BILL ANALYSIS Ó SB 353 Page 1 SENATE THIRD READING SB 353 (Lieu) As Amended September 4, 2013 Majority vote SENATE VOTE :26-11 HEALTH 13-5 APPROPRIATIONS 12-5 ----------------------------------------------------------------- |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 | | | | | | ----------------------------------------------------------------- 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; SB 353 Page 2 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. SB 353 Page 3 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 SB 353 Page 4 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 Page 5