BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  AB 1263
          Author:   John A. Pérez (D)
          Amended:  7/10/13 in Senate
          Vote:     21

           
           SENATE PUBLIC EMPLOYMENT & RETIREMENT COMM.  :  3-2, 6/24/13
          AYES:  Beall, Block, Yee
          NOES:  Walters, Gaines

           SENATE HEALTH COMMITTEE  :  7-2, 7/3/13
          AYES:  Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,  
            Wolk
          NOES:  Anderson, Nielsen

           SENATE APPROPRIATIONS COMMITTEE  :  5-2, 8/30/13
          AYES:  De León, Hill, Lara, Padilla, Steinberg
          NOES:  Walters, Gaines

          ASSEMBLY FLOOR  :  55-23, 5/29/13 - See last page for vote


           SUBJECT :    Medi-Cal:  CommuniCal

           SOURCE  :     Author


           DIGEST  :    This bill requires the Department of Health Care  
          Services (DHCS) to establish the Medi-Cal Patient-Centered  
          Communication Program, called CommuniCal, to provide and  
          reimburse for medical interpretation services to Medi-Cal  
          beneficiaries who are limited-English proficient (LEP),  
          establishes a certification process and registry of CommuniCal  
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          interpreters at DHCS and grants CommuniCal interpreters  
          collective bargaining rights with the state.

           ANALYSIS  :    

          Existing federal law:

          1. Provides increased federal matching funding for translation  
             and interpretation services provided in connection with the  
             enrollment, retention, and use of services under Medicaid  
             (Medi-Cal in California) and the Children's Health Insurance  
             Program (CHIP is  known as the Healthy Families Program in  
             California).

          2. 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.

          Existing state law:

          1. Establishes the Medi-Cal program, which is administered by  
             DHCS, under which qualified low-income individuals receive  
             health care services.

          2. Requires, under the Kopp Act, commercial health plans to  
             assess their members' language preference and provide  
             interpretation and translation services in threshold  
             languages.

          3. Requires hospitals to provide language services,  
             interpreters, or bilingual staff, under specified  
             circumstances, and to identify and record patients' primary  
             languages in hospital records.

          4. Requires, under the Dymally-Alatorre Bilingual Services Act,  
             state and local agencies providing services to a substantial  
             number of non-English speaking people to provide bilingual  
             services.

          This bill:


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           Creation and Administration of CommuniCal
           
          1. Requires DHCS to establish the CommuniCal program to provide  
             and reimburse for certified medical interpretation services  
             to LEP Medi-Cal enrollees.

          2. Requires CommuniCal to offer medical interpretation services  
             to Medi-Cal providers who are providing services on either a  
             fee-for-service (FFS) or managed care basis.

          3. Requires DHCS to adopt policies, in consultation with the  
             Community Advisory Committee (CAC), to prohibit duplicate  
             payments to CommuniCal interpreters and Medi-Cal managed care  
             plans (MCP) for services provided to Medi-Cal MCP enrollees.

          4. Permits a health care provider and other entities entering  
             into a Medi-Cal managed care contract with the state to  
             utilize CommuniCal to provide medical interpreter services to  
             Medi-Cal beneficiaries.

          5. Requires all contracts between Medi-Cal managed care  
             organizations (MMCOs) and their subcontractors to include  
             provisions describing access to CommuniCal medical  
             interpreter services.

          6. Requires DHCS, in consultation with CAC, to pursue all  
             available sources of federal funding to establish and operate  
             CommuniCal and to seek any federal approvals necessary to  
             implement this article.

          7. Requires CommuniCal to include in-person, telephonic, and  
             video medical interpretation services by a CommuniCal  
             interpreter. 
           
          8. Provides that, whenever possible, in-person interpreter  
             services shall be the preferred mode of interpretation in the  
             following instances:


             A.    Family meeting regarding medical care;

             B.    Medical encounters involving difficult or agitated  
                patients;


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             C.    Medical encounters to make treatment decisions; 

             D.    Obtaining informed consent involving review of  
                documents;

             E.    Any medical encounter that, in the physician's judgment  
                requires in-person interpretation for the health, safety  
                or well-being of the patient;

             F.    Psychiatric encounters;

             G.    End-of-life discussions; and

             H.    Other circumstances identified by the CAC.

          9. Requires CommuniCal to be administered by a patient-centered  
             communication broker.

          10.Requires DHCS to create and administer a competitive Request  
             for Proposals (RFP) for the communication broker who shall be  
             responsible for the following duties: 


             A.    Registering CommuniCal interpreters with Medi-Cal;

             B.    Verifying Medi-Cal eligibility of an interpreter to  
                provider CommuniCal services with DHCS;

             C.    Verifying Medi-Cal eligibility for interpreter services  
                utilizing the state's Medi-Cal Eligibility Data System  
                (MEDS);

             D.    Submitting billing summaries to Medi-Cal and  
                aggregating the cost for services provided;

             E.    Ensuring compliance with Medi-Cal and applicable  
                CommuniCal reporting requirements;

             F.    Making payments to CommuniCal interpreters, including  
                any dues and fee service deductions;

             G.    Scheduling CommuniCal interpreter appointments with  
                Medi-Cal providers;


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             H.    Monitoring the quality of CommuniCal interpreter  
                services and complying with state oversight requirements  
                of CommuniCal, as specified;

             I.    Creating CommuniCal promotional materials for  
                distribution to providers, MMCOs and beneficiaries; and

             J.    Any other duties deemed to be appropriate by the CAC.

          11.Requires DHCS to make all applicable Medi-Cal reporting  
             requirements known to the broker and be responsible for the  
             broker's compliance with these requirements.

          12.Requires interpreters to be certified as a CommuniCal  
             interpreter by DHCS to participate in CommuniCal.

          13.Requires CommuniCal interpreters to be responsible for all of  
             the following:


             A.    Preforming interpreter services independent of other  
                policies, rules, or procedures;

             B.    Preforming interpreter services independent of  
                direction;

             C.    Preparing and submitting documentation to the broker in  
                support of time worker or services rendered; and,
             D.    Directing and controlling the manner and means of  
                interpretation services. 

          14.Permits, unless otherwise prohibited, CommuniCal interpreters  
             to advertise, promote, or otherwise communicate availability  
             for services to the general public and provide office space,  
             equipment, support services, forms, supplies, and business  
             cards.

          15.Provides that for the purposes of the CommuniCal program:


             A.    CommuniCal interpreters are independent contractors of  
                the state;

             B.    CommuniCal interpreters are not employees of the  

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                broker, health care providers, or consumers; and
             C.    The state action antitrust exemption to the application  
                of federal and state antitrust laws is applicable to the  
                activities of CommuniCal interpreters and their exclusive  
                representatives.

          16.Establishes the base reimbursement rate for CommuniCal  
             interpreters to be subject to collective bargaining and  
             authorizes the rate to be adjusted, in consultation with the  
             CAC, for factors such as geography, language spoken,  
             availability of interpreters, level of certification, travel  
             time, or other factors.

          17.Requires DHCS to issue guidance, in consultation with the  
             CAC, on the administration of the CommuniCal program to  
             ensure compliance with the provisions of this bill and all  
             applicable state and federal laws by all contractors and  
             subcontractors of the program.

          18.Establishes the CommuniCal Program Fund (Fund) in the state  
             treasury and requires any interest and dividends earned by  
             the Fund be retained in the Fund for specified purposes.   
             Provides that moneys in the Fund are to be used solely to  
             fund the CommuniCal program.

           Certification and Registration of CommuniCal Medical  
             Interpreters
           
          19.Provides that the DHCS shall serve as the CommuniCal  
             interpreter certifying body, and requires DHCS, as the  
             certifying body to:


             A.    Develop, monitor and evaluate interpreter competency,  
                qualifications, training, certification, and continuing  
                education requirements for medical interpreters.

             B.    Approve an examination and certification process, in  
                consultation with CAC, to test and certify the  
                competency of medical interpreters by September 1, 2014.

          20.Requires that, as a condition of certification, an  
             interpreter complete at least one of the following and  
             specifies that upon completing one of the following, the  

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             interpreter shall be certified as a CommuniCal Certified  
             Medical Interpreter (CCMI) and listed on the CommuniCal  
             Medical Interpreter Registry:


             A.    Pass an examination administered by a nonprofit  
                organization selected by DHCS that is nationally  
                accredited to offer certification exams for health care  
                interpreters;

             B.    Pass an examination developed by a state-established  
                language testing and certification program that includes  
                oral and written components and specified competency  
                standards; or 

             C.    Achieve the designation of Certified Healthcare  
                Interpreter from the Certification Commission for  
                Healthcare Interpreters or Certified Medical Interpreter  
                from the National Board of Certification for Medical  
                Interpreters.

          21.Establishes an alternate certification process, beginning  
             July 1, 2014, for interpreters of languages for which a CCMI  
             examination has not been created and requires it to consist  
             of a screening test established by DHCS, in consultation with  
             CAC that contains the following:


             A.    A written component testing for specified knowledge,  
                skills and abilities including, managing an interpreter  
                encounter, health care terminology, interacting with  
                other health care professionals, preparing for an  
                interpreting encounter, and cultural responsiveness;  
                and

             B.    An oral component utilizing the target language to  
                test his/her linguistic and interpreting skills.

          22.Requires, by July 1, 2014, an interpreter to be CCMI  
             certified or authorized to provide CommuniCal services  
             through the alternate certification process referenced in 21)  
             in order to provide CommuniCal services.

          23.Requires DHCS to maintain a list of authorized CommuniCal  

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             interpreters called the CommuniCal Medical Interpreter  
             Registry.

          24.Permits DHCS, in order to meet anticipated demand, to  
             authorize an interpreter to provide CommuniCal services prior  
             to becoming certified if the interpreter meets all of the  
             following requirements: 


             A.    Is at least 18 years of age and demonstrates that as  
                of January 1, 2014 he or she has worked regularly and  
                professionally as an in-person medical interpreter  
                during the previous two years;


             B.    Holds a minimum of a Untied States high school  
                diploma or General Education Development (GED), or its  
                equivalent from another country; and

             C.    Has demonstrated linguistic proficiency in English  
                and another specified language.

          25.Specifies that an individual authorized under the provisional  
             requirements who does not subsequently become certified or  
             receive permanent authorization by January 1, 2016, is no  
             longer be authorized to provide CommuniCal services.

          26.Requires the certifying body to establish and charge fees,  
             not to exceed the reasonable costs, for applicants to take an  
             applicable exam.  Requires a single fee that does not exceed  
             the reasonable costs for certification, authorization, and  
             listing on the registry.

          27.Requires CommuniCal interpreters to pay a registry and  
             certification or authorization fee, by July 1 of each year,  
             in order to remain on the registry.

          28.Requires DHCS to establish, maintain, administer and publish  
             annually an updated registry of CommuniCal interpreters and  
             permits DHCS to remove the name of a person from the registry  
             if the person is deceased, notifies the board that they are  
             unable to work, does not submit an authorization or renewal  
             fee, or fails to meet the quality standards and medical  
             certification requirements.

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          29.Waives, for the 2013-14 fiscal year only, the fee for  
             certification and listing on the registry.

          30.Requires DHCS to adopt quality standards and medical  
             interpretation certification requirements through  
             regulations, to include, but not be limited to, maintaining  
             patient confidentiality and familiarity or experience working  
             with medical terminology and determine the testing  
             requirements for certification in each language.

          31.Requires a CAC to be established to make recommendations on  
             interpreter certification and services and to assist with  
             developing standards and requirements.

          32.Requires the CAC to include stakeholders that reflect the  
             diversity of the state in terms of race, ethnicity, gender,  
             sexual orientation, immigration status, and geography,  
             including representatives from government, health care  
             providers, LEP consumers, health care or language access  
             advocates, medical or health care interpreters, and any other  
             individual DHCS deems appropriate.

          33.Requires the exclusive representative of CommuniCal  
             interpreters, the CAC, and a nonprofit organization to  
             partner to create and administer a training program for  
             medical interpreters, in order to prepare interpreters for  
             exams or other certification standards established for  
             languages of lesser diffusion and to provide continuing  
             education for those CommuniCal interpreters placed on the  
             registry.

          34.Specifies that, unless otherwise specified, the relationship  
             of CommuniCal interpreters to all parties and recipients of  
             service is one of independent contractor. 

           Collective Bargaining for CommuniCal Certified Medical  
          Interpreters
           
          35.Requires only CommuniCal interpreters be represented by a  
             labor organization for the purposes of collective bargaining  
             as established by this bill.

          36.Grants CommuniCal interpreters the right to form, join, and  

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             participate in the activities of a labor organization of  
             their own choosing for purpose of representation.

          37.Applies the state action antitrust exemption and state and  
             federal antitrust laws to the activities of CommuniCal  
             interpreters and their exclusive representatives.

          38.Requires CommuniCal interpreters to have the right to be  
             represented by an exclusive labor organization of their own  
             choosing for the purpose of collective bargaining with the  
             state of California on matters of mutual concern, including  
             but not limited to, a list of 10 specific provisions,  
             including: development; maintenance and application of the  
             registry; the setting of reimbursements and rates for  
             state-funded medical interpreter programs; professional  
             development and certification; scheduling; dispute resolution  
             mechanism; mediums and modes of delivery of interpretation  
             services; and, collection and disbursement of dues.

          39.Requires the appropriate bargaining unit for CommuniCal  
             interpreters to be a statewide unit of eligible CommuniCal  
             interpreters.

          40.Provides that CommuniCal interpreters are not public  
             employees and that this bill does not establish an  
             employer-employee relationship between CommuniCal  
             interpreters and the state or patient-centered communication  
             brokers for any purpose.

          41.Requires DHCS to furnish, upon request by a labor  
             organization that is signed by 20% of CommuniCal  
             interpreters, a list of all CommuniCal interpreters including  
             full names, telephone numbers, e-mail addresses and mailing  
             or home address to the labor organization within 5 days of  
             the request.

          42.Requires the Public Employment Relations Board (PERB), upon  
             application by petition, authorization cards, or union  
             membership cards of a labor organization adequately showing  
             that a majority of CommuniCal interpreters in the state  
             desire to be represented exclusively by that labor  
             organization and no other, to certify and grant exclusive  
             representation to the labor organization.  Requires, if less  
             than a majority but at least 30% of CommuniCal interpreters  

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             desire to be represented exclusively by that labor  
             organization, the matter to be set for a mail ballot  
             election.

          43.Requires PERB to accept, review, and certify all valid  
             applications submitted pursuant to the above requirements.  
             Provides that if a PERB regulation or rule conflicts with  
             this section, this section shall control.

          44.Requires any representation election to be a mail ballot  
             election.

          45.Establishes requirements for a pre-election conference within  
             10 days of receipt of an adequate petition or authorization  
             cards.  Requires the labor organization and the state to  
             engage in a good faith effort to reach a consent election  
             agreement, as specified.

          46.Prohibits other labor organizations from being allowed to  
             intervene in an election unless the intervening labor  
             organization shows at least 30% of the CommuniCal  
             interpreters desire to be represented exclusively by the  
             intervening labor organization and requires PERB to initiate  
             a mail ballot election.

          47.Requires PERB to determine all issues or matters in dispute.   
             Requires the determination and a directed election order or  
             consent election agreement between the labor organization and  
             the state to be made within seven days of the conference. 

          48.Requires PERB to initiate a mail ballot election within 10  
             days of the execution of a directed election order or consent  
             election agreement. Provides that the proposition receiving  
             the votes of a majority of all valid votes cast shall win the  
             election and if no option receives an absolute majority vote  
             of all valid votes cast, requires a runoff vote between the  
             two options receiving the highest number of votes to occur  
             within seven days.

          49.Requires a pre-election meeting between the labor  
             organization and the state 30 minutes prior to the mailing of  
             ballots for the purpose of resolving any final issues.

          50.Requires PERB to validate the ballots against the list of  

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             CommuniCal interpreters provided by DHCS.

          51.Requires discussions and collective bargaining between the  
             certified labor organization and the state and its designated  
             agents to commence within 30 days upon certification and at  
             any time thereafter upon request of the labor organization.

          52.Requires the state, through its designated agents to meet and  
             collectively bargain in good faith with representatives of a  
             certified labor organization and to fully consider the  
                                                      proposals made by the labor organization on behalf of  
             CommuniCal. 

          53.Provides that an agreement resulting from collective  
             bargaining be legally binding, reduced to writing, and  
             presented to the appropriate governing body in the form of a  
             binding agreement, resolution, bill, law, or other form  
             required for adoption.

          54.Prohibits anything in this bill from affecting the right of a  
             CommuniCal interpreter to authorize dues or a service fee  
             deduction from his or her reimbursement, provides for the  
             deduction of dues or services fees, fair share services fees,  
             and transmittal to the treasurer of the labor organization,  
             and requires that such fees and dues shall continue in effect  
             as long as the labor organization is the recognized  
             representative.

          55.Requires the state to meet and collectively bargain in good  
             faith, as defined. Prohibits the state from interfering with,  
             intimidating, restraining, coercing, or discriminating  
             against CommuniCal and requires a complaint alleging a  
             violation of this provision to be processed as an unfair  
             practice charge.

          56.Requires that execution of a valid written agreement between  
             the state and the certified labor organization to bar the  
             filing of an application or petition for certification of a  
             majority representative for the length of the agreement  
             except as otherwise provided in this bill.

          57.Prohibits the state from encouraging or discouraging  
             membership in a labor organization, or discriminating against  
             any CommuniCal interpreter.

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          58.Permits the state to adopt reasonable rules and regulations  
             after consultation in good faith with representatives of a  
             certified labor organization for administration of CommuniCal  
             interpreter labor relations under this bill.

          59.Provides, in the event of a judicial declaration declaring  
             any provision invalid, the remaining provisions remain in  
             force.

           Comments
           
          Data on language in California. According to the US 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." According to the California Health Interview  
          Survey, of the 3.5 million adults in the Medi-Cal program, about  
          281,000 (8.1%) had difficulty understanding their doctor and/or  
          needed another person to help them understand their doctor.   
          Among the parents of 1.8 million children under age 12 in the  
          Medi-Cal program, about 135,000 (7.4) had difficulty  
          understanding the child's doctor and/or needed another person's  
          help to understand the doctor. 

           Prior legislation
           
          AB 2392 (Perez) would have required DHCS to establish the  
          CommuniCal program to provide and reimburse for certified  
          medical interpretation services provided to Medi-Cal  
          beneficiaries who are LEP.  AB 2392 would have established the  
          State Personnel Board as the certifying body for the CommuniCal  
          CCMI, and would have required CommuniCal to be administered by a  
          patient-centered communication broker that is a third-party  
          administrator.  AB 2392 was moved to the Assembly inactive file  
          on concurrence.

          SB 442 (Calderon of 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.  Would  

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          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 the Governor. 

          SB 1405 (Soto of 2006) would have required DHCS to create the  
          Task Force on Reimbursement for Language Services, as specified,  
          to develop a mechanism for seeking federal matching funds from  
          CMS 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:

           One-time costs of $1.4 million to develop program guidelines,  
            seek necessary federal approvals, and develop billing systems  
            (50% General Fund, 50% federal funds).

           One-time costs of about $50,000 to develop regulations  
            relating to collective bargaining of translators by PERB  
            (General Fund).

           One-time costs of about $90,000 and ongoing costs of about  
            $50,000 to oversee an election by translators to choose a  
            collective bargaining agent by PERB (General Fund).

           Periodic costs up to $1 million for negotiating a memorandum  
            of understanding with the established bargaining unit and  
            overseeing the implementation by the Department of Human  
            Resources (General Fund).

           Ongoing costs of about $30 million per year to provide  

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            translation services in fee-for-service Medi-Cal (General Fund  
            and federal funds).

           Unknown costs in Medi-Cal managed care (General Fund and  
            federal funds).  Under existing law, health plans are required  
            to provide interpretation services, including managed care  
            plans that contract with the DHCS.  It is unclear whether this  
            bill's requirement to provide "certified medical  
            interpretation services" at reimbursement rates subject to  
            collective bargaining will increase costs for translation  
            services, above the costs already being incurred.

           The federal financial participation rate for the costs above  
            may vary.  For interpretive services provided to children and  
            their family members, the state can claim a 75% federal  
            financial participation rate.  However, those costs are only  
            eligible for a 75% federal cost share if they are billed as  
            administrative costs (as opposed to benefits).  For childless  
            adults, the rate is generally 50%.

           SUPPORT  :   (Verified  9/3/13)

          AFSCME
          Access California Services, Anaheim
          Asian Americans for Civil Rights and Equality
          Asian Pacific American Librarian Association, San Diego
          Asian Pacific Health Foundation, San Diego
          BaySide Community Center, San Diego
          Binational Center for the Development of Oaxacan Indigenous  
          Communities
          California Church IMPACT
          California Immigrant Policy Center
          California Pan-Ethnic Health Network
          Cambodian Buddhist Society of San Diego
          Campeonas de la Salud, San Jose
          Catholic Charities of Santa Clara County
          Central American Refugee Committee, Oakland
          Chinese Service Center, San Diego
          Coalition for the Human Rights of Immigrants, Los Angeles
          Dolores Huerta Foundation
          East Bay Refugee Forum
          East Bay Sanctuary Covenant, Berkeley
          Eastside Neighborhood Center, San Jose
          Fresno Interdenominational Refugee Ministries

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          Greater Logan Heights Community Partnership, San Diego
          Healing Hope, Fresno
          Health Access California
          Hmong Women's Heritage Association, Sacramento
          Horn of Africa Community, San Diego
          Interpreting for California
          Khmer Girls in Action, Long Beach
          Korean American Senior Association of San Diego County
          Korean Community Services, Buena Park
          La Maestra Community Health Centers, San Diego
          Lao Community Action Network, Sacramento
          Latino Coalition for a Healthy California
          Latino Democrat Club
          Little Saigon Foundation, San Diego
          Los Angeles County Federation of Labor
          Low-Income Self-Help Center
          Mid-City Community Advocacy Network
          National Association for the Advancement of Colored People, San  
          Diego
          National Association of Social Workers, California Chapter
          National Hmong American Farmers, Fresno
          Operation Samahan, National City
          Planned Parenthood Affiliates of CA
          Russian Orthodox Church, San Diego
          San Diego and Imperial Counties Labor Council AFL-CIO
          San Diego LGBT Pride
          San Diego Vietnamese Senior Club, San Diego
          Services, Immigrants' Rights and Education Network, San Jose
          Solami Family Services, San Diego
          Somos Mayfair
          Southern Sudanese Community Center, San Diego
          St. John's Wellness Center, Los Angeles
          Street Level Health Project, Oakland
          The Cambodian Family, Santa Ana
          Transnational Institute for Grassroots Research and Action
          United Domestic Workers of America/AFSCME Local 3930
          Viet-CARE, Westminster
          Vietnamese Community of San Diego
          Wat Lao Buddhavam of San Diego

           OPPOSITION  :    (Verified  9/3/13)

          National Right to Work Committee


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           ARGUMENTS IN SUPPORT  :    The California Pan-Ethnic Health  
          Network writes that California's population is one of the most  
          diverse in the country with over 100 different languages spoken  
          and an estimated 6 to 7 million Californians LEP. Barriers to  
          communication in the health care setting can result in increased  
          risk of misdiagnoses and misunderstandings, resulting in lower  
          quality care and reduced adherence to medication. The American  
          Federation of State, County and Municipal Employees (AFSCME)  
          argue that communication is critical to quality of care and  
          cultural competency in our state's Medicaid program.  With the  
          expansion of Medi-Cal and the exchange market under the ACA, the  
          state has a clear opportunity to create an interpreters program  
          that will allow patients and providers to clearly communicate  
          with each other.  Health Access California maintains that  
          building a strong workforce of certified interpreters is crucial  
          to adequately serving the hundreds of thousands of LEP  
          Californians who will be coming into coverage in the new world  
          of health reform. This is an important measure that will help  
          ensure that newly insured Californians can truly benefit from  
          their new access to care.   

           ARGUMENTS IN OPPOSITION  :    The National Right to Work Committee  
          states that this bill would grant union bosses monopoly  
          bargaining powers over virtually all CCMIs operating under the  
          program, stripping every one of these individuals of the  
          fundamental right to negotiate for themselves.  If this bill  
          passes, independent contractors would be forced to union boss  
          representation and would then have union dues stripped from  
          their compensation and transferred straight to the treasury of  
          the Big Labor representative they didn't want.  
           
           ASSEMBLY FLOOR  :  55-23, 5/29/13
          AYES:  Achadjian, Alejo, Ammiano, Atkins, Bloom, Blumenfield,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Chesbro, Cooley, Daly, Dickinson,  
            Eggman, Fong, Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez,  
            Gordon, Gray, Hall, Roger Hernández, Jones-Sawyer, Levine,  
            Lowenthal, Medina, Mitchell, Mullin, Muratsuchi, Nazarian,  
            Nestande, Pan, Perea, V. Manuel Pérez, Quirk, Quirk-Silva,  
            Rendon, Salas, Skinner, Stone, Ting, Weber, Wieckowski,  
            Williams, Yamada, John A. Pérez
          NOES:  Allen, Bigelow, Chávez, Conway, Dahle, Donnelly, Beth  
            Gaines, Gorell, 
          Grove, Hagman, Harkey, Jones, Linder, Logue, Maienschein,  

                                                                CONTINUED





                                                                    AB 1263
                                                                     Page  
          18

            Mansoor, Melendez, Morrell, Olsen, Patterson, Wagner, Waldron,  
            Wilk
          NO VOTE RECORDED:  Holden, Vacancy


          JL:d  9/3/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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