BILL ANALYSIS                                                                                                                                                                                                    Ó






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       AB 2325
          AUTHOR:        John A. Pérez
          AMENDED:       June 12, 2014
          HEARING DATE:  June 18, 2014
          CONSULTANT:    Bain

          SUBJECT  : Medi-Cal: CommuniCal.
           
          SUMMARY  : 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, establishes a certification process  
          and registry of CommuniCal interpreters at DHCS, and grants  
          CommuniCal interpreters collective bargaining rights with the  
          state.


          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.

          
          Existing federal law:

                                                         Continued---



          AB 2325 | Page 2




          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 was previously known as the Healthy Families  
            Program in California; these children are now enrolled in  
            Medi-Cal).


          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.


          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  
            limited English proficient (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, commencing July  
            1, 2015. Defines an "interpreter" as an oral interpreter who  
            is fluent in English and in a necessary second language, who  
            can accurately speak, read, and readily interpret the  
            necessary second language, but does not include a sign  
            language interpreter or transliterator.



          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, an entity entering into a  
            Medi-Cal provider agreement, or a Medi-Cal managed care  
            contract with the state to utilize CommuniCal to provide  
            medical interpreter services to Medi-Cal beneficiaries.




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          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 to pursue all available sources of federal  
            funding to establish and operate CommuniCal and to seek any  
            federal approvals necessary to implement specified provisions  
            of this bill, in consultation with CAC.


          7.Requires CommuniCal to include in-person, telephonic, and  
            video medical interpretation services by a CommuniCal  
            interpreter. 
           

          8.Requires that in-person interpreter services be the preferred  
            mode of interpretation in the following instances whenever  
            possible:



                  a.        Family meetings regarding medical care;

                  b.        Medical encounters involving difficult or  
                    agitated patients;

                  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.




          AB 2325 | Page 4







          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, and requires  
            the broker to be responsible for the following duties: 



                  a.        Registering CommuniCal interpreters with  
                    Medi-Cal;

                  b.        Verifying the eligibility of an interpreter to  
                    provide 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;

                  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 appropriate by the  
                    CAC.





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          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 that only interpreters certified or authorized by  
            DHCS under this bill as CommuniCal interpreters are allowed to  
            participate in CommuniCal.



          13.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  
                    direction;

                  c.        Preparing and submitting documentation to the  
                    broker in support of time worked 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;




          AB 2325 | Page 6





                  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.



          16.Requires the base reimbursement rate for CommuniCal  
            interpreters to be subject to collective bargaining. Permits  
            reimbursement to be adjusted for factors, including but not  
            limited to, geography, language spoken, availability of  
            interpreters, level of certification, travel time, or other  
            factors, in consultation with the CAC.


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


          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. Requires  
            that moneys in the Fund are to be used solely to fund the  
            CommuniCal program.


           Certification and Registration of CommuniCal Medical  
          Interpreters

           19.  Requires that DHCS 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  




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                    process, in consultation with CAC, to test and certify  
                    the competency of medical interpreters by September 1,  
                    2015.



          1.Requires that, as a condition of certification, an interpreter  
            to complete at least one of the following and specifies that  
            upon completing one of the following, the interpreter to 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, or hold a  
                    current interpreter's certification under specified  
                    provisions of existing law.



          21.  Requires DHCS to establish an alternate certification  
            process, beginning July 1, 2015, that authorizes CommuniCal  
            services to be provided by an interpreter of languages of  
            lesser diffusion or language for which a CCMI examination has  
            not been created. Requires DHCS, in consultation with CAC, to  
            authorize an interpreter to provide CommuniCal services if the  
            interpreter passes a screening test that includes both of the  
            following:


                  a.        A written component testing for specified  
                    knowledge, skills and abilities, including managing an  




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                    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.


          1.Requires, by July 1, 2015, 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.


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


          3.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 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.


          4.Specifies that an individual authorized under the provisional  
            requirements who does not subsequently become certified or  
            receive permanent authorization by December 31, 2017, is no  
            longer be authorized to provide CommuniCal services.






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          5.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. Requires the purpose of the fee to  
            cover the annual projected cost of carrying out the  
            DHCS-related CommuniCal provisions.


          6.Requires CommuniCal interpreters to pay a registry and  
            certification or authorization fee not to exceed the  
            reasonable costs, by July 1 of each year, in order to remain  
            on the registry.


          7.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  
            unavailable to work, does not submit an authorization or  
            renewal fee, or fails to meet the quality standards and  
            medical certification requirements.


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


          9.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, and create a list of those  
            languages where standards permit registration of the  
            interepreter.


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


          11.  Requires the CAC to include stakeholders that reflect the  
            diversity of the state in terms of race, ethnicity, gender,  




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            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.


          12.  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.


          13.  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

           14.  Requires only CommuniCal interpreters be represented by a  
            labor organization for the purposes of collective bargaining  
            as established by this bill. Defines a labor organization as  
            defined in a specified provision of the Internal Revenue Code  
            which has as its primary purpose the representation of public  
            service providers in their relations with state and other  
            public entities.



          36.  Requires CommuniCal interpreters to have the right to form,  
            join, and 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  




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            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 percent 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.


          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 percent of CommuniCal interpreters 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  




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            applications submitted pursuant to the above requirements.  
            Provides that if a PERB regulation or rule conflicts with 41)  
            and 42) above, 41) and 42) to 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 percent 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 wins 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.






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          50.  Requires PERB to validate the ballots against the list of  
            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  
            before any regulation is proposed, promulgated, set or  
            otherwise presented concerning any of the purposes for  
            collective bargaining. 


          53.  Requires any agreement resulting from collective bargaining  
            to be legally binding, 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.


          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, services fees or fair share service fees,  
            and transmittal to the treasurer of the labor organization,  
            and requires that such fees and dues to 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.




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


          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.



           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee:


          1. One-time costs likely in the hundreds of thousands of dollars  
             to develop program guidelines, seek necessary federal  
             approvals, and contract for CommuniCal administration;

          2. Ongoing costs potentially exceeding several million dollars  
             per year to provide interpreter services in FFS Medi-Cal.   
             The actual cost of this voluntary program will depend on the  
             demand level for interpreter services not already being met;

          3. Minor costs in Medi-Cal managed care. Under current law,  
             health plans are required to provide interpretation services,  
             including MCP that contract with DHCS. It is unclear whether  
             the bill's provisions would increase costs above what is  
             already incurred;

          4. Potential one-time costs of $139,000 and ongoing annual costs  
             of $53,000 per year to PERB; and,

          5. State General Fund (GF) costs would be offset by an enhanced  
             federal match of 75 percent, pursuant to a 2010 federal  
             guidance, rather than the 50 percent match generally  
             attributable for administrative costs.  





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           PRIOR VOTES  :  
          Assembly Health:                             13- 6
          Assembly Public Employees, Retirement, and Social Security:5- 1
          Assembly Appropriations:                     12- 5
          Assembly Floor:                              53- 25
           
          COMMENTS  :  
           1.Author's statement.  According to the author, more than 40  
            percent of Californians speak a language other than English at  
            home. Almost seven 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. Today, language  
            assistance in medical settings is provided by trained or  
            untrained staff or in an informal manner by family members or  
            friends. 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.

          2.Enhanced federal matching funds for translation and  
            interpretation services. The    Children's Health Insurance  
            Program Reauthorization Act (CHIPRA), Public Law 111-3,  
            enacted on February 4, 2009, contains provisions that affect  
            both 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 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 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 is typically  
            50 percent in California for Medi-Cal and 65 percent for the  
            Healthy Families Program). 




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          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 federal match for translation or interpretation  
            services differs for Medicaid and CHIP. For Medicaid, the  
            increased match is 75 percent of allowable expenditures. For  
            CHIP, the increased match is 75 percent, or the state's  
            enhanced FMAP plus five percent, whichever is higher (in  
            California, it would be 75 percent). However, the increased  
            federal match 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 percent for Medi-Cal and 65  
            percent for CHIP). In addition, the expenditures that qualify  
            for the increased match under CHIP are subject to the 10  
            percent cap on administrative expenditures.
          

          3.Federal anti-discrimination law. 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. 
          

          4.OCR policy guidance. 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 access to their  




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            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 "one size fits all" 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.


          5.Data on language in California. According to the US Census  
            Bureau 2010 American Community Survey, 43.7 percent of  
            Californians over the age of 5 speak a language other than  
            English, and 19.9 percent of Californians over the age of 5  
            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 percent) 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 percent) had difficulty understanding the  
            child's doctor and/or needed another person's help to  
            understand the doctor. 
          

          6.Prior legislation. AB 1263 (Pérez) was similar to this bill.  
            AB 1263 was vetoed by Governor Brown. In his veto message,  
            Governor Brown stated California has embarked on an  




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            unprecedented expansion to add more than a million people to  
            our Medi-Cal program. Given the challenges and the many  
            unknowns the state faces in this endeavor, I don't believe it  
            would be wise to introduce yet another complex element.



            AB 2392 (Pérez) 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 (SPB) as the certifying body for the  
            CommuniCal certified medical interpreter (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. 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 the Governor. 
          

            SB 1405 (Soto), of 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 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.






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          19


          

            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.

          7.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.

          8.Opposition. The National Right to Work Committee (NRWC) 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. NRWC argues these  
            individuals would be subject to a so-called "card check"  
            recognition and could be forced under union control by the  
            authorization of merely 30 percent of CCMIs in the state. If  
            this bill passes, NRWC argues 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.

           SUPPORT AND OPPOSITION  :
          Support:  American Federation of State, County and Municipal  
                    Employees, AFL-CIO
                    California Communities United Institute
                    California Immigrant Policy Center
                    California Medical Association
                       California Pan-Ethnic Health Network
                    City and County of San Francisco
                    Congress of California Seniors
                    Health Access California




          AB 2325 | Page 20




                    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

          Oppose:   National Right to Work Committee



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