BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 388
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|AUTHOR: |Mitchell |
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|VERSION: |February 25, 2015 |
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|HEARING DATE: |April 22, 2015 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Solicitation and enrollment
SUMMARY :
1.Makes uniform summary of benefits and coverage information,
which must be provided to consumers by health plans and
insurers under the federal Affordable Care Act and state law,
a vital document and therefore subject to translation
requirements. Requires, not later than January 1, 2016, the
Department of Managed Health Care and the California
Department of Insurance, to make available on their Internet
Websites written translations of the template of uniform
summary of benefits and coverage, and requires the departments
to consider existing law in developing the translations.
Existing law:
1.Requires the Department of Managed Health Care (DMHC) and the
California Department of Insurance (CDI) to develop and adopt
regulations establishing standards and requirements to provide
health plan enrollees and insureds with appropriate access to
language assistance in obtaining health care services.
2.Requires DMHC and CDI to require every health plan,
specialized health plan, health insurer and specialized health
insurer to assess the linguistic needs of the enrollee or
insured population, excluding Medi-Cal enrollees, and to
provide for translation and interpretation for medical
services, including translating vital documents in threshold
languages based on the size of enrollment and the needs
assessment, as required.
a. Includes as vital documents to be translated:
i. Applications;
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ii. Consent forms;
iii. Letters containing important
information regarding eligibility and
participation criteria;
iv. Notices pertaining to the denial,
reduction, modification, or termination of
services and benefits, and the right to file a
grievance or appeal; and,
v. Notices advising
limited-English-proficient persons of the
availability of free language assistance and
other outreach materials that are provided to
enrollees.
b. Excludes as vital documents, explanation of
benefits or similar claims processing information that
is sent to enrollees or insureds, unless the document
requires a response by the enrollee or insured.
3.Requires a health plan or health insurer that advertises or
markets products in the individual or small group markets, or
allows any other person or business to market or advertise on
its behalf in the individual or small group markets, in a
non-English language that does not meet specified requirements
related to vital documents to translate specified documents in
the same non-English language, including, the uniform summary
of benefits and coverage (SBC), as specified.
4.Establishes multiple consumer disclosure requirements on
health plans, including a requirement related to individual
and small group products, for a uniform health plan benefits
and coverage matrix containing the plan's major provisions in
order to facilitate comparisons between plan contracts.
Establishes consumer disclosures on disability insurers
offering health insurance coverage.
5.Requires, under the federal Affordable Care Act (ACA), health
insurance issuers to provide uniform SBC information.
6.Permits a health plan subject to the ACA uniform SBC
requirement to satisfy state requirements for a uniform health
plan benefits and coverage matrix if all applicable benefit
disclosure requirements are met in other health plan
documents, and, if applicants and enrollees are advised that
enrollees are not financially responsible in the payment of
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emergency services, in any amount that the health plan is
obligated to pay, beyond the enrollee's cost sharing
requirements.
7.Requires on and after January 1, 2014, a disability insurer
offering health insurance coverage subject to the ACA uniform
SBC to ensure that all applicable disclosures are met in other
documents provided to policyholders and insureds. Requires
the uniform SBC to be provided to the Insurance Commissioner
together with the corresponding health insurance policy
information, as specified.
This bill:
1.Makes the uniform SBC information required under the ACA and
state law, a vital document, as specified.
2.Requires, not later than January 1, 2016, DMHC and CDI, to
make available on their Internet Websites written translations
of the template of uniform SBC, and requires the departments
to consider existing law in developing the translations.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, the ACA requires
health plans and insurers to provide consumers with an easy-to
understand SBC to help them evaluate and compare their health
insurance options. The SBC includes key features of coverage
such as covered benefits, cost-sharing provisions, and
coverage limitations as well as a standard glossary of terms.
The ACA requires this information to be provided in a
"culturally and linguistically appropriate manner."
Unfortunately, federal standards on translating the SBC are
inconsistent with California's translation requirements. The
federal rule states that the document should be translated
into languages spoken by 10 percent or more of the population
residing in a consumer's county. By contrast, California law
requires a "vital" document to be translated when a limited
English proficient (LEP) population is a certain percent of
the plan's enrollment. SB 388 makes clear that translation of
the SBC must be consistent with California's current language
access laws, helping to ensure that Californians are informed
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about their health coverage options and have equal access to
critical information about their healthcare.
2.California Language Access. California health plans are
required to provide language assistance services, including
translation and interpretation services, to LEP enrollees. The
regulation became effective on January 1, 2009. The DMHC
Division of Plan Surveys monitors compliance with the
regulation in its routine medical survey process, which takes
place at least every three years for each health plan. In
addition, the DMHC tracks complaints filed with its Help
Center to identify trends in compliance with the regulation.
According to a report to the Legislature issued by DMHC for
the January 2011-December 2012 period, DMHC completed 38
routine medical surveys during the reporting period. While
deficiencies were cited, those deficiencies were corrected,
and to date there have been no serious concerns identified
through medical surveys. Likewise, there have been few
complaints to the DMHC Help Center. One action by the DMHC
Office of Enforcement resulted in a $2,500 fine for failing to
translate a vital document. Overall, DMHC has not noted any
trend toward non-compliance with the regulation. An update to
this report is forthcoming. DMHC also makes available on its
website threshold languages by health plan. For example
Molina Health Care of California has the following threshold
languages identified: English, Spanish, Vietnamese, Chinese,
Russian, and Hmong.
Medi-Cal defines threshold language as a language that has been
identified as the primary language of 3,000 beneficiaries or
five percent of the beneficiary population, whichever is
lower, in an identified geographic area. Thirteen distinct
languages qualify as threshold languages, according to a May
2014 Medi-Cal statistical brief. Those languages are:
Spanish, Vietnamese, Cantonese, Armenian, Russian, Mandarin,
Tagalog, Korean, Arabic, Hmong, Farsi, Cambodian, and other
Chinese. Spanish is the most frequently occurring, threshold
language (34.5 percent) and was represented in the greatest
number of counties (49). Los Angeles has the greatest number
of threshold languages (12) of any county.
3.ACA SBC. The ACA directs the federal Departments of Labor,
Health and Human Services (HHS), and Treasury to develop
standards for use by a group health plan (which includes both
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insured and self-insured plans) and a health insurance issuer
offering group or individual health insurance coverage in
compiling and providing a SBC that ''accurately describes the
benefits and coverage under the applicable plan or coverage,''
and also calls for the ''development of standards for the
definitions of terms used in health insurance coverage.'' The
ACA requires group health plans and health insurance issuers
offering group and individual coverage to provide the SBC and
uniform glossary in a culturally and linguistically
appropriate manner.
The regulations indicate a group health plan and a health
insurance issuer offering group or individual health insurance
coverage are considered to provide relevant notices in a
culturally and linguistically appropriate manner if the plan
or issuer provides oral language services (such as a telephone
customer assistance hotline) that include answering questions
in any applicable non-English language and providing
assistance with filing claims and appeals (including external
review) in any applicable non-English language. Additionally,
the plan or issuer must provide, upon request, a notice in any
applicable non-English language; and, the plan or issuer must
include in the English versions of all notices, a statement
prominently displayed in any applicable non-English language
clearly indicating how to access the language services
provided by the plan or issuer. The regulations require these
plans and issuers to make certain accommodations for notices
sent to an address in a county meeting a threshold percentage
of people who are literate only in the same non-English
language. This threshold percentage is set at 10 percent or
more of the population residing in the claimant's county, as
determined based on American Community Survey data published
by the United States Census Bureau. Twenty-five California
counties meet the 10 percent threshold requirement to
translate SBCs in Spanish. Those counties are: Colusa,
Fresno, Glenn, Imperial, Kern, Kings, Los Angeles, Madera,
Merced, Monterey, Napa, Orange, Riverside, San Benito, San
Bernardino, San Diego, San Joaquin, San Mateo, Santa Barbara,
Santa Cruz, Stanislaus, Sutter, Tulare, Ventura and Yolo. One
county (San Francisco) meets the 10 percent threshold
requirement to translate SBCs in Chinese.
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4.Prior legislation.
a. SB 353 (Lieu), Chapter 447, Statutes of 2013,
requires the translation of specified documents by
trained and qualified translators when a health plan,
insurer, or any other person or business markets or
advertises health insurance products in the individual or
small group markets in a non-English language that is not
a threshold language under existing law.
b. SB 853 (Escutia), Chapter 713, Statutes of 2003,
required DMHC to adopt, not later than January 1, 2006,
regulations establishing standards and requirements to
provide health plan enrollees with access to language
assistance in obtaining health care services.
5.Support. This bill is sponsored by the California Pan-Ethnic
Health Network (CPEHN) because in California residents speak
over 100 different languages and more than 40 percent speak a
language other than English at home. Although federal law
requires the SBC to be provided in a culturally and
linguistically appropriate manner, the federal definition
differs from California's long-standing language access
requirements. The federal standard for California counties
requires translation into two languages, Spanish and Chinese
(only in San Francisco). CPEHN writes, in California there
are ten languages that meet language access thresholds under
California law: Spanish, Vietnamese, Chinese, Korean,
Tagalog, Russian, Armenian, Khmer, Arabic and Hmong, with
Spanish, Chinese, and Vietnamese being the most commonly
required language for translations. CPEHN informally surveyed
Covered California Qualified Health Plans (QHPs) and found
only seven QHPs are providing SBCs in Spanish upon request
even though nine are required by law. Only six QHPs are
providing SBCs in Chinese upon request even though seven are
required by law, only three are providing SBCs in Vietnamese
upon request even though five are required by law, and none
are providing SBCs in Korean even though one is required to by
law. CPEHN also states that most QHPs are using the federal
SBC template, which only includes taglines for where to access
language assistance services in the four federally required
non-English languages: Spanish, Chinese, Navajo, and Tagalog.
This list is not representative of California's demographics.
Additionally, this bill would require DMHC and CDI to post
online a standard translated glossary of terms. Currently
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different glossaries are being used and the federal glossary
is only available in the four federally required non-English
languages.
6.Requested Amendments. The California Association of Health
Plans (CAHP) believes this bill is duplicative of information
currently translated in the matrix and that clarification is
needed to ensure that plans are only required to translate one
document summarizing coverage. They also ask that this bill
be implemented six months after the revised federal SBC
template is published.
7.Amendments. The author requests the committee adopt the
following amendment on page 6, line 2 and page 7, line 38
(revised to apply to CDI regulated health insurance).
(B) The uniform summary of benefits and coverage referenced in
this paragraph shall constitute a vital document for the
purposes of Section 1367.04. Not later than January 1, 2016,
the department shall make available on its Internet Web site
written translations of the template uniform summary of
benefits and coverage. In developing the translations, the
department shall consider subdivision (c) of Section 1367.04.
This requirement is in addition to the requirements of Section
1367.041.
SUPPORT AND OPPOSITION :
Support: California Pan-Ethnic Health Network (sponsor)
Asian Law Alliance
California State Council of the Service Employees
International Union
Consumers Union
Guam Communications Network
Having Our Say Coalition
National Health Law Program
Planned Parenthood Affiliates of California
Southeast Asia Resource Action Center
Western Center on Law and Poverty
Oppose: None received
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