BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 389| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 AB 389 Page 2 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. AB 389 Page 3 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 AB 389 Page 4 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 AB 389 Page 5 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 AB 389 Page 6 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 AB 389 Page 7 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 AB 389 Page 8 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 **** END ****