BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 635
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|AUTHOR: |Atkins |
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|VERSION: |August 18, 2016 |
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|HEARING DATE: |August 24, | | |
| |2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medical interpretation services
SUMMARY : This bill requires the Department of Health Care Services
(DHCS) to
conduct a study to identify current requirements for medical
interpretation services, and requires DHCS to work with
identified stakeholders to establish a pilot project in up to
four separate sites to evaluate a mechanism to provide and
improve medical interpretation services for limited-English
proficient Medi-Cal beneficiaries based on the recommendations
of the study related to pilot projects and available funding.
Existing law:
Existing federal law:
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
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DHCS, under which qualified low-income individuals receive
health care services.
2)Makes available, pursuant to budget bill language in the 2016
Budget Act, up to $3 million General Fund for the support of
activities related to a medical interpreters pilot project,
study, or both. The budget bill language made the expenditure
or encumbrance of these funds contingent upon the chaptering
of future legislation authorizing the medical interpreters
pilot project, study, or both, and upon approval by the
Department of Finance.
This bill:
1)States legislative intent that to support activities related
to a medical interpretation pilot project, study, or both, to
be administered by DHCS, in order to assess the process for
delivering language interpretation services for limited
English proficient (LEP) Medi-Cal beneficiaries and make
recommendations regarding existing medical interpretation
services and possible mechanisms to improve those services.
2)Requires DHCS to work with identified stakeholders to conduct
a study to identify current requirements for medical
interpretation services as well as education, training, and
licensure requirements, analyze other state Medicaid programs,
and make recommendations on strategies that may be employed
regarding the provision of medical interpretation services for
Medi-Cal beneficiaries who are LEP.
3)Requires the study to also assess and make recommendations on
pilot projects that would further the objectives of this bill,
including funding for those activities and the allowable use
of federal funding.
4)Requires DHCS to work with identified stakeholders to
establish a pilot project in up to four separate sites to
evaluate a mechanism to provide and improve medical
interpretation services for LEP Medi-Cal beneficiaries based
on the recommendations of the study and available funding.
5)Requires DHCS, in identifying sites, to take into account both
the need for those services and the recommendations from the
study.
6)Permits DHCS to use, or contract with, an external vendor,
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vendors, or other contracted subject matter experts to
implement the activities described in this bill.
7)Requires DHCS to consult with identified stakeholders
regarding the draft initial scope of work that is to be used
to seek and evaluate proposals pursuant to this bill.
8)Requires DHCS, each year, commencing in 2017, during the
annual state budget process, to provide an update to the
legislative budget committees on implementation of this bill.
9)Authorizes DHCS to expend up to $3 million under a specified
provision in the Budget Act of 2016 for the support of
activities related to a medical interpreters pilot project,
study, or both.
10)Permits DHCS to seek any available federal funding for
support of activities relating to medical interpretation
services as provided under this bill.
11)Makes the expenditure or encumbrance of the funds
described in this bill contingent upon approval by the
Department of Finance.
12)Sunsets the provisions of this bill on July 1, 2020, and
repeals its provisions as of January 1, 2021.
FISCAL EFFECT: Unknown.
PRIOR
VOTES :
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|Assembly Floor: |72 - 2 |
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|Assembly Appropriations Committee: |13 - 1 |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS:
1)Author's statement. According to the author, more than 40% of
Californians speak a language other than English at home.
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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)2016 Budget Act funding. (SB 826, Leno, Chapter 23, Statutes
of 2016), the 2016 Budget Act, contained budget bill language
in the DHCS Medi-Cal budget making available up to $3 million
for the support of activities related to a medical
interpreters pilot project, study, or both. The budget bill
language made the expenditure or encumbrance of these funds
contingent upon the chaptering of future legislation
authorizing the medical interpreters pilot project, study, or
both, and upon approval by the Department of Finance.
3)Data on languages spoken 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.
4)Support. The California Pan-Ethnic Health Network writes in
support of the previous version of this bill 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 writes in
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support of the previous version of this bill 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.
5)Amendments. The Senate floor amendments of August 18th delete
the existing provisions of this bill requiring DHCS to seek
federal funding to establish a program to provide and
reimburse for certified medical interpretation services and
related legislative intent language.
SUPPORT AND OPPOSITION :
Support: 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 Immigrant Policy Center
California Pan-Ethnic Health Network
California Workers' Compensation Interpreter's
Association
Community Clinic Association of Los Angeles County
County Welfare Directors Association of California
Health Access
National Association of Social Workers, California
Chapter
Planned Parenthood Affiliates of California
United Domestic Workers of America, AFSCME Local 3930,
AFL-CIO Western Center on Law and Poverty
Oppose: None received
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