BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     AB 389


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          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  








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            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.









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          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  








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            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.









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          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  








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               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  








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            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









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          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









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          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