BILL ANALYSIS                                                                                                                                                                                                    Ó






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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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