BILL ANALYSIS �
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THIRD READING
Bill No: AB 505
Author: Nazarian (D)
Amended: 6/19/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/12/13
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Monning, Wolk
NOES: Anderson, Nielsen
NO VOTE RECORDED: Pavley
SENATE APPROPRIATIONS COMMITTEE : 7-0, 6/24/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 72-0, 5/16/13 - See last page for vote
SUBJECT : Medi-Cal: managed care: language assistance
services
SOURCE : California Pan-Ethnic Health Network
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to require all managed care plans contracting
with DHCS to provide Medi-Cal services to provide language
assistance services to limited-English-proficient Medi-Cal
beneficiaries who are mandatorily enrolled in managed care by
requiring interpretation services to be provided in any language
on a 24-hour basis at key points of contact, and requiring oral
translation services to be provided to the language groups
identified by DHCS meeting specified numeric thresholds.
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ANALYSIS :
Existing law:
1.Establishes the Medi-Cal program, which is administered by
DHCS, under which qualified low-income individuals receive
health care services.
2.Permits the director of DHCS to contract, on a bid or non-bid
basis, with any qualified individual, organization, or entity
to provide services to, arrange for or case manage the care of
Medi-Cal beneficiaries; permits, at the director's discretion,
the contract to be exclusive or non-exclusive, statewide or on
a more limited geographic basis, and includes provisions to
provide for delivery of services in a manner consistent with
managed care principles, techniques, and practices directed at
ensuring the most cost-effective and appropriate scope,
duration, and level of care.
3.Prohibits, under Title VI of the Civil Rights Act of 1964, a
person in the United States, on the grounds of race, color, or
national origin, from being excluded from participation in,
denied the benefits of, or subjected to discrimination under
any program or activity receiving federal financial
assistance.
This bill:
1.Requires DHCS to require all managed care plans contracting
with DHCS that provide Medi-Cal services to provide language
assistance services to limited-English-proficient (LEP)
beneficiaries who are mandatorily enrolled in managed care in
the following manner:
A. Oral interpretation services in any language on a
24-hour basis at key points of contact.
B. Translation services to the language groups identified
by DHCS.
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1.Requires DHCS to determine when an LEP population meets the
requirement for translation services using one of the
following numeric thresholds:
A. A population group of 3,000 Medi-Cal beneficiaries, who
are mandatorily enrolled in managed care, reside in the
service area, and who indicate their primary language as
other than English; or
B. A population group of Medi-Cal beneficiaries, who are
mandatorily enrolled in managed care, reside in the service
area, who indicate their primary language as other than
English, and that meet a concentration standard of 1,000
beneficiaries in a single ZIP Code or 1,500 beneficiaries
in two contiguous ZIP Codes.
1.Requires DHCS to make this determination if any of the
following occurs:
A. A nonmanaged care county becomes a new managed care
county;
B. A new population group becomes a mandatory Medi-Cal
managed care beneficiary population; or
C. A period of three years has passed since the last
determination.
1.Requires DHCS to instruct managed care plans of the language
groups that meet the numeric threshold by means of
incorporating this requirement into plan contracts, all-plan
letters or similar instructions.
2.Designates a person as "LEP" if an individual speaks English
less than very well.
3.Does not apply to mental health plans contracting with DHCS,
pursuant to existing law.
This bill achieves the goals of the federal Affordable Care Act
(ACA) to increase access and availability of health care options
and strengthens consumer protections for Medi-Cal managed care
LEP enrollees by codifying in state law the language assistance
requirements in Medi-Cal managed care. The author's office
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states language barriers limit access to health care at every
level, from scheduling an appointment to receiving a medical
diagnosis. This bill ensures that necessary protections for LEP
individuals are not lost in the process of implementing the
changes made by the ACA.
Background
Percentage of Californians who are LEP and current DHCS
standards. According to the U.S. Census Bureau 2010 American
Community Survey, 43.7% of Californians over the age of five
speak a language other than English, and 19.9% of Californians
over the age of five speak English "less than very well." DHCS'
Medi-Cal Managed Care Division is responsible for determining
statewide translation threshold languages and their numeric
estimate for Medi-Cal managed care counties. DHCS establishes
the thresholds through its contractual language with plans and
through DHCS-issued All Plan Letters (APLs). Through contract,
DHCS requires its Medi-Cal managed care plans to ensure equal
access to health care services for its members without regards
to a member's proficiency in the English language.
A June 2002 APL, requires plans to provide 24-hour interpreter
service for all LEP members at all provider sites within the
plans' service areas. In addition, plans are required to provide
translation services to their Medi-Cal LEP members based on
certain population levels, which this bill codifies. Plans must
provide interpreter and translation services when a LEP member
population meets a numeric threshold of 3,000 members residing
in its service area. Both services must be provided to LEP
member populations meeting concentration standards of 1,000
members in a single zip code, or 1,500 members in two contiguous
zip codes. There are currently 13 Medi-Cal threshold languages
(English, Arabic, Armenian, Cambodian, Cantonese, Farsi, Hmong,
Korean, Mandarin, Russian, Spanish, Tagalog, and Vietnamese).
DHCS' APL and contract does not define LEP. This bill defines
LEP as an individual who speaks English less than very well,
which is the definition used by the United States Census.
Prior Legislation
AB 2392 (John A. P�rez, 2012), was substantially similar to AB
1263. AB 2392 died on the Assembly inactive file.
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SB 442 (Calderon, 2011), would have required general acute care
hospital policies for the provision of language assistance to
patients with language or communication barriers to include
procedures for discussing with the patient any cultural,
religious, or spiritual beliefs or practices that may influence
care, and to increase the ability of hospital staff to
understand and respond to the cultural needs of patients. SB
442 would have required hospitals' policies on language
assistance services to include criteria on proficiency similar
to those that apply to health plans. SB 442 was vetoed by
Governor Brown.
SB 1405 (Soto, 2006), would have required the Department of
Health Services (now DHCS) to create the Task Force on
Reimbursement for Language Services, as specified, to develop a
mechanism for seeking federal matching funds from federal
Centers for Medicare and Medicaid Services to pay for language
assistance services, as specified. SB 1405 was placed on the
Inactive File.
AB 800 (Yee, Chapter 313, Statutes of 2005), requires all health
facilities (hospitals, skilled nursing facilities, intermediate
care facilities, correctional treatment centers) and all primary
care clinics to include a patient's principal spoken language on
the patient's health records.
SB 853 (Escutia, Chapter 713, Statutes of 2003), requires the
Department of Managed Health Care and the Department of
Insurance to adopt regulations to ensure enrollees have access
to language assistance in obtaining health care services.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Ongoing costs likely between $40,000 and $75,000 every
three years to determine the thresholds for translating
documents by Medi-Cal managed care plans by DHCS (50%
General Fund, 50% federal funds).
No significant increased costs for providing
interpretation and translation services are expected. This
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bill essentially recodifies existing law and practice.
SUPPORT : (Verified 6/25/13)
California Pan-Ethnic Health Network (source)
100% Campaign
American Civil Liberties Union of California
American Federation of State, County and Municipal Employees,
AFL-CIO
California Association of Public Authorities
California Coverage and Health Initiatives
California Immigrant Policy Center
Children Now
Children's Defense Fund - California
Children's Partnership
Health Access California
National Association of Social Workers
National Health Law Program
PICO California
Southeast Asia Resource Action Center
Street Level Health Project
United Ways of California
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : This bill is sponsored by the
California Pan-Ethnic Health Network (CPEHN) to strengthen
consumer protections for Medi-Cal managed care enrollees who
speak English less than very well, by codifying existing
language assistance requirements in Medi-Cal managed care.
According to CPEHN, an estimated 6 to 7 million Californians are
LEP and over 1.4 million individuals will be newly eligible for
Medi-Cal, over one-third of whom will speak English less than
very well. CPEHN states language barriers limit access to
quality health care at every level, from scheduling an
appointment to receiving an improper medical diagnosis. In
addition, CPEHN states federal and state laws require health
plans to meet the language needs of LEP persons as Title VI of
the 1964 Civil Rights Act prohibits discrimination against
persons based upon national origin, which has been interpreted
to include people who do not speak English very well. By
codifying these current language assistance requirements, CPEHN
argues this bill will ensure LEP members' access to quality
health care.
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ASSEMBLY FLOOR : 72-0, 5/16/13
AYES: Achadjian, Alejo, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Ch�vez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray,
Hagman, Hall, Harkey, Roger Hern�ndez, Jones, Jones-Sawyer,
Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor,
Medina, Mitchell, Mullin, Muratsuchi, Nazarian, Nestande,
Olsen, Pan, Patterson, Perea, V. Manuel P�rez, Quirk,
Quirk-Silva, Rendon, Salas, Skinner, Ting, Torres, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, John A.
P�rez
NO VOTE RECORDED: Allen, Donnelly, Grove, Holden, Melendez,
Morrell, Stone, Vacancy
JL:ej 6/25/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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