BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 353
Author: Lieu (D)
Amended: 9/4/13
Vote: 21
SENATE HEALTH COMMITTEE : 7-2, 4/10/13
AYES: Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,
Wolk
NOES: Anderson, Nielsen
SENATE APPROPRIATIONS COMMITTEE : 5 -2, 5/23/13
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SENATE FLOOR : 26-11, 5/30/13
AYES: Beall, Block, Calderon, Corbett, Correa, De León,
DeSaulnier, Evans, Galgiani, Hancock, Hernandez, Hill, Hueso,
Jackson, Leno, Lieu, Liu, Monning, Padilla, Pavley, Price,
Roth, Torres, Wolk, Wright, Yee
NOES: Anderson, Berryhill, Cannella, Emmerson, Fuller, Gaines,
Huff, Knight, Nielsen, Walters, Wyland
NO VOTE RECORDED: Lara, Steinberg, Vacancy
ASSEMBLY FLOOR : 51-25, 9/9/13 - See last page for vote
SUBJECT : Health care coverage: language assistance
SOURCE : California Immigrant Policy Center
California Pan-Ethnic Health Network
Health Access California
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DIGEST : This bill 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 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.
Assembly Amendments delete provisions prohibiting an insurer
from publishing or distributing any advertisement unless both of
the following conditions are met at least 30 days prior or any
shorter period as CDI allows by regulation: (1) a true copy of
the advertisement has first been filed with CDI; and (2) CDI has
not found the advertisement, wholly or in part, to be untrue,
misleading, deceptive, or otherwise not in compliance, and has
specified any deficiencies within 30 days.
ANALYSIS :
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
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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.
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 limited-English-proficient (LEP)
persons of the availability of free language assistance
and other outreach materials that are provided to
enrollees.
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 LEP persons of the availability of
no-cost translation and interpretation services;
D. Notices pertaining to the right to file a grievance and
instructions on how an enrollee may file a grievance; and,
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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.
Background
On March 23, 2010, President Obama signed ACA. Among other
provisions, the law makes statutory changes affecting the
regulation of and payment for certain types of private health
insurance. Beginning in 2014, individuals will be required to
maintain health insurance or pay a penalty, with exceptions. As
a result of implementation of the ACA, it is estimated that
three to seven million Californians will be newly eligible for
health insurance starting in 2014.
Language assistance . SB 853 (Escutia, Chapter 713, Statutes of
2003) required DMHC to develop regulations that require health
plans to provide language assistance services, including certain
translation and interpretation services, to LEP enrollees. The
language assistance regulations require health plans to conduct
periodic enrollee assessments to evaluate the linguistic needs
of the enrollee population, maintain policies and procedures to
ensure that LEP enrollees are able to access language assistance
services, instruct staff on the use of the language assistance
services, and monitor the plan's operations and services to
ensure compliance with the language assistance regulations.
Plans must provide translation services for their identified
threshold languages as determined by the periodic enrollee
assessment and translate specified documents.
Health plans are required to place a notice of the availability
of language assistance services on all English versions of all
enrollment materials, all correspondence from the plan
confirming a new or renewed enrollment, brochures, newsletters,
outreach and marketing materials, and other materials routinely
disseminated to enrollees. Interpretation services are also
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required to be provided to enrollees at all plan points of
contact where the enrollee might have need for such services.
Health plans are required to provide interpretation services for
any language requested by an enrollee, irrespective of whether
the language is identified as one of the plan's threshold
languages.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
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).
SUPPORT : (Verified 5/23/13) (Unable to reverify at time of
writing)
California Immigrant Policy Center (co-source)
California Pan-Ethnic Health Network (co-source)
Health Access California (co-source)
ACT for Women and Girls
AFSCME
American Cancer Society Cancer Action Network
Asian Americans for Civil Rights and Equality
Asian Pacific American Legal Center
California Black Health Network
California Communities United Institute
California Coverage and Health Initiatives
California Rural Legal Assistance Foundation
California School Employees Association
Cal-Islanders Humanitarian Association
Children's Partnership
Consumers Union
Earth Mama Healing, Inc.
Greenling Institute
Guam Communication Network
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Street Level Health Project
United Nurses Association of California/Union of Health Care
Professionals
OPPOSITION : (Verified 5/23/13) (Unable to reverify at time
of writing)
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Chamber of Commerce
ASSEMBLY FLOOR : 51-25, 9/9/13
AYES: Alejo, Ammiano, Atkins, Bloom, Bocanegra, Bonilla, Bonta,
Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Chesbro, Cooley, Dickinson, Eggman, Fong, Frazier, Garcia,
Gomez, Gonzalez, Gordon, Gray, Hall, Roger Hernández, Holden,
Jones-Sawyer, Levine, Logue, Lowenthal, Medina, Mitchell,
Mullin, Muratsuchi, Nazarian, Pan, Perea, V. Manuel Pérez,
Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting,
Weber, Wieckowski, Williams, Yamada, John A. Pérez
NOES: Achadjian, Allen, Bigelow, Chávez, Conway, Dahle, Daly,
Donnelly, Beth Gaines, Gatto, Gorell, Grove, Hagman, Harkey,
Jones, Linder, Maienschein, Mansoor, Morrell, Nestande, Olsen,
Patterson, Wagner, Waldron, Wilk
NO VOTE RECORDED: Fox, Melendez, Vacancy, Vacancy
JL:k 9/10/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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