BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 635|
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THIRD READING
Bill No: AB 635
Author: Atkins (D)
Introduced:2/24/15
Vote: 21
SENATE HEALTH COMMITTEE: 7-1, 6/24/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nielsen
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/27/15
AYES: Lara, Beall, Hill, Leyva, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 72-2, 6/2/15 - See last page for vote
SUBJECT: Medical interpretation services
SOURCE: Author
DIGEST: This bill requires the Department of Health Care
Services to seek federal funding to establish a program to
provide and reimburse for certified medical interpretation
services for Medi-Cal beneficiaries who are limited English
proficient. This bill requires the program to offer medical
interpreter services to Medi-Cal providers serving beneficiaries
on either a fee-for-service or managed care basis.
ANALYSIS:
Existing federal law:
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1)Provides increased federal matching funding for translation
and interpretation services provided in connection with the
enrollment, retention, and use of services under Medicaid
(Medi-Cal in California) and the Children's Health Insurance
Program (CHIP was previously known as the Healthy Families
Program in California; these children are now enrolled in
Medi-Cal).
2)Prohibits, under Title VI of the Civil Rights Act of 1964, 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.
Existing state law:
1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Requires commercial health plans to assess their members'
language preference and provide interpretation and translation
services in threshold languages.
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 state and local agencies providing services to a
substantial number of non-English speaking people to provide
bilingual services.
This bill:
1)Requires DHCS to seek federal funding to establish a program
to provide and reimburse for certified medical interpretation
services to Medi-Cal beneficiaries who are limited English
proficient.
2)Requires the program to offer medical interpreter services to
Medi-Cal providers serving beneficiaries on either a
fee-for-service or managed care basis.
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3)Permits a health care provider or entity entering into a
Medi-Cal provider agreement or Medi-Cal managed care contract
with the state, including Medi-Cal managed care organizations
(MMCOs) and their subcontracting plans, and fee-for-service
providers, to utilize the program to provide medical
interpreter services to Medi-Cal beneficiaries.
4)Requires all contracts between MMCOs and their subcontractors,
including health providers and other health plans, to include
provisions describing access to medical interpreter services
under the program.
5)Requires DHCS to pursue all available sources of federal
funding to establish and administer the program and to seek
federal approvals necessary to implement this article.
6)Requires DHCS to create a community advisory committee,
consisting of stakeholders and health care providers, to
advise on the implementation of this bill.
7)Exempts from this bill sign language interpretation services.
Comments
1)Author's statement. According to the author, more than 40% of
Californians speak a language other than English at home.
Almost seven million Californians are estimated to speak
English "less than very well." Research finds that language
barriers can contribute to inadequate patient evaluation and
diagnosis, lack of appropriate and/or timely treatment, or
other medical errors that can jeopardize patient safety and
lead to unnecessary procedures and costs. Today language
assistance in medical settings is provided by trained or
untrained staff, or in an informal manner by family members or
friends. California has an opportunity to develop a more
comprehensive language assistance program by seeking
additional federal funding for medical interpreter services in
the Medi-Cal program.
2)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
race, color, or national origin under any program or activity
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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, non-profits, 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.
3)OCR policy guidance. The Centers for Medicare and Medicaid
Services (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 proficient (LEP), pursuant to Title VI of the Civil
Rights Act of 1964.
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
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VI compliance with respect to LEP persons, and what
constitutes "reasonable steps" for large providers may not be
reasonable where small providers are concerned.
4)Current DHCS health plan contractual requirements. DHCS' model
contract with Medi-Cal managed care plans requires plans to
ensure equal access to health care services for its members
without regards to a member's proficiency in the English
language. This includes ensuring that all monolingual,
non-English-speaking or LEP Medi-Cal beneficiaries receive
24-hour oral interpreter services at all key points of
contact. Key points of contact include medical care settings
(telephone, advice and urgent care transactions, and
outpatient encounters with health care providers including
pharmacists) and non-medical care setting (member services,
orientations, and appointment scheduling). A June 2015 Bureau
of State Audits audit entitled "Department of Health Care
Services: Improved Monitoring of Medi-Cal Managed Care Health
Plans Is Necessary to Better Ensure Access to Care" found DHCS
did not review plan's language assistance programs.
5)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, of the 3.5 million adults in the Medi-Cal program,
about 281,000 (8.1%) had difficulty understanding their doctor
and/or needed another person to help them understand their
doctor. Among the parents of 1.8 million children under age 12
in the Medi-Cal program, about 135,000 (7.4%) had difficulty
understanding the child's doctor and/or needed another
person's help to understand the doctor.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)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).
2)Ongoing administrative costs of about $600,000 per year for
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oversight by DHCS (General Fund and federal funds).
3)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).
4)Unknown costs in Medi-Cal managed care (General Fund and
federal funds). Under existing law, health plans are required
to provide interpretation services, including managed care
plans that contract with DHCS. It is unclear whether this
bill's requirement to provide "certified medical
interpretation services" through the program would increase
costs above the costs already being incurred.
5)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, DHCS indicates that the
provision of interpretation services under this bill will be
considered Medi-Cal benefits and would be subject to the
normal federal match.
SUPPORT: (Verified8/28/15)
AARP
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
California Academy of Family Physicians
California Academy of Physician Assistants
California Black Health Network
California Chapter of the National Association of Social Workers
California Equity Leaders Network
California Immigrant Policy Center
California Pan-Ethnic Health Network
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California Workers' Compensation Interpreter's Association
Community Clinic Association of Los Angeles County
County Welfare Directors Association of California
Health Access California
Planned Parenthood Affiliates of California
United Domestic Workers of America, AFSCME Local 3930, AFL-CIO
Western Center on Law and Poverty
OPPOSITION: (Verified8/28/15)
Department of Finance
Department of Health Care Services
ARGUMENTS IN SUPPORT: The California Pan-Ethnic Health
Network writes that California's population is one of the most
diverse in the country with over 100 different languages spoken
and an estimated six to seven million Californians LEP. Barriers
to communication in the health care setting can result in
increased risk of misdiagnoses and misunderstandings, resulting
in lower quality care and reduced adherence to medication. The
American Federation of State, County and Municipal Employees
argue that communication is critical to quality of care and
cultural competency in our state's Medicaid program. With the
expansion of Medi-Cal and the exchange market under the
Affordable Care Act, the state has a clear opportunity to create
an interpreters program that will allow patients and providers
to clearly communicate with each other.
ARGUMENTS IN OPPOSITION: DHCS writes this bill is
unnecessary as LEP Medi-Cal beneficiaries currently have
reliable access to language interpretation services, and this
bill creates an administratively costly system for the provision
of medical interpreter services that would duplicate services
currently available and could not be absorbed with existing
staff and resources.
ASSEMBLY FLOOR: 72-2, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau,
Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd, Eggman,
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Frazier, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger
Hernández, Holden, Irwin, Jones-Sawyer, Kim, Lackey, Levine,
Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty,
Medina, Mullin, Nazarian, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NOES: Beth Gaines, Harper
NO VOTE RECORDED: Brough, Chávez, Dahle, Jones, Melendez,
Obernolte
Prepared by:Scott Bain / HEALTH /
8/30/15 19:42:19
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