BILL ANALYSIS                                                                                                                                                                                                    Ó



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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 Hernández,          |     |Donnelly, Eggman, Gomez,  |
          |     |Lowenthal, Maienschein,   |     |Hall, Ammiano, Linder,    |
          |     |Mansoor, Mitchell,        |     |Pan, Quirk, Wagner, Weber |
          |     |Nazarian, Nestande,       |     |                          |
          |     |V. Manuel Pérez, Wagner,  |     |                          |
          |     |Wieckowski, Wilk          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           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








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