BILL ANALYSIS Ó
AB 635
Page 1
ASSEMBLY THIRD READING
AB
635 (Atkins)
As Introduced February 24, 2015
Majority vote
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|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 | |
| | | | |
| | | | |
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AB 635
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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
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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.
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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
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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
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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