BILL ANALYSIS Ó AB 389 Page 1 Date of Hearing: April 7, 2015 ASSEMBLY COMMITTEE ON HEALTH Rob Bonta, Chair AB 389 (Chau) - As Introduced February 18, 2015 SUBJECT: Hospitals: language assistance services. SUMMARY: Requires general acute care hospitals to provide annually, their language assistance policies to the Department of Public Health (DPH) and the Office of Statewide Health Planning and Development (OSHPD) and requires hospitals, DPH, and OSHPD to post the policies on their internet Websites. EXISTING LAW: 1)Establishes DPH which licenses and regulates general acute care hospitals. 2)Establishes OSHPD and designates it as the single state agency to collect specified health facility or clinic data for use by all state agencies. 3)Requires hospitals to adopt and annually review a policy for providing language assistance services to patients with language or communication barriers and for the policies to include procedures for providing, to the extent possible, as AB 389 Page 2 determined by the hospital: a) The use of an interpreter whenever a language or communication barrier exists, unless the patient chooses to use a family member or friend; b) The efficient use of interpreters including minimizing delays in providing interpreters to patients; and, c) That interpreters are available, either on the premises or accessible by telephone, 24 hours a day. 4)Requires hospitals to develop and post in conspicuous locations, notices that advise patients and their families of the availability of interpreters, the procedure for obtaining an interpreter, and the telephone numbers where complaints may be filed concerning interpreter service problems, including but not limited to a T.D.D. number for the hearing impaired. 5)Requires hospitals to identify and record a patient's primary language and dialect on one or more of the following: a) The patient medical chart; b) The hospital bracelet; c) The bedside notice; or, d) The nursing card. AB 389 Page 3 6)Requires hospitals to prepare and maintain, as needed, a list of interpreters who have been identified as proficient in sign language and in the languages of the population of the geographical area served, and notify employees of the hospital's commitment to provide interpreters to all patients who request them. 7)Provides that non-compliance with these provisions is reportable to licensing authorities, but that violations will not result in fines. FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee. COMMENTS: 1)PURPOSE OF THIS BILL. According to the author, California has been a leader in ensuring that the state's healthcare infrastructure meets the needs of Limited English Proficient (LEP) patients, however existing practices for ensuring hospital compliance with language assistance policy submittal requirements lack central oversight by DPH. The author notes that by requiring hospitals to submit their language assistance policies to both DPH and OSHPD, and requiring hospitals, DPH, and OSHPD to post them on their Websites, this bill will provide greater oversight and enable policymakers and consumers to access information the law already guarantees. 2)BACKGROUND. SB 1840 (McCorquodale), Chapter 672, Statues of 1990, was implemented with the intent of increasing the quality of care for patients with limited English proficiency, however, as noted, DPH cannot issue fines and current law does not require the notices to be posted on either the hospital's AB 389 Page 4 or DPH's Website. DPH most recently sent an All Facilities Letter on May 11, 2012, reminding all general acute care hospitals to submit their language assistance policies on an annual basis to their local Licensing and Certification District Office; however, according to a survey conducted on behalf of the California Pan-Ethnic Health Network (CPHEN), hospital compliance has waned over the last several years. 3)SUPPORT. CPEHN is the sponsor of this bill and states language barriers are correlated to higher rates of death and illness. CPEHN notes that patients who face language barriers are more likely to have higher rates of hospitalization, encounter drug complications, and fail to return for follow-ups after an emergency room visit. CPEHN contends that by making language assistance policies available online, this bill will provide consumers access to information already required by current law. Health Access California (HAC) also supports this bill and writes, according to recent estimates, the majority of those newly eligible for health care coverage under the Patient Protection and Affordable Care Act will be from communities of color, and 40% of those newly eligible for subsidies in Covered California will be LEP. HAC concludes that making language assistance policies available online will provide greater transparency and oversight of a key accountability measure serving the needs of LEP patients. 4)RELATED LEGISLATION. AB 635 (Atkins) would require the Department of Health Care Services (DHCS) to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services, except sign language interpretation services, to Medi-Cal beneficiaries who are LEP. AB 389 Page 5 5)PREVIOUS LEGISLATION. a) AB 2325 (John A. Pérez) of 2014 would have required 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 LEP, to establish a certification process and registry of CommuniCal interpreters at DHCS, and granted CommuniCal interpreters collective bargaining rights with the state. AB 2325 was vetoed by the Governor. b) AB 1263 (John A. Pérez) of 2013 was substantially similar to AB 2325. 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. c) AB 2392 (John A. Pérez) of 2012 was substantially similar to AB 1263 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. d) SB 442 (Ron 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 AB 389 Page 6 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 local level. e) SB 1405 (Soto) of 2006 would have required DHCS to create the Task Force on Reimbursement for Language Services to develop a mechanism for seeking federal matching funds from the Centers for Medicare & Medicaid Services to pay for language assistance services. SB 1405 was placed on the Senate inactive file. f) AB 800 (Yee), Chapter 313, Statutes of 2005, requires all health facilities (hospitals, skilled nursing facilities, intermediate care facilities, and correctional treatment centers) and all primary care clinics to include a patient's principal spoken language on the patient's health records. g) 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. 6)SUGGESTED AMENDMENTS. In order to insure that LEP patients truly have access to language assistance policies and services, the Committee may wish to amend this bill to require hospitals to post a notice on their Website, in the top languages other than English most commonly spoken in their AB 389 Page 7 service area, regarding the availability of language assistance services at the hospital. REGISTERED SUPPORT / OPPOSITION: Support California Pan-Ethnic Health Network (sponsor) AARP, Sacramento Advancement Project Asian & Pacific Islander American Health Forum Asian Americans Advancing Justice - Los Angeles Asian Americans Advancing Justice - Sacramento AB 389 Page 8 Asian Law Alliance California Communities United Institute California Health Nail Salon Collaborative California Immigrant Policy Center California Rural Legal Assistance Foundation Consumers Union Having Our Say Coalition Health Access California Language World Services, Inc. Multicultural Health Institute San Francisco General Hospital and Trauma Center Southeast Asia Resource Action Center Stanford Healthcare AB 389 Page 9 Union of Pan Asian Communities - Positive Solutions Program United Way of Merced County Western Center on Law and Poverty Numerous individuals Opposition None on file. Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097