BILL ANALYSIS Ó
SB 353
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SENATE THIRD READING
SB 353 (Lieu)
As Amended September 4, 2013
Majority vote
SENATE VOTE :26-11
HEALTH 13-5 APPROPRIATIONS 12-5
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Chesbro, | |Bradford, |
| |Gomez, | |Ian Calderon, Campos, |
| |Roger Hernández, | |Eggman, Gomez, Hall, |
| |Lowenthal, Mitchell, | |Holden, Pan, Quirk, Weber |
| |Nazarian, V. Manuel | | |
| |Pérez, Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Maienschein, Mansoor, |Nays:|Harkey, Bigelow, |
| |Nestande, Wagner, Wilk | |Donnelly, Linder, Wagner |
| | | | |
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SUMMARY : Requires the translation of specified documents by
trained and qualified translators when a health care service
plan, regulated by the Department of Managed Health Care (DMHC),
insurer, regulated by the California Department of Insurance
(CDI), or any other person or business markets or advertises
health insurance products in the individual or small group
markets in a non-English language that is not a threshold
language under existing law. Specifically, this bill :
1)Requires translation of the following documents using a
trained and qualified translator:
a) Welcome letters or notices of initial coverage, if
provided;
b) Applications for enrollment and any information
pertinent to eligibility or participation;
c) Notices advising limited-English-proficient (LEP)
persons of the availability of no-cost translation and
interpretation services;
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d) Notices pertaining to the right to file a grievance and
instructions on how an enrollee may file a grievance; and,
e) Uniform summaries of benefits of coverage required by
the Patient Protection and Affordable Care Act (ACA) and
any rules or regulations promulgated thereunder.
2)Requires any specialized plan or insurer that offers an
essential health benefit (EHB), as defined, but not any
specialized plan or insurer that does not offer an EHB, to
also translate the documents in 1) above when marketing or
advertising in non-English languages.
EXISTING LAW :
1)Requires the translation of vital documents as follows:
a) Requires a health care service plan or insurer with an
enrollment of one million or more to translate vital
documents into the top two languages other than English, as
determined by the needs assessment, as required by existing
law and any additional languages when 0.75% or 15,000 of
the enrollee population, whichever number is less,
excluding Medi-Cal enrollment and treating Healthy Families
program (HFP) enrollment separately indicates a preference
for written materials in that language;
b) Requires a health care service plan or insurer with an
enrollment of 300,000 or more but less than one million to
translate vital documents into the top one language other
than English as determined by the needs assessment and any
additional languages when 1% or 6,000 of the enrollee
population, whichever number is less, excluding Medi-Cal
enrollment and treating HFP enrollment separately indicates
a preference for written materials in that language; and,
c) Requires a health care service plan or insurer with an
enrollment of less than 300,000 to translate vital
documents into a language other than English when 3,000 or
more or 5% of the enrollee population, whichever number is
less, excluding Medi-Cal enrollment and treating HFP
enrollment separately indicates a preference for written
materials in that language.
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2)Specifies as vital documents that are required to be
translated all of the following:
a) Applications;
b) Consent forms;
c) Letters containing important information regarding
eligibility and participation criteria;
d) Notices pertaining to the denial, reduction,
modification, or termination of services and benefits, and
the right to file a grievance or appeal; and,
e) Notices advising LEP persons of the availability of free
language assistance and other outreach materials that are
provided to enrollees.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time costs of about $250,000 for the adoption of
regulations by DMHC (Managed Care Fund). One-time costs of
$70,000 for review of health plan contracts and other documents
by the DMHC to ensure that health plan policies comply with this
bill's requirements (Managed Care Fund). Potential ongoing
enforcement costs in the tens of thousands annually to CDI and
DMHC, based on complaints for violations of this bill's
requirements by health plans (Insurance Fund and Managed Care
Fund). One-time costs of about $150,000 for the adoption of
regulations by CDI (Insurance Fund).
COMMENTS : According to the author, the federal ACA has the
potential to cover 4-5million individuals who currently lack
access to health care coverage. In the California Health
Benefit Exchange (Exchange), over two million people will be
eligible for subsidies to help them purchase health insurance.
The author states that consumer trust in the establishment and
operation of the Exchange is critical to its success. The
opportunities for confusion, misinformation, and outright
deception about the individual mandate, employer requirements,
who is eligible for what type of coverage, and other provisions
of federal health reform will be considerable. In particular,
low-income consumers, communities of color, and LEP individuals
as well as the small business owners in those communities are
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often the most preyed upon. There are some existing protections
in the Knox-Keene Health Care Service Plan Act of 1975 and some
in the Insurance Code. This legislation builds on those
protections to ensure consumers trust in the expansion of this
program and are protected against bad actors or unscrupulous
individuals.
Health Access California (HAC) writes in support that this bill
extends the prior approval of marketing materials for health
insurers using the same statutory language that has been in
place since 1975 for health plans. Of major concern to sponsors
of this bill, the California Immigrant Policy Center, HAC, and
California Pan-Ethnic Health Network is the vulnerability of
immigrants and LEP individuals to deceptive marketing practices,
their unfamiliarity with the health insurance system, and likely
confusion about the individual mandate and eligibility rules.
The sponsors add that this bill requires a health plan or
insurer that markets in a language other than English to provide
a list of materials in that language so that the consumer
choosing coverage knows what he or she is buying, even if he or
she speaks a language other than English.
The California Association of Health Plans (CAHP) and the
Association of California Life and Health Insurance Companies
(ACLHIC), in their opposition, argue that this bill could have
the unintended consequence of lessening outreach to underserved
communities because these requirements would not only
drastically increase marketing and advertising costs to
underserved communities, but would create delays in getting
these materials approved and add significant workload to CDI.
ACLHIC and CAHP explain that their members already routinely
provide interpreter services upon request, either by phone or in
writing, for individuals who speak languages beyond threshold
languages. The California Association of Dental Plans (CADP) is
opposed to the inclusion of specialized plans offering EHBs.
CADP believes this would have a chilling effect on outreach
efforts to underserved communities.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0002321
SB 353
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