BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2325
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          Date of Hearing:   April 23, 2014

            ASSEMBLY COMMITTEE ON PUBLIC EMPLOYEES, RETIREMENT AND SOCIAL  
                                      SECURITY
                                  Rob Bonta, Chair
                 AB 2325 (Perez) - As Introduced:  February 21, 2014
           
          SUBJECT  :   Medi-Cal: CommuniCal.

           SUMMARY  :   Requires the California 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  
          interpreters at DHCS and grants CommuniCal interpreters  
          collective bargaining rights with the state.  Specifically,  this  
          bill  :  

          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, beginning July 1, 2015, CommuniCal to offer medical  
            interpretation services to Medi-Cal providers provide services  
            on either a fee-for-service or managed care basis.

          3)Requires DHCS to adopt policies to prohibit duplicate payments  
            to CommuniCal interpreters and Medi-Cal managed care  
            organizations (MCOs) for services provided to their Medi-Cal  
            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 MCOs and their  
            subcontractors to include provisions describing access to  
            CommuniCal medical interpreter services.

          6)Requires DHCS to pursue all available sources of federal  
            funding to establish and operate CommuniCal and to seek any  








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            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)Requires a Community Advisory Committee (CAC) be established  
            to make recommendations on interpreter certification and  
            services and to assist with developing standards and  
            requirements.

          9)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.

          10)Specifies the instances in which in-person interpreter  
            services are to be the preferred mode of interpretation,  
            whenever possible. 

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

          12)Requires DHCS to create and administer a competitive Request  
            for Proposals for the communication broker and specifies the  
            duties for which the communication broker is responsible.

          13)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.

          14)Requires interpreters certified or authorized under the  
            requirements contained in this bill can participate in  
            CommuniCal.

          15)Requires CommuniCal interpreters to be responsible for all of  
            the following:

             a)   Performing interpreter services independent of other  
               policies, rules, or procedures;

             b)   Performing interpreter services independent of  








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               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.

          16)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.

          17)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 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.

          18)Establishes the base reimbursement rate for CommuniCal  
            interpreters to be subject to collective bargaining.  Allows  
            reimbursement 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.

          19)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.

          20)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 for the  
            CommuniCal program.








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          Certification and Registration of CommuniCal Medical  
          Interpreters:
          
          1)Provides that 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; and,

             b)   Approve an examination and certification process, in  
               consultation with CAC, to test and certify the competency  
               of medical interpreters by September 1, 2015.

          2)Requires DHCS to maintain a list of authorized CommuniCal  
            interpreters called the CommuniCal Medical Interpreter  
            Registry (Registry).

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

             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; or,

             d)   Hold a current interpreter's certification as a court  
               interpreter.

          4)Requires DHCS to authorize CommuniCal services to be provided  
            by an interpreter of less common languages or languages for  








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            which a CCMI examination has not been created, and requires  
            DHCS to establish a test, 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 or her linguistic and interpreting skills.

          5)Requires, by July 1, 2015, an interpreter to be CCMI certified  
            or authorized by DHCS to provide CommuniCal services.

          6)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, 2015, 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 United 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.

          7)Specifies that an individual authorized under the provisional  
            requirements, who does not subsequently become certified or  
            receive permanent authorization by January 1, 2017, is no  
            longer be authorized to provide CommuniCal services.

          8)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 for certification,  
            authorization, and listing on the Registry that does not  
            exceed the reasonable costs.

          9)Requires CommuniCal interpreters to pay a Registry and  








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            certification or authorization fee, by July 1 of each year, in  
            order to remain on the Registry.

          10)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.

          11)Waives, for the 2014-15 fiscal year only, the fee for  
            certification and listing on the Registry.

          12)Requires DHCS to adopt quality standards and medical  
            interpretation certification requirements through regulations,  
            which address maintaining patient confidentiality and  
            familiarity or experience working with medical terminology,  
            testing requirements and languages where standards permit  
            interpret certification.

          13)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.

          14)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:
          
          1)Authorizes CommuniCal interpreters to be represented by a  
            labor organization for the purposes of collective bargaining.   
            Applies the state action antitrust exemption and state and  
            federal antitrust laws to the activities of CommuniCal  
            interpreters and their exclusive representatives.

          2)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  








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            state of California on matters of mutual concern, including  
            but not limited to, a list of specific provisions, including: 

             a)   Development, maintenance and application of the  
               registry; 

             b)   The setting of reimbursements and rates for state-funded  
               medical interpreter programs;

             c)   The allocation, process, procedure, distribution,  
               methodology, and manner of payment of interpreter  
               reimbursements and rates:

             d)   Professional development, certification and training,  
               recruitment and retention of interpreters, and language  
               access quality standards;

             e)   Dispute resolution mechanisms binding on third-party  
               administrators and their subcontractors;

             f)   Mechanisms and funding to improve interpreter programs  
               and their stability;

             g)   Scheduling systems of interpreter services;

             h)   Mediums and modes of delivery of interpretation  
               services; 

             i)   The improvement and expansion of quality medical  
               interpretation services; and,

             j)   The collection and disbursement of dues or fees to the  
               exclusive representative.

          3)Specifies that these provisions do not apply to work performed  
            as an employee of an employer.

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

          5)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.








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          6)Defines labor organization for purpose of these provisions.

          7)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 five days of the request.

          8)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 labor organization is currently certified as the  
            exclusive representative, to certify and grant exclusive  
            representation to the labor organization.  Requires, if less  
            than a majority but at least 30% of CommuniCal interpreters  
            desire to be represented exclusively by that labor  
            organization, the matter to be set for a mail ballot election  
            administered by PERB.

          9)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.

          10)Requires any representation election to be a mail ballot  
            election.

          11)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.  Specifies that the state shall be  
            represented by the Department of Human Resources (CalHR) and  
            DHCS.

          12)Prohibits other labor organizations from being allowed to  
            intervene in an election unless, prior to the pre-election  
            conference, the intervening labor organization shows at least  
            30% of the CommuniCal interpreters desire to be represented  
            exclusively by the intervening labor organization.

          13)Requires PERB to determine all issues or matters in dispute  








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            and 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.

          14)Requires PERB to initiate a mail ballot election within 10  
            days of the execution of a directed election order or consent  
            election agreement.  Requires the election to provide for an  
            affirmative vote for employee representation by the  
            petitioning employee organization.  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.

          15)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 and  
            requires the election to be conducted in accordance with the  
            procedures established in the consent election agreement or  
            directed election order.

          16)Requires PERB to determine the date and time ballots must be  
            received by for tabulation, which cannot be sooner than 10  
            days or more than 20 days from the date voting begins.

          17)Requires PERB to validate the ballots against the list of  
            CommuniCal interpreters provided by DHCS.

          18)Specifies that the labor organization certified by PERB as  
            receiving a majority of the valid votes cast is the exclusive  
            representative of all eligible CommuniCal interpreters and  
            requires all CommuniCal interpreters eligible for bargaining  
            to be part of the bargaining unit and represented by the  
            certified labor organization.

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

          20)Requires the state and its designated agents to meet with the  
            certified labor organization before any collective bargaining  
            regulation is proposed, promulgated, set or otherwise  








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            presented.

          21)Requires any agreement resulting from collective bargaining  
            be legally binding upon the state, committed to writing, and  
            presented to the appropriate administrative, legislative, or  
            other governing body in the form of a binding agreement,  
            resolution, bill, law, or other form required for adoption.   
            Specifies that this provision does not prevent the parties  
            from agreeing to and implementing provisions of an agreement  
            which have received legislative approval or do not require  
            legislative action.

          22)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.

          23)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 interpreters and requires a complaint alleging a  
            violation of this provision to be processed as an unfair  
            practice charge by PERB, as specified.

          24)Specifies that the execution of a valid written agreement  
            between the state and the certified labor organization shall  
            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.  Prohibits an  
            application or petition for certification from being valid  
            within one year of any prior certification.

          25)Prohibits the state from encouraging or discouraging  
            membership in a labor organization, or discriminating against  
            any CommuniCal interpreter.  Prohibits a CommuniCal  
            interpreter from being subject to punitive action, or  
            threatened with punitive action, for exercising lawful action  
            as an elected, appointed, or recognized representative of a  
            bargaining unit.

          26)Permits the state to adopt reasonable rules and regulations  








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            after consultation in good faith with representatives of a  
            certified labor organization for administration of CommuniCal  
            interpreter labor relations under this bill.

           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 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 state and local agencies providing services to a  
            substantial number of non-English speaking people to provide  
            bilingual services.

          5)Establishes PERB as a quasi-judicial administrative agency  
            charged with administering the collective bargaining statutes  
            covering employees of California's public schools, colleges,  
            and universities, employees of the State of California,  
            employees of California local public agencies (cities,  
            counties and special districts), trial court employees and  








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            supervisory employees of the Los Angeles County Metropolitan  
            Transportation Authority.

           FISCAL EFFECT  :   Unknown.

           COMMENTS  :   According to the author, more than 40% of  
          Californians speak a language other than English at home.   
          Almost 7 million Californians are estimated to speak English  
          "less than very well."  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 notes, often  
          language assistance in medical settings is provided by trained  
          or untrained staff or in an informal manner by family members or  
          friends.  The author argues, 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 following information was provided to this Committee by the  
          Assembly Committee on Health:  

               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.

               Federal Matching Funds:  The Children's Health Insurance  
               Program Reauthorization Act (CHIPRA), Public Law 111-3,  
               enacted on February 4, 2009, contains provisions that  
               affect two important federal programs providing funding to  
               states for healthcare program, CHIP and Medicaid.  In July  
               2010, the Centers for Medicare and Medicaid Services (CMS)  
               provided guidance on the implementation of Section 201(b)  
               of CHIPRA, which provides increased administrative funding  
               for translation or interpretation services provided under  








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               CHIP and Medicaid.  Under Medicaid, increased federal  
               funding for translation and interpretation services  
               available under CHIPRA is limited to children and family  
               members of those children.  Under CHIP, increased federal  
               funding for translation and interpretation services  
               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 is  
               typically 50% in California for Medi-Cal and 65% for those  
               receiving services funded by CHIP).  Both CHIPRA and  
               Medicaid provide enhanced federal match of 75% for  
               translation services.


               Federal Guidance:  Title VI of the Civil Rights Act of 1964  
               and its implementing regulations provide that no person  
               shall be subject to discrimination on the basis of race,  
               color, or national origin under any program or activity  
               that receives federal financial assistance.  Each federal  
               department has a civil rights office that is charged with  
               ensuring that its programs are free of discrimination.  The  
               federal Department of Health and Human Services (HHS)  
               Office for Civil Rights (OCR) responsibilities include  
               enforcing the Civil Rights Act, the Americans with  
               Disabilities Act, and the Age Discrimination Act.  Any  
               organization or individual who receives monies through  
               HHS-health departments, health plans, social service  
               agencies, nonprofits, hospitals, clinics, and physicians-is  
               subject to OCR oversight.  The OCR has the authority to  
               investigate complaints related to linguistic barriers, to  
               initiate its own reviews, and to withhold federal funds for  
               noncompliance.

               CMS issued a State Medicaid Director letter on August 31,  
               2000, that informed states of the policy guidance that the  
               OCR had issued on the prohibition against national origin  
               discrimination as it affects persons with LEP, pursuant to  
               Title VI of the Civil Rights Act of 1964.

               OCR Policy Guidance requires recipients of federal  
               assistance to take reasonable steps to ensure meaningful  








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               access to their programs and activities by LEP persons.   
               The guidance explains that the obligation to provide  
               meaningful access is fact-dependent and starts with an  
               individualized assessment that balances four factors: a)  
               the number or proportion of LEP persons eligible to be  
               served or likely to be encountered by the program or  
               grantee; b) the frequency with which LEP individuals come  
               into contact with the program; c) the nature and importance  
               of the program, activity or service provided by the  
               grantee/recipient to its beneficiaries; and, d) the  
               resources available to the grantee/recipient and the costs  
               of interpretation/ translation services.  CMS states there  
               is no set solution for Title VI compliance with respect to  
               LEP persons, and what constitutes reasonable steps for  
               large providers may not be reasonable where small providers  
               are concerned.

          Support:  The American Federation of State, County and Municipal  
          Employees speaking in support of the measure, 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.  The United Domestic Workers state by expanding patient  
          access to trained medical interpreters the state will improve  
          the quality and coordination of care in our state's Medi-Cal  
          program.  The City and County of San Francisco note research has  
          found that language barriers can contribute to inadequate  
          patient evaluation and diagnosis; lack of appropriate and or  
          timely treatment and other medical errors that jeopardize  
          patients' safety and lead to unnecessary procedures and costs.   
          The Western Center on Law and Poverty supports this bill because  
          the implementation of the CommuniCal program would create a  
          system that provides high-quality language assistance to  
          beneficiaries.  Planned Parenthood Affiliates of California note  
          that language assistance is often done in an informal manner by  
          friends or family members, including children of these patients  
          and these informal translators are often limited in their  
          ability to accurately translate important and sensitive medical  
          information.

          Support if Amended:  The California Healthcare Interpreting  
          Association supports the bill because it would set minimum  
          standards for healthcare interpreting and provide federal  








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          funding streams and payment mechanisms for providing language  
          assistance in Medi-Cal and other government programs.  They are  
          concerned the bill emphasizes in-person interpreting, an  
          approach they argue may be unworkable at certain settings based  
          on frequency of need and the language required.  In addition,  
          the association argues staff interpreters may be more  
          cost-effective than hiring outside contractors and these staff  
          interpreters may already be part of a bargaining unit.

          Opposition:  The National Right to Work Committee argues this  
          bill will grant union bosses monopoly bargaining powers over  
          virtually all interpreters 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 accept 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.

          
          Prior Legislation:

          AB 1263 (John A. Pérez) of 2013 was substantially similar to  
          this bill.  AB 1263 was vetoed by Governor Brown who expressed  
          concern given the substantial growth in Medi-Cal as a result of  
          health care reform, he did not believe would be wise to start a  
          new program.

          AB 2392 (John A. Pérez) of 2012 was substantially similar to  
          this bill with the exception of naming the State Personnel Board  
          as the certifying body for the CommuniCal program.  AB 2392 was  
          held on the inactive file when the bill was in the Assembly for  
          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  
          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  
          who said these types of policies should be developed at the  








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                                                                  Page  16

          local level.

          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 California Department  
          of Insurance to adopt regulations to ensure enrollees have  
          access to language assistance in obtaining health care services.

          Double Referred:  This bill has been double-referred to the  
          Assembly Health Committee where it was heard on April 8, 2014,  
          and passed out of the Committee on a vote of 13 to 6.  

           















          REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          American Academy of Pediatrics
          American Federation of State, County and Municipal Employees,  








                                                                  AB 2325
                                                                  Page  17

          AFL-CIO
          California Communities United Institute
          California Medical Association
          California Pan-Ethnic Health Network
          City and County of San Francisco
          Congress of California Seniors
          Health Access California
          National Association of Social Workers, California Chapter
          Planned Parenthood Affiliates of California
          United Domestic Workers of America, AFSCME Local 3930
          Western Center on Law and Poverty


           Opposition 
           
          National Right to Work Committee
           
          Analysis Prepared by  :    Karon Green / P.E., R. & S.S. / (916)  
          319-3957