defined pursuant to
subparagraph B be translated into an indicated language, as follows:

   (i) A health insurer with an insured population of 1,000,000 or
more shall translate vital documents into the top two languages other
than English as determined by the needs assessment pursuant to
paragraph (2) of subdivision (b) and any additional languages when
0.75 percent or 15,000 of the insured population, whichever, number
is less, indicates in the needs assessment pursuant to paragraph (2)
of subdivision (b) a preference for written materials in that
language.
   (ii) A health insurer with an insured population of 300,000 or
more but less than 1,000,000 shall translate vital documents into the
top one language other than English as determined by the needs
assessment pursuant to paragraph (2) of subdivision (b) and any
additional languages when 1 percent or 6,000 of the insured
population, whichever number is less, indicates in the needs
assessment pursuant to paragraph (2) of subdivision (b) a preference
for written materials in that language.
   (iii) A health insurer with an insured population of less than
300,000 shall translate vital documents into a language other than
English when 3,000 or more or five percent of the insured population,
whichever number is less, indicates in the needs assessment pursuant
to paragraph (2) of subdivision (b) a preference for written
materials in that language.
   (B) Specification of vital documents produced by the insurer that
are required to be translated.  The specification of vital documents
shall not exceed that of the Department of Health and Human Services
(FIHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal
Register 52762 (August 30, 2000)), but shall include all of the
following:
   (i) Applications.
   (ii) Consent forms.
   (iii) Letters containing important information regarding
eligibility or participation criteria.
   (iv) Notices pertaining to the denial, reduction, modification or
termination of services and benefits, the right to file a complaint
or appeal.
   (v) Notices advising Limited English proficient persons of the
availability of free language assistance and other outreach materials
that are provided to insureds.
   (vi) Translated documents shall not include an insurer's
explanation of benefits or similar claim processing information that
are sent to insureds unless, the document requires a response by the
insured.
   (C) For those documents described in subparagraph (B) that are not
standardized but contain insured specific information, health
insurers shall not be required to translate the documents into the
threshold languages identified by the needs assessment pursuant to
paragraph (2) of subdivision (b) but rather shall include with the
document a written notice of the availability of interpretation
services in the threshold languages identified by the needs
assessment pursuant to paragraph (2) of subdivision (b).
   (i) Upon request, the insured shall receive a written translation
of those documents.  The health insurer shall have up to, but not to
exceed 21 days to comply with the insured's request for a written
translation.  If an enrollee requests a translated document, all
timeframes and deadlines requirements related to the documents that
apply to the health insurer and insureds under the provisions of this
chapter and under any regulations adopted pursuant to this chapter
shall begin to run upon the health insurer's issuance of the
translated document.
   (ii) For appeals that require expedited review and response in
accordance with the statutes and regulations of this chapter.  The
health insurer may satisfy this requirement by providing notice of
the availability and access to oral interpretation services.
   (D) A requirement that health insurers advise Limited English
proficient insureds of the availability of interpreter services.
   (4) Standards to ensure the quality and accuracy of the written
translation and that a translated document meets the same standards
required for the English version of the document.  The English
language documents shall determine the rights and obligations of the
parties, and the translated documents shall be admissible in evidence
only if there is a dispute regarding a substantial difference in the
material terms and conditions of the English language document and
the translated document.
   (5) Requirements for individual access to interpretation services.

   (6) Standards to ensure the quality and timeliness of oral
interpretation services provided by health insurers.
   (c) In developing the regulations, standards, and requirements
described in this section, the commissioner shall consider the
following:
   (1) Publications and standards issued by federal agencies,
including the Culturally and Linguistically Appropriate Services
(CLAS) in Health Care issued by the United States Department of
Health and Human Services Office of Minority Health in December 2000,
and the Department of Health and Human Services (FIHS) Office of
Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762
(August 30, 2000)).

(2) Other cultural and linguistic requirements under state programs,
including the Medi-Cal Managed Care Policy Letters, cultural and
linguistic requirements imposed by the State Department of Health
Services on health care service plans that contract to provide
Medi-Cal managed care services, and cultural and linguistic
requirements imposed by the Managed Risk Medical Insurance Board on
health insurers that contract to provide services in the Healthy
Families Program.
   (3) Standards adopted by other states pertaining to language
assistance requirements for health insurers.
   (4) Standards established by California or nationally recognized
accrediting, certifying, or licensing organizations and medical and
health care interpreter professional associations regarding
interpretation services.
   (5) Publications, guidelines, reports, and recommendations issued
by state agencies or advisory committees, such as the report card to
the public on the comparative performance of plans and reports on
cultural and linguistic services issued by the Office of Patient
Advocate and the report to the Legislature from the Task Force on
Culturally and Linguistically Competent Physicians and Dentists
required pursuant to Section 852 of the Business and Professions
Code.
   (6) Examples of best practices relating to language assistance
services by health care providers and health insurers that contract
for alternative rates of payment with providers, including existing
practices.
   (7) Information gathered from complaints to the commissioner and
consumer assistance help lines regarding language assistance
services.
   (8) The cost of compliance and the availability of translation and
interpretation services and professionals.
   (9) Flexibility to accommodate variations in networks and method
of service delivery.  The commissioner shall allow for health insurer
flexibility in determining compliance with the standards for oral
and written interpretation services.
   (d) In designing the regulations, the commissioner shall consider
all other relevant guidelines in an effort to accomplish maximum
accessibility within a cost-efficient system of indemnification.  The
commissioner shall seek public input from a wide range of interested
parties.
   (e) Services, verbal communications, and written materials
provided by or developed by the health insurers that contract for
alternative rates of payment with providers shall comply with the
standards developed under this section.
   (f) Beginning on January 1, 2008, the department shall report
biennially to the Legislature regarding health insurer compliance
with the standards established by this section, including results of
compliance audits made in conjunction with other audits and reviews.
The department shall also utilized the reported information to make
recommendations for changes that further enhance standards pursuant
to this section.  The commissioner shall work to ensure that biennial
reports required by this section, and the data collected for the
reports do not require duplicative or conflicting data collection
with other reports as may be required by government-sponsored
programs.  The commissioner may also delay or otherwise phase in
implementation of the standards and requirements in recognition of
costs and availability of translation and interpretation services and
professionals.
   (g) Nothing in this section shall prohibit a government purchaser
from including in their contracts additional translation or
interpretation requirements, to meet the linguistic and cultural
needs, beyond those set forth pursuant to this section.
  SEC. 5.  Section 10133.9 is added to the Insurance Code, to read:
   10133.9.  Within a year after the health insurer's assessment
pursuant to paragraph (2) of subdivision (b) of Section 10133.8,
health insurers shall report to the Department of Insurance on
internal policies and procedures related to cultural appropriateness,
in a format specified by the department, in the following ways:
   (a) Collection of data regarding the insured population based on
the needs assessment as required by paragraph (2) of subdivision (b)
of Section 10133.8.
   (b) Education of health insurer staff who have routine contact
with insureds regarding the diverse needs of the insured population.

   (c) Recruitment and retention efforts that encourage workforce
diversity.
   (d) Evaluation of the health insurer's programs and services with
respect to the insurer's enrollee populations, using processes such
as an analysis of complaints and satisfaction survey results.
   (e) The periodic provision of information regarding the ethnic
diversity of the insurer's insured population and any related
strategies to insurers providers.  Insurers may use existing means of
communication.
   (f) The periodic provision of educational information to insureds
on the insurer's services and programs.  Insurers may use existing
means of communication.
  SEC. 6.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.