BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 635 (Atkins) - Medical interpretation services
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|Version: February 24, 2015 |Policy Vote: HEALTH 7 - 1 |
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|Urgency: No |Mandate: No |
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|Hearing Date: July 13, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 635 would require the Department of Health Care
Services to establish a program to provide certified medical
interpretation services in the Medi-Cal program.
Fiscal
Impact:
One-time costs of $1.4 million to develop program guidelines,
seek necessary federal approvals, and develop billing systems
(50% General Fund, 50% federal funds).
Ongoing administrative costs of about $600,000 per year for
oversight by the Department of Health Care Services (General
Fund and federal funds).
Ongoing costs of about $30 million per year to provide
translation services in fee-for-service Medi-Cal, based on
estimates of the existing Medi-Cal fee-for-service population
with limited English proficiency (General Fund and federal
funds).
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Unknown costs in Medi-Cal managed care (General Fund and
federal funds). Under current law, health plans are required
to provide interpretation services, including managed care
plans that contract with the Department of Health Care
Services. It is unclear whether the bill's requirement to
provide "certified medical interpretation services" through
the program would increase costs above the costs already being
incurred.
The federal financial participation rate for the costs above
may vary. Generally, the federal government pays for 50% of
Medi-Cal costs. However, the federal government pays an
increased reimbursement rate the former Healthy Families
population of 65%. Finally, for the Medi-Cal expansion
population, the federal government pays 100% of the cost,
declining to 90% by 2020. Federal law allows for a 75% match
for certain costs of interpretation that are considered
administrative costs. However, the Department indicates that
the provision of interpretation services under the bill would
be considered Medi-Cal benefits and would be subject to the
normal federal match.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to pregnant women, children and their parents with
low incomes, as well as blind, disabled, and certain other
populations. Pursuant to the federal Affordable Care Act,
California has opted to expand eligibility for Medi-Cal up to
138 percent of the federal poverty level and to include
childless adults.
With the exception of certain populations (for example,
individuals eligible for limited scope Medi-Cal benefits or
individuals dually eligible for Medi-Cal and Medicare in most
counties), managed care is the primary system for providing
Medi-Cal benefits. The Department estimates that in 2014-15, 7.5
million Medi-Cal beneficiaries (73% of total enrollment) will
receive care through the managed care system.
The federal Civil Rights Act of 1964 and implementing
regulations prohibit the discrimination against any person based
on race, color, or national origin by entities that receive
AB 635 (Atkins) Page 2 of
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federal assistance. The federal Office for Civil Rights enforces
these requirements and has indicated through guidance that
entities receiving federal funding may be required to provide
access to translation services for limited English-speaking
program beneficiaries.
Current state law requires all licensed managed care plans to
provide interpretation services to enrollees who are limited
English proficient. Current law also requires all licensed
managed care plans to provide translation services based on the
concentration of non-English speaking enrollees. These
requirement apply to most Medi-Cal managed care plans, but allow
the regulatory agencies to deem Medi-Cal managed care plans in
compliance if they meet more stringent requirements through
contractual requirements.
Despite these requirements in law, there are indications that
not all Medi-Cal beneficiaries are receiving care in a
linguistically appropriate manner. According to the California
Health Interview Survey, about 8% of adults in Medi-Cal had
difficulty understanding their doctor or required another person
to help them understand their doctor. Similarly, about 7% of the
parents of children enrolled in Medi-Cal had difficulty
understanding their doctor or needed another person to help them
understand their doctor.
Proposed Law:
AB 635 would require the Department of Health Care Services to
establish a program to provide certified medical interpretation
services in the Medi-Cal program.
Specific provisions of the bill would:
Require the Department of Health Care Services to seek federal
funding to establish a program to provide and reimburse for
certified medical translation services to Medi-Cal
beneficiaries who are limited English proficient;
Require the services to be available through Medi-Cal managed
care and the Medi-Cal fee-for-service program;
Authorize all managed care plans and providers to utilize the
program to provide certified interpretation services;
Require all contracts between managed care plans,
subcontractors, and providers to include provisions describing
access to the program;
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Require the Department to create a community advisory
committee;
Specify that the bill's provisions do not apply to sign
language interpretation services.
Related
Legislation: AB 2325 (J. Perez, 2014), AB 1263 (J. Perez , 2013) and AB
2392 (J. Perez, 2012) all would have created a certified medical
interpretation program within the Medi-Cal program. Each of
those bills also addressed the collective bargaining rights of
the interpreters who would provide services in the program. AB
2325 and AB 1263 were vetoed by Governor Brown and AB 2392 was
moved to the Assembly Inactive File on concurrence in Senate
amendments.
Staff
Comments: The availability of enhanced federal financial participation
for translation services indicates that there may be
opportunities to improve access to care for non-English
proficient Medi-Cal beneficiaries at a reduced cost to the
state. On the other hand, it is not clear whether the program to
provide certified translation services, as required under the
bill, would be a more economical method of providing translation
services than the current methods used by health care providers.
If a centralized system managed by the Department is more costly
than the methods currently in use, cost savings may be minimal.
Improving translation services for people with limited English
proficiency would likely have mixed impacts on Medi-Cal costs.
By improving enrollees' ability to communicate with providers,
the bill is likely to enable enrollees to more easily access
care, increasing utilization and costs. On the other hand,
better communication between a patient and a provider may
improve the patient and the provider's ability to manage the
patient's health, potentially reducing long-term costs.
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