BILL ANALYSIS �
AB 505
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ASSEMBLY THIRD READING
AB 505 (Nazarian)
As Amended April 17, 2013
Majority vote
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Harkey, Bigelow, |
| |Bonilla, Bonta, Chesbro, | |Bocanegra, Bradford, Ian |
| |Gomez, | |Calderon, Campos, |
| |Roger Hern�ndez, | |Donnelly, Eggman, Gomez, |
| |Lowenthal, Maienschein, | |Hall, Ammiano, Linder, |
| |Mansoor, Mitchell, | |Pan, Quirk, Wagner, Weber |
| |Nazarian, Nestande, | | |
| |V. Manuel P�rez, Wagner, | | |
| |Wieckowski, Wilk | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires the Department of Health Care Services (DHCS)
to require all Medi-Cal managed care (MCMC) plans (MCPs)
contracted to provide Medi-Cal services to provide language
assistance to limited-English-proficient (LEP) enrollees as
specified. Specifically, this bill :
1)Requires interpretation services to be provided by the MCPs on
a 24 hour basis at all points of service.
2)Requires translation services to be provided to the language
groups identified by DHCS.
3)Requires DHCS to determine when an LEP population meets the
requirement for translation services using one of the
following numeric thresholds:
a) Three thousand LEP persons eligible for Medi-Cal reside
in the plan's service area, or 1,000 LEP persons eligible
for Medi-Cal reside in a single zip code; or,
b) Two contiguous zip codes with 1,500 LEP persons eligible
for Medi-Cal are in a health plan's service.
FISCAL EFFECT : According to the Assembly Appropriations
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Committee, this bill has minor and absorbable costs to DHCS, as
this bill essentially codifies current practice.
COMMENTS : According to the author, this bill is intended to
codify language assistance requirements in current contracts
between DHCS and MCPs, in order to strengthen these access
standards. The author points out more than 40% of Californians
speak a language other than English at home, and an estimated
six to seven million people (one in five) are LEP, meaning they
speak English less than "very well." The author states that for
over a decade, DHCS has required MCPs to provide language
assistance to LEP members. MCPs must provide oral
interpretation services, in all languages, on a 24 hour basis.
Currently, by contract, translation services of written
documents, such as application for enrollment or notice of
benefits, must be provided when the LEP population meets one of
the numeric thresholds specified in this bill. According to the
author, the following languages meet the current threshold
required for translation services: Arabic; Armenian; Cambodian;
Cantonese; Farsi; Hmong; Korean; Mandarin; Russian; Spanish;
Tagalog; and, Vietnamese. The author explains that DHCS
instructs the MCPs on how to provide both the oral
interpretation and written translation services through policy
letters and contract requirements. The author states that in
2003, language assistance requirements were codified for
commercial plans licensed by the Department of Managed Health
Care or at the California Department of Insurance, but not for
MCPs.
Currently MCMC in California serves about 5.2 million enrollees
in 30 counties, or about 69% of the total Medi-Cal population.
DHCS has embarked upon an ambitious array of initiatives that
could result in over two million new enrollees into MCPs in 2012
and 2013. These program changes include all age groups and all
geographic regions. For example, DHCS is currently in the
process of transitioning approximately 860,000 Healthy Families
Program children statewide into the Medi-Cal program in four
phases throughout 2013. In November of 2010, California
obtained federal approval for a Section 1115(b) Medicaid
Demonstration Waiver from the Centers for Medicare and Medicaid
Services entitled "A Bridge to Reform Waiver." Among other
provisions, this waiver authorized mandatory enrollment into
MCPs of over 600,000 low-income seniors and persons with
disabilities (SPDs) who are eligible for Medi-Cal only (not
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Medicare) in the 14 two-plan and two Geographic Managed Care
(GMC) counties. Enrollment was phased in over a one-year period
in the affected counties beginning on June 1, 2011. Prior to
this, mandatory enrollment was limited to children and their
families for 30 counties and SPDs in the 14 counties served by
the County Operated Health System (COHS). In eight counties,
DHCS will begin adding Long-Term Services and Supports,
previously carved out of managed care and largely provided
through fee-for-service, as services provided through the MCPs.
The counties include two COHS counties, one GMC county, and the
other five are two-plan model. In addition, under the Federal
Patient Protections and Affordable Care Act, states must expand
Medicaid eligibility up to 138% of the federal poverty level
(FPL) for families, pregnant women, and children. States also
have the option to cover childless adults between ages 19 and 65
with incomes under 138% of the FPL who are not currently
Medi-Cal eligible. This expansion is estimated to result in
between one million and 1.4 million more Californians enrolling
in Medi-Cal by 2019. Most of these newly eligible will be
enrolled in MCMC.
According to the sponsors, the thresholds were developed as part
of a MCMC work group convened by DHCS in the early '90s when
California was planning to transition the majority of their
Medi-Cal beneficiaries into managed care. Work group members,
in partnership with the Office of Multicultural Health, reviewed
Medi-Cal data on the language needs of the beneficiaries and
determined that setting the threshold at 3,000 in a county would
provide translated materials to two-thirds of the beneficiaries
whose primary language is other than English. This threshold
has been codified for purposes of Steven M. Thompson Physician
Corps Loan Repayment Program and the Steven M. Thompson Medical
School Scholarship Program. Both programs require priority
consideration to applicants who speak a Medi-Cal threshold
language, along with those coming from an economically
disadvantaged background or having experience in a medically
underserved area or with medically underserved populations.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000441
AB 505
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