BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 388|
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UNFINISHED BUSINESS
Bill No: SB 388
Author: Mitchell (D)
Amended: 7/6/15
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 4/22/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan,
Roth, Wolk
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/1/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 9/3/15 - See last page for vote
SUBJECT: Health care coverage: solicitation and enrollment
SOURCE: California Pan-Ethnic Health Network
DIGEST: This bill makes uniform summary of benefits and
coverage (SBC) information which must be provided to consumers
by health plans and insurers under the federal Affordable Care
Act (ACA) and California law, a vital document, subject to
specified translation requirements commencing October 1, 2016.
This bill requires, not later than July 1, 2016, the Department
of Managed Health Care (DMHC) and the California Department of
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Insurance (CDI), to make available on their Internet Web sites
written translations of the template of uniform SBC, and
specifies the language groups which require translation.
Assembly Amendments (1) delay implementation of the requirement
that the uniform SBC constitute a vital document to October 1,
2016; (2) delay the date the departments must make available on
their Internet Web sites written translations of the template
uniform SBC, as specified, to not later than July 1, 2016; and
(3) require the written translations for all language groups
identified by the State Department of Health Care Services in
all plan letters as of August 27, 2014, for translation
services, as specified, except for any language group for which
the United States Department of Labor has already prepared a
written translation.
ANALYSIS:
Existing law:
1)Requires the DMHC and 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 specified.
3)Includes as vital documents to be translated:
a) Applications.
b) Consent forms.
c) Letters containing important information regarding
eligibility and participation criteria.
d) Notices pertaining to the denial, reduction,
modification, or termination of services and benefits, and
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the right to file a grievance or appeal.
e) Notices advising limited-English-proficient (LEP)
persons of the availability of free language assistance and
other outreach materials that are provided to enrollees.
4)Excludes as vital documents, explanation of benefits or
similar claims processing information that are sent to
enrollees or insureds, unless the documents require a response
by the enrollee or insured.
5)Requires the translation of specified documents, including the
uniform SBC, if a health plan or health insurer advertises or
markets products in a non-English language that is not a
threshold language or allows any other person or business to
market or advertise on its behalf. This applies to health
plan and health insurance products advertised or marketed in
the individual and small group market.
6)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.
7)Requires under the ACA, health insurance issuers to provide
uniform SBC information.
8)Permits, under state law, a health plan subject to the ACA
uniform SBC 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
emergency services, in any amount that the health plan is
obligated to pay, beyond the enrollee's copayments,
coinsurance, and deductibles as provided in the enrollee's
health plan contract.
9)Requires on and after January 1, 2014, a disability insurer
offering health insurance coverage subject to the ACA uniform
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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, commencing October 1, 2016, the uniform SBC information
required under the ACA and state law, a vital document, as
specified.
2)Requires, not later than July 1, 2016, DMHC and CDI, to make
available on their Internet Web sites written translations of
the template of uniform SBC, for all language groups
identified by the State Department of Health Care Services in
all plan letters as of August 27, 2014, for translation
services, as specified, except for any language group for
which the United States Department of Labor has already
prepared a written translation.
3)Requires not later than July 1, 2016, the departments to make
available on its Internet Website written translations of the
template uniform SBC developed by the departments, and written
translations prepared by the United States Department of
Labor, if available, for any language group, as specified.
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% or more of the population
residing in a consumer's county. By contrast, California law
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requires a "vital" document to be translated when a 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 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, the DMHC has not noted any trend
toward non-compliance with the regulation. DMHC also makes
available on its Web site 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
5% of the beneficiary population, whichever is lower, in an
identified geographic area. 13 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%)
and was represented in the greatest number of counties (49).
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Los Angeles has the greatest number of threshold languages
(12) of any county.
3)ACA SBC. Amendments to the Public Health Service Act, made by
the ACA direct the federal Departments of Labor, Health and
Human Services, and the Treasury to develop standards for use
by a group health plan (which includes both 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% 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. 25 California counties
meet the 10% threshold requirement to translate SBCs in
Spanish. Those counties are: Colusa, Fresno, Glenn,
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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% threshold requirement to translate
SBCs in Chinese.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Appropriations Committee:
1)Estimated one-time costs of $350,000 (Managed Care Fund) to
DMHC for translation, policy development, and technical
assistance to plans regarding issues related to using the
templates.
2)Similar one-time costs for similar activities at CDI, as well
as $60,000 ongoing to ensure compliance (Insurance Fund).
SUPPORT: (Verified9/3/15)
California Pan-Ethnic Health Network (source)
American Cancer Society-Cancer Action Network
American Federation of State, County and Municipal Employees,
AFL-CIO
Asian Law Alliance
California Council of the Service Employees International Union
California Immigrant Policy Center
California State Council of the Service Employees International
Union
Community Health Councils
Consumers Union
Guam Communications Network
Having Our Say Coalition
Latino Coalition for a Healthy California
National Health Law Program
Planned Parenthood
SEIU California
Southeast Asia Action Resource Center
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Western Center on Law & Poverty
OPPOSITION: (Verified9/3/15)
None received
ARGUMENTS IN SUPPORT: California Pan-Ethnic Health Network
(CPEHN), this bill's sponsor, writes this bill is necessary
because California residents speak over 100 different languages
and more than 40% 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 10 languages that meet language access thresholds
under California law, 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. Only six QHPs are providing SBCs in
Chinese upon request even though seven are required to and only
three are providing SBCs in Vietnamese upon request even though
five are required to and none are providing SBCs in Korean even
though one is required. 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.
ASSEMBLY FLOOR: 79-0, 9/3/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
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Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Beth Gaines
Prepared by: Teri Boughton / HEALTH /
9/3/15 18:23:02
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