BILL ANALYSIS Ó AB 635 Page 1 ASSEMBLY THIRD READING AB 635 (Atkins) As Introduced February 24, 2015 Majority vote ------------------------------------------------------------------- |Committee |Votes |Ayes |Noes | | | | | | | | | | | |----------------+------+--------------------+----------------------| |Health |16-0 |Bonta, Maienschein, | | | | |Bonilla, Burke, | | | | |Chávez, Chiu, | | | | |Gomez, Gonzalez, | | | | |Lackey, Nazarian, | | | | |Ridley-Thomas, | | | | |Rodriguez, | | | | |Santiago, Thurmond, | | | | |Waldron, Wood | | | | | | | |----------------+------+--------------------+----------------------| |Appropriations |13-1 |Gomez, Bonta, |Bigelow | | | |Calderon, Chang, | | | | |Daly, Eggman, | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Quirk, Rendon, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------- AB 635 Page 2 SUMMARY: Establishes the Medi-Cal Medical Interpretation services program at the Department of Health Care Services (DHCS) to provide and reimburse for certified medical interpretation (CMI) services to limited English proficient (LEP) Medi-Cal enrollees. Specifically, this bill: 1)Requires DHCS to seek federal funding to establish a program to provide CMI services to Medi-Cal beneficiaries who are limited in their English proficiency. 2)Requires the program to be available in both Medi-Cal fee-for-service (FFS) and Medi-Cal managed care. 3)Authorizes Medi-Cal providers and any providers contracting with Medi-Cal managed care organizations to use the programs. EXISTING FEDERAL LAW: 1)Prohibits, a person in the United States, on the grounds of race, color, or national origin, from being excluded from participation in, denied the benefits of, or subjected to discrimination under any program or activity receiving federal financial assistance. 2)Requires federal agencies to ensure meaningful access to services for LEP persons through regulations. EXISTING STATE LAW: 1)Prohibits discrimination based on ancestry, age, color, disability, genetic information, gender, gender identity, and AB 635 Page 3 gender expression, marital status, medical condition, national origin (includes language use restrictions), race, religion, sex, sexual orientation in any program or activity operated or administered by a state agency. 2)Requires state and local agencies to provide services to a substantial number of non-English speaking people to provide interpretation services. 3)Requires hospitals to provide language services, interpreters, or bilingual staff under specified circumstances and to identify and record patients' primary languages in hospital records. 4)Requires commercial health plans to assess their members language preference and provide interpretation and translation services in threshold languages. FISCAL EFFECT: According to the Assembly Appropriations Committee: 1)One-time administrative costs in the range of $1 million (General Fund (GF)/federal) to DHCS to seek federal approvals, create system protocols, develop an information technology infrastructure, design communications and guidance, promulgate regulations, and other initial program development activities. 2)Assuming 2 million LEP individuals receive one additional office visit annually with interpretive services provided through this program at a cost of $20 per visit, additional costs would be about $40 million annually. 3)Medi-Cal costs would be at a 50% GF, 50% federal funds matching rate, except for costs for individuals at higher matching rates. AB 635 Page 4 4)Improved access to high-quality interpretive services is likely to improve access to care and increase overall medical costs to the Medi-Cal program for LEP beneficiaries. It would also likely result in some offsetting cost savings associated with the provision of higher-quality care and fewer medical errors. The magnitude of savings as compared to costs is unknown, but evidence suggests that, on balance, the Medi-Cal program would experience increased medical costs if centralized, high-quality interpretive services were available. COMMENTS: According to the author, California has an opportunity to draw down enhanced federal funding to develop a more comprehensive language assistance program for LEP beneficiaries. These critical services will help ensure better health outcomes for individuals by reducing language barriers that could lead to lack of or inappropriate preventive and primary care. More than 40% of Californians speak a language other than English at home and almost 7 million Californians are estimated to speak English "less than very well." As a result, language assistance in medical settings is often provided by untrained staff or, more frequently, in an informal manner by family members or friends. The author notes that research finds language barriers can contribute to inadequate patient evaluation and diagnosis; lack of appropriate and/or timely treatment; and/or other medical errors that can jeopardize patient safety and lead to unnecessary procedures and cost. The author concludes, as a recent University of California, Los Angeles report indicates, despite state regulations, health plan enrollees who are LEP still face communication barriers. In 2006 various stakeholders created a task force charged with developing recommendations for a system to provide language services for Medi-Cal enrollees, which evolved into the Medi-Cal AB 635 Page 5 Language Access Services (MCLAS) Taskforce. According to the 2009 MCLAS Report, "Providing Language Services for Limited English Proficient Patients in California," more than 25 languages are recorded as Medi-Cal beneficiaries' preferred language. Almost half (45.2%) speak a language other than English. Each federal department has a civil rights office that is charged with ensuring that its programs are free of discrimination. The responsibilities of the federal Department of Health and Human Services (HHS) Office for Civil Rights (OCR) 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 Centers for Medicare and Medicaid Services issued a State Medicaid Director letter on August 31, 2000, that informed states of the policy guidance the OCR had issued on the prohibition against national origin discrimination as it affects persons with LEP, pursuant to Title VI the Civil Rights Act. 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. Supporters, including the Western Center on Law and Poverty, Health Access California and the American Federation of State, County and Municipal Employees support this bill citing the critical need for providing and reimbursing trained medical interpreters. They state that California's population is incredibly diverse and that almost 44% of Californians speak another language at home, and the Medi-Cal population is even more diverse. They argue that when these Californians go to their doctor it is imperative that they can effectively communicate with their doctor. They conclude it is critical to have a system, particularly for FFS Medi-Cal of medical interpreters. The California Pan-Ethnic Health Network supports this bill because it will assist the state in meeting their legal obligations under AB 635 Page 6 Title VI of the Civil Rights Act of 1964. The support sees this bill as improving the quality of health care services for California's diverse populations. They also argue the bill will help lower health care costs by ensuring the state is able to access federal funds to help pay for the language assistance services it is already required to provide, a view shared by other supporters such as the Homecare Providers Union. Analysis Prepared by: Roger Dunstan / HEALTH / (916) 319-2097 FN: 0000645