BILL ANALYSIS Ó
AB 635
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CONCURRENCE IN SENATE AMENDMENTS
AB
635 (Atkins)
As Amended August 18, 2016
Majority vote
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|ASSEMBLY: |72-2 |(June 2, 2015) |SENATE: | 31-7 |(August 25, |
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Original Committee Reference: HEALTH
SUMMARY: Requires the Department of Health Care Services (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 limited English proficient (LEP), in
compliance with applicable state and federal requirements.
Specifically, this bill:
1)Requires the study to 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.
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2)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, as
specified. Requires DHCS to take into account both the need
for those services, and the recommendations from the study.
3)Authorizes DHCS to use or contract with an external vendor or
other subject matter experts to implement this bill. Requires
DHCS to consult with identified stakeholders regarding the
draft initial scope of work that will be used to seek and
evaluate proposals.
4)Requires DHCS, commencing in 2017, during the annual state
budget process, to provide an update to the Legislature
regarding this bill's implementation.
5)Authorizes DHCS to expend up to $3,000,000 under the Budget
Act of 2016, for the support of activities related to a
medical interpreters pilot project, study, or both.
6)Authorizes DHCS to seek any available federal funding for
support of this bill.
7)Makes the expenditure or encumbrance of the funds under this
bill contingent on approval by the Department of Finance.
8)Sunsets this bill on July 1, 2020 and repeals its provisions
on January 1, 2021.
The Senate amendments require DHCS to conduct a study relating
to medical interpretation services.
FISCAL EFFECT: According to the Senate Appropriations
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Committee:
1)One-time costs of $1.4 million to develop program guidelines,
seek necessary federal approvals, and develop billing systems
(50% General Fund (GF), 50% federal funds (FF)).
2)Ongoing administrative costs of about $600,000 per year for
oversight by the DHCS (GF/FF).
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 (GF/FF).
4)Unknown costs in Medi-Cal managed care (GF/FF). Under current
law, health plans are required to provide interpretation
services, including managed care plans that contract with the
DHCS. 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.
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 the bill would be
considered Medi-Cal benefits and would be subject to the
normal federal match.
COMMENTS: According to the author, California has an
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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.
This bill implements a provision in SB 826 (Leno), Chapter 23,
Statutes of 2016 or the Budget Act of 2016. Specifically, SB
826 provides under Provision 14 of Item 4260-101-0001 of Section
2.00 "[o]f the funds appropriated in Schedule (3), $3,000,000 is
for the support of activities related to a medical interpreters
pilot project, study, or both. Expenditure or encumbrance of
these funds is contingent upon the chaptering of future
legislation authorizing the medical interpreters pilot project,
study, or both, and upon approval by the Department of Finance."
Analysis Prepared by:
Rosielyn Pulmano / HEALTH / (916) 319-2097 FN:
0004724
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