BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 389|
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THIRD READING
Bill No: AB 389
Author: Chau (D)
Amended: 9/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/17/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 77-0, 4/30/15 (Consent) - See last page for
vote
SUBJECT: Hospitals: language assistance services
SOURCE: California Pan-Ethnic Health Network
DIGEST: This bill requires hospitals to post, on their
Internet Web sites, their language assistance policies, as well
as a notice of the availability of language assistance services
in English and in up to the five other languages most commonly
spoken in the hospital's service area. This bill also requires
the Department of Public Health to post each hospital's language
assistance policy on its Internet Web site.
ANALYSIS:
Existing law:
1)Licenses general acute care hospitals under the Department of
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Public Health (DPH).
2)Establishes the Office of Statewide Health Planning and
Development (OSHPD), and designates OSHPD as the single state
agency to collect specified health facility or clinic data for
use by all state agencies.
3)Requires general acute care hospitals, in order to ensure
access to health care information and services for
limited-English-speaking or non-English-speaking residents and
deaf residents, to adopt and annually review a policy for
providing language assistance services to patients with
language or communication barriers (language assistance
policy).
4)Defines "language or communication barriers," for purposes of
the language assistance policy with respect to spoken
language, as barriers that are experienced by individuals who
are limited-English-speaking or non-English-speaking
individuals who speak the same primary language and comprise
at least 5% of the population of the geographical area served
by the hospital. With respect to sign language, a language or
communication barrier is experienced by individuals who are
deaf and whose primary language is sign language.
5)Requires a hospital's language assistance policy to include
procedures for providing, to the extent possible, the use of
an interpreter whenever a language or communication barrier
exists, except when the patient, after being informed of the
availability of the interpreter service, chooses to use a
family member or friend who volunteers to interpret.
6)Requires a hospital's language assistance policy to be
designed to maximize efficient use of interpreters and
minimize delays in providing interpreters to patients, and to
ensure, to the extent possible, that interpreters are
available, either on the premises or by telephone, 24 hours a
day.
7)Requires hospitals to annually transmit to the DPH a copy of
the updated language assistance policy and to include a
description of its efforts to ensure adequate and speedy
communication between patients with language or communication
barriers and staff.
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8)Requires hospitals to post notices in conspicuous locations
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. Requires these notices to be
posted, at a minimum, in the emergency room, the admitting
area, the entrance, and in outpatient areas. Requires these
notices to list the languages for which interpreter services
are available.
9)Requires hospitals to prepare and maintain a list of
interpreters who have been identified as proficient in sign
language and in the languages of the population of the
geographical area serviced by the hospital.
This bill:
1)Requires a general acute care hospital, on or before July 1,
2016, and every January 1 thereafter, to make a notice of
availability of language assistance services available to the
public on its Internet Web site.
2)Requires the notice in 1) above to be in English and in up to
five other languages most commonly spoken in the hospital's
service area, if the individuals speaking those languages meet
the definition of a language barrier, as specified.
3)Requires a general acute care hospital and DPH to make updated
language assistance policies available to the public on their
respective Internet Web sites.
Comments
1)Author's statement. According to the author, this bill aims
to require DPH and OSHPD to post hospital language assistance
policies online. Specifically, this bill will require
hospitals to make language assistance policies available on
their websites, in English and up to the five other most
commonly spoken languages in the hospital's service area, and
to file copies with OSHPD, which collects and disseminates
information on California's healthcare system. Thus, both
OSPHD and DPH would be required to post hospital language
assistance information online. This bill will provide greater
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transparency and oversight of a key accountability measure
serving the needs of limited English proficient patients by
making policies available online.
2)Hospital information spread across two state agencies. Under
existing state law, DPH licenses and regulates all health
facilities, including hospitals, and conducts inspections both
for state licensing purposes, and on behalf of the Centers for
Medicare and Medicaid Services (CMS) to ensure hospitals can
continue to be an approved provider under federal payment
programs. On DPH's website, there is a link for the "Consumer
Information System," which includes information about
administrative penalties levied against hospitals, penalties
for breaches of patient confidentiality, and a map of
infection rates by hospital.
OSHPD has oversight over the construction and modification of
health facility buildings, including ensuring compliance with
seismic safety laws, and also serves as the data collection
entity for many different types of hospital reports, including
discharge data reports and summary financial reports. OSHPD
has a "Healthcare Information Division," which includes
quality reports on hospitals (such as risk-adjusted outcome
reports), hospital financial reports, patient discharge
reports, emergency department encounters, ambulatory surgery
reports, and a number of other types of reports. OSHPD also
collects and publishes each hospital's fair pricing policy, as
well as their community benefit plans.
3)Data on language in California. According to the US Census
Bureau 2010 American Community Survey, 43.7% of Californians
over the age of five speak a language other than English, and
19.9% of Californians over the age of five speak English "less
than very well." According to the California Health Interview
Survey, within the Medi-Cal program, about 8.1% of adults had
difficulty understanding their doctor and/or needed another
person to help them understand their doctor, and about 7.4% of
parents of children under the age of 12 in the Medi-Cal
program had difficulty understanding the child's doctor and/or
needed another person's help to understand the doctor.
4)Federal anti-discrimination law. Title VI of the Civil Rights
Act of 1964 and its implementing regulations provide that no
person shall be subject to discrimination on the basis of
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race, color, or national origin under any program or activity
that receives federal financial assistance. Each federal
department has a civil rights office that is charged with
ensuring that its programs are free of discrimination. The
federal Department of Health and Human Services (HHS) Office
for Civil Rights (OCR) responsibilities include enforcing the
Civil Rights Act, the Americans with Disabilities Act, and the
Age Discrimination Act. Any organization or individual who
receives monies through HHS-health departments, health plans,
social service agencies, nonprofits, hospitals, clinics, and
physicians-is subject to OCR oversight. The OCR has the
authority to investigate complaints related to linguistic
barriers, to initiate its own reviews, and to withhold federal
funds for noncompliance.
CMS issued a State Medicaid Director letter on August 31, 2000,
that informed states of the policy guidance that the OCR had
issued on the prohibition against national origin
discrimination as it affects persons with limited English
proficiency (LEP), pursuant to Title VI of the Civil Rights
Act of 1964. The OCR policy guidance requires recipients of
federal assistance to take reasonable steps to ensure
meaningful access to their programs and activities by LEP
persons. The guidance explains that the obligation to provide
meaningful access is fact-dependent and starts with an
individualized assessment that balances four factors:
a) The number or proportion of LEP persons eligible to be
served or likely to be encountered by the program or
grantee;
b) The frequency with which LEP individuals come into
contact with the program;
c) The nature and importance of the program, activity or
service provided by the grantee/recipient to its
beneficiaries; and,
d) The resources available to the grantee/recipient and the
costs of interpretation/ translation services.
CMS states there is no "one size fits all" solution for Title
VI compliance with respect to LEP persons, and what
constitutes "reasonable steps" for large providers may not be
reasonable where small providers are concerned.
FISCAL EFFECT: Appropriation: No Fiscal
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Com.:YesLocal: Yes
According to the Senate Appropriations Committee, minor costs
for DPH to post hospital language assistance policies on its
website/Licensing and Certification Program Fund.
SUPPORT: (Verified8/28/15)
California Pan-Ethnic Health Network (source)
AARP
Advancement Project
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
Asian Americans Advancing Justice - Los Angeles
Asian and Pacific Islander American Health Forum
Asian Health Services
Asian Law Alliance
California Commission on Asian and Pacific Islander American
Affairs
California Communities United Institute
California Healthy Nail Salon Collaborative
California Immigrant Policy Center
California Rural Legal Assistance Foundation
California State Council of the Service Employees International
Union
Community Health Partnership
Consumers Union
Having Our Say
Health Access
Justice in Aging
Language Care/United Way of Merced County
Language World Services, Inc.
Latino Coalition for a Healthy California
National Council of Asian Pacific Islander Physicians
San Francisco General Hospital and Trauma Center
Southeast Asia Resource Action Center
The City Project
The Greenlining Institute
Union of Pan Asian Communities
Union of Pan Asian Communities - Positive Solutions Program
Western Center on Law and Poverty
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OPPOSITION: (Verified8/28/15)
None received
ARGUMENTS IN SUPPORT: This bill is sponsored by the
California Pan-Ethnic Health Network (CPEHN), which states that
California's population is one of the most diverse in the
country, especially with respect to language needs. CPEHN states
that with the implementation of the federal Affordable Care Act,
the majority of those newly eligible for health care coverage
will be from communities of color and 40% of those newly
eligible for subsidies in Covered California will be limited
English proficient. CPEHN states that thirty years ago,
California policy makers had the foresight to require language
assistance in hospitals, and required each hospital to annually
adopt and report to DPH a policy for providing language
assistance to limited English proficient patients. However,
CPEHN states that instead of submitting these reports to a
centralized location, hospitals currently submit their policies
and procedures on paper to their respective DPH Licensing and
Certification District Office, which maintain hard copies of
these policies. Any member of the public seeking to view a
hospital's language assistance policy must make the request at
the district office. CPEHN states that having the policies
spread out makes it difficult for policymakers and the public to
access them, verify compliance, and ensure adherence to the
appropriate protections and practices set forth by law.
This bill is supported by numerous organizations. The Western
Center on Law and Poverty states in support that making policies
available online delivers greater oversight and helps ensure
limited English proficient patients have access to information
already guaranteed by the law. The Latino Coalition for a Health
California states in support that failure to provide language
access can lead to serious consequences such as higher rates of
hospitalization, drug complications, and not returning for
follow-ups after an emergency room visit. Asian Health Services
states that adequate language assistance is essential to
accessing basic health care services, and the current law is
outdated and lacks the oversight to ensure limited English
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proficient patients understand their right to language
assistance when accessing hospital services.
ASSEMBLY FLOOR: 77-0, 4/30/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau,
Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gonzalez, Gordon, Gray, Grove,
Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Campos, Chávez, Gomez
Prepared by:Vince Marchand / HEALTH /
9/1/15 21:57:03
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