BILL ANALYSIS Ó
AB 1263
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1263 (John A. Pérez)
As Amended July 10, 2013
Majority vote
-----------------------------------------------------------------
|ASSEMBLY: |55-23|(May 29, 2013) |SENATE: |25-9 |(September 11, |
| | | | | |2013) |
-----------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY : Establishes the Medi-Cal Patient Centered Communication
(CommuniCal) program at the Department of Health Care Services
(DHCS) to provide and reimburse for certified medical interpretation
services to limited English proficient (LEP) Medi-Cal enrollees.
Establishes a certification process and registry of CommuniCal
medical interpreters (CCMI) at DHCS and grants collective bargaining
rights with the state.
The Senate amendments
1)Revise the certifying body to be DHCS instead of the California
Department of Human Resources (CalHR).
2)Require DHCS to, by September 1, 2014, in consultation with the
Community Advisory Committee, approve an examination and
certification process to test and certify the competency of
medical interpreters and deletes the requirement that CalHR select
an examination within 120 days of implementation of this bill.
3)Require DHCS to establish a Community Advisory Committee as
specified.
4)Require DHCS to develop, monitor, and evaluate interpreter
competency, qualifications, training, certification, and
continuing education requirements for medical interpreters.
5)Add the following options as a condition of certification, in
addition to an examination administered by a nonprofit
organization:
a) Passes an examination developed by a state-established
language testing and certification program with a written and
oral component that meets specified standards;
AB 1263
Page 2
b) Achieves the designation of Certified Healthcare Interpreter
from the Certification Commission for Healthcare Interpreters
(CCHI);
c) Achieves the designation of Certified Medical Interpreter
from the National Board of Certification for Medical
Interpreters (NBCMI); or,
d) Holds a current interpreter's certification under existing
provisions.
6)Add a process for authorizing CommuniCal services to be provided
by an interpreter of languages of lesser diffusion or languages
for which a CCCMI examination has not been created.
7)Revise requirement for a provisional authorization that allow
interpreters to be authorized prior to the development of the full
testing and certification program at DHCS and requires the person
meet the full standards by December 31, 2016.
8)Delete the requirement that the base reimbursement rate be set at
$60 per hour and instead provide that it be subject to collective
bargaining.
9)Make other technical and clarifying changes.
FISCAL EFFECT : According to the Senate Appropriations Committee:
1)One-time costs of $1.4 million to develop program guidelines, seek
necessary federal approvals, and develop billing systems (50%
General Fund (GF), 50% federal funds).
2)One-time costs of about $50,000 to develop regulations relating to
collective bargaining of translators by PERB (GF).
3)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 (GF).
4)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 (GF).
5)Ongoing costs of about $30 million per year to provide translation
AB 1263
Page 3
services in fee-for-service Medi-Cal (GF and federal funds).
6)Unknown costs in Medi-Cal managed care (GF and federal funds).
Under current law, health plans are required to provide
interpretation services, including managed care plans that
contract with DHCS. It is unclear whether the bill's requirement
to provide "certified medical interpretation services" at
reimbursement rates subject to collective bargaining would
increase costs for translation services, above the costs already
being incurred.
7)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%.
COMMENTS : According to the author, this bill is to establish a
program to provide and reimburse for medical interpretation services
to LEP Medi-Cal enrollees and to allow for collective bargaining for
certified medical interpreters. The author cites data that show
more than 40% of Californians speak a language other than English at
home. In addition, almost seven million Californians are estimated
to speak English "less than very well." Other research finds that
language barriers can contribute to inadequate patient evaluation
and diagnosis, lack of appropriate and/or timely treatment, or other
medical errors that can jeopardize patient safety and lead to
unnecessary procedures and costs. The author argues that today,
language assistance in medical settings is provided by trained or
untrained staff or in an informal manner by family members or
friends. In conclusion, the author states that California has an
opportunity to develop a more comprehensive language assistance
program by seeking additional federal funding for medical
interpreter services in the Medi-Cal program.
The Children's Health Insurance Program Reauthorization Act (CHIPRA)
of 2009 contains provisions that affect both the federal Children's
Health Insurance Program (CHIP) and Medicaid. In July 2010, the
Centers for Medicare and Medicaid Services provided guidance on the
implementation of the provisions of CHIPRA relating to increased
administrative funding for translation or interpretation services
provided under CHIP and Medicaid. For Medicaid, increased federal
funding for translation and interpretation services available under
CHIPRA is limited to children and family members of those children.
AB 1263
Page 4
For CHIP, increased federal funding for translation and
interpretation services is not just limited to children, and
includes pregnant women receiving CHIP coverage. Prior to CHIPRA,
states could claim federal matching funds for translation or
interpretation costs as either an administration expense or as a
medical assistance-related expense, and were reimbursed at the
standard Federal Medical Assistance Percentage (regular FMAP rate
which in California is typically 50% for Medi-Cal and 65% for the
Healthy Families Program (HFP)). Although children in the HFP are
currently transitioning to Medi-Cal, it is still considered a CHIP
program for FMAP purposes. CHIPRA provides increased federal
matching funding for translation or interpretation services provided
to eligible individuals for whom English is not their primary
language. The increased FMAP for translation or interpretation
services differs for Medicaid and CHIP. For Medicaid, the increased
match is 75% of allowable expenditures. For CHIP, the increased
match is 75%, or the State's enhanced FMAP plus 5%, whichever is
higher (in California, it would be 75%). However, the increased
FMAP is only available for eligible expenditures claimed for
administration of the Medicaid or CHIP plan, and not expenditures
claimed for benefits (which are matched at the State's usual FMAP
rate of 50% for Medi-Cal and 65% for CHIP). In addition, the
expenditures that qualify for the increased match under CHIP are
subject to the 10% cap on administrative expenditures.
Supporters such as Interpreting for California, The Low-Income
Self-Help Center and Catholic Charities of Santa Clara County, write
that this bill address the need for interpreters in Medi-Cal as the
state will experience greater demand when 35% of the newly eligible
enrollees speak English less than well. These supporters state that
this bill will make it possible for the 2.5 million Medi-Cal
enrollees who are LEP to communicate with healthcare providers,
reducing medical errors and improving the standard of care by
providing access to trained interpreters. Other supporters such as
The American Federation of State, County and Municipal Employees,
AFL-CIO and Somos Mayfair writes in support that, with the expansion
of Medi-Cal and the implementation of the California Health Benefit
Exchange under federal health care reform, the State has a clear
opportunity to create an interpreters' program that will allow
patients and providers to clearly communicate with each other.
According to these supporters, in 2003 California passed the
strongest law in the country requiring all private health plans to
provide language assistance services to LEP individuals beginning in
2009. However, the supporters assert, patient interpretation needs
remain unmet despite these laws and explicit policy directives to
AB 1263
Page 5
Medi-Cal managed care plans to provide interpreter services.
According to the Transnational Institute for Grassroots Research and
Action (TIGRA), LEP Californians frequently reported problems
related to their experience of care. TIGRA asserts that LEP
enrollees of the state's seven largest health plans were more likely
than English proficient enrollees to report problems understanding
their physician (1.2% versus 2.6%) and believe they would have
received better care if they were of a different race/ethnicity (14%
versus 3.2%).
Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097
FN:
0002235