BILL NUMBER: AB 2392 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 21, 2012
AMENDED IN ASSEMBLY MAY 25, 2012
AMENDED IN ASSEMBLY APRIL 24, 2012
INTRODUCED BY Assembly Member John A. Pérez
FEBRUARY 24, 2012
An act to add Chapter 13 (commencing with Section 3599.50) to
Division 4 of Title 1 of the Government Code, and to add
Article 4.6 (commencing with Section 14146) to Chapter 7 of Part 3 of
Division 9 of the Welfare and Institutions Code, relating to
Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2392, as amended, John A. Pérez. Medi-Cal: interpreter
services. CommuniCal.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing federal law provides for
increased administrative funding for translation and interpretation
services provided in connection with the enrollment, retention, and
use of services under the Medicaid Program.
This bill would require the department to seek federal funding to
establish a program to provide and reimburse for medical
interpretation services to Medi-Cal beneficiaries who are limited
English proficient. The bill would require the department to leverage
existing funding to fully offset any General Fund costs of the
program, as specified.
This bill would require the department to establish the Medi-Cal
Patient-Centered Communication program (CommuniCal), to be
administered by a 3rd-party administrator, to, commencing July 1,
2013, provide and reimburse for medical interpretation services to
Medi-Cal beneficiaries who are limited English proficient (LEP). This
bill would establish the CommuniCal Program Fund in the State
Treasury, which would consist of moneys dedicated to the CommuniCal
program, to be used upon appropriation by the Legislature to the
department solely to fund the CommuniCal program.
Existing law provides for the certification of administrative
hearing interpreters and medical examination interpreters for
purposes of administrative adjudications.
This bill would require the State Personnel Board to be the
certifying body for CommuniCal certified medical interpreters
(CCMIs), to establish a certifying examination for those
interpreters, and to maintain a registry of those persons who pass
the exam, as specified. Commencing July 1, 2013, the bill would
require Spanish-language interpreters to be required to pass the exam
and be listed on the registry in order to be eligible to provide
services under CommuniCal. The bill would require the State Personnel
Board, by July 1, 2013, to determine appropriate testing, training,
and experience standards for other language interpreters to also be
placed on the registry as CCMIs, as specified. The bill would also
require the State Personnel Board to establish and charge fees that
do not exceed reasonable costs for applicants to take the exam and be
certified and listed in the registry and would require the State
Personnel Board to adopt quality standards and medical interpretation
certification requirements through regulations.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all
of the following:
(a) California has long been recognized as one of the most
racially and linguistically diverse states; the state is home to over
200 languages.
(b) Approximately one in five Californians is limited English
proficient (LEP) and identifies as speaking English less than very
well.
(c) Language access and the right to interpretation services is
required under Title VI of the federal Civil Rights Act of 1964, the
Dymally-Alatorre Bilingual Services Act of 1973 (Chapter 17.5
(commencing with Section 7290) of Division 7 of Title 1 of the
Government Code), the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code), Section 11135 of the Government Code,
Section 1259 of the Health and Safety Code, and California civil
rights law.
(d) The demand for medical interpretation services by Medi-Cal
beneficiaries is significant, with 45.2 percent of Medi-Cal
beneficiaries speaking a language other than English.
(e) The state will experience an even greater demand for language
services as health care reform measures are implemented over the next
few years and 35 percent of Californians expected to become newly
eligible for Medi-Cal as a result of the federal Patient Protection
and Affordable Care Act (Public Law 111-148) will speak English less
than well.
(f) In California, language assistance services are provided in an
uncoordinated manner that lacks transparency and accountability, and
a majority of services are currently provided ad-hoc by family
members and friends or untrained staff.
(g) California has the opportunity to meet the growing demand
early on by accessing millions of dollars in federal matching funds
to provide medical interpretation services to LEP Medi-Cal
beneficiaries.
(h) Professional medical interpretation services help reduce
avoidable medical errors and provider malpractice liability for
physicians and other health care providers.
(i) A coordinated program to offer medical interpreter services
will improve health care outcomes for LEP Californians and help
control health care costs that result from a lack of access to
preventative and primary care.
SEC. 2. It is the intent of the Legislature to do
all of the following:
(a) Create the CommuniCal program, which shall provide reliable
access to language interpretation for Medi-Cal beneficiaries who are
limited English proficient.
(b) Establish a mechanism for accessing federal Medicaid matching
funds to provide a majority of the funding for the CommuniCal
program.
(c) Enable trained and qualified interpreters to meet the demand
for language services for a significant portion of the estimated
three million Medi-Cal beneficiaries with limited English
proficiency.
(d) Facilitate accurate and timely communication between limited
English proficient patients and their health care providers, which
will improve quality of care, reduce medical errors, increase patient
understanding and compliance with health diagnoses and care plans,
and reduce the cost of health care by eliminating waste, such as
unnecessary tests and other care.
SEC. 3. Chapter 13 (commencing with Section
3599.50) is added to Division 4 of Title 1 of the
Government Code , to read:
CHAPTER 13. COMMUNICAL CERTIFIED MEDICAL INTERPRETERS
Article 1. Certification and Registration of CommuniCal
Medical Interpreters
3599.50. (a) For purposes of this chapter, the following
definitions apply:
(1) "CommuniCal" means the Medi-Cal Patient-Centered Communication
program established pursuant to Article 4.6 (commencing with Section
14146) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code.
(2) "CommuniCal certified medical interpreter" or "CCMI" means an
interpreter who has been certified pursuant to Section 3599.51.
(3) "Certifying body" means the State Personnel Board.
(4) "Exam" means the CommuniCal Certified Medical Interpreter
Exam.
(b) Notwithstanding any other law, the State Personnel Board shall
serve as the CommuniCal certified medical interpreter (CCMI)
certifying body. The certifying body shall select an examination
through which competency will be tested and provide for the
certification of Spanish-language medical interpretation within 120
days of the implementation of this bill. The examination shall be
known as the CommuniCal Certified Medical Interpreter Exam. It shall
have both an oral and a written component. The oral component shall
be conducted in person in each of the major metropolitan areas in the
State of California.
3599.51. (a) The certifying body shall select a nonprofit
organization to administer the exam. The nonprofit organization shall
have a statewide presence. A list of all interpreters who pass the
exam shall be maintained by the certifying body and shall be known as
the CommuniCal Certified Medical Interpreter Registry. A CCMI is
someone who has passed the exam, is listed on the registry, and has
been issued a certificate by the certifying body attesting that the
person is a CommuniCal Certified Medical Interpreter.
(b) (1) Commencing July 1, 2013, in order to be eligible to
provide services under CommuniCal, Spanish-language interpreters
shall be required to pass the exam and be listed on the registry.
(2) For those languages of lesser diffusion or languages for which
a recognized medical interpreter exam has not been created, the
certifying body shall, by July 1, 2013, determine, with certified
medical interpreters, appropriate testing, training, and experience
standards for interpreters to also be placed on the registry and
listed as CommuniCal Certified Medical Interpreters.
(3) In order to meet anticipated demand for services under
CommuniCal, all interpreters who have been previously otherwise
certified as medical interpreters by the certifying body within 30
days of the operative date of this chapter shall be immediately
listed on the registry.
3599.52. (a) The certifying body shall establish and charge fees,
which do not exceed the reasonable costs, for applicants to take the
exam. The certifying body shall establish and charge a single fee
that does not exceed the reasonable costs for certification and
listing on the registry. The purpose of these fees is to cover the
annual projected costs of carrying out this article. The fees may be
adjusted each fiscal year by a percent that is equal to or less than
the percent change in the California Necessities Index prepared by
the Commission on State Finance.
(b) Each CCMI shall pay a registry and certification fee, not to
exceed the reasonable costs, for the renewal of the certification and
continued listing on the registry. The registry and certificate fee
shall be due on July 1 of each year.
(c) The certifying body shall establish, maintain, administer, and
publish annually an updated registry of CCMIs. The certifying body
may remove the name of a person from the registry if any of the
following conditions occurs:
(1) The person is deceased.
(2) The person notifies the board that the person is unavailable
for work.
(3) The person does not submit a registry and certification fee or
renewal fee as required by subdivision (b).
(d) For the 2013-14 fiscal year only, the fee for certification
and listing on the registry pursuant to paragraph (3) of subdivision
(b) of Section 3599.51 is waived.
3599.53. The certifying body shall adopt quality standards and
medical interpretation certification requirements through
regulations. It shall determine the testing requirements for
certification in each language and create a list of those languages
where standards permit registration of the interpreter.
SEC. 4. Article 4.6 (commencing with Section
14146) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 4.6. CommuniCal
14146. For the purposes of this article, the following
definitions shall apply:
(a) "CommuniCal" means the Medi-Cal Patient-Centered Communication
program.
(b) "CommuniCal certified medical interpreter" or "CCMI" means an
interpreter certified under the CommuniCal program pursuant to
Article 1 (commencing with Section 3599.50) of Chapter 13 of Division
4 of Title 1 of the Government Code.
(c) "Department" means the State Department of Health Care
Services.
(d) "Medi-Cal managed care organizations" or "MMCOs" means all
models of Medi-Cal managed care, including county-organized health
systems, geographic managed care, and two-plan models.
(e) "Patient-centered communication broker" or "broker" means the
third-party administrator for the CommuniCal program.
14146.10. (a) The department shall establish the CommuniCal
program to provide and reimburse for certified medical interpretation
services to Medi-Cal beneficiaries who are limited English
proficient (LEP).
(b) Commencing July 1, 2013, CommuniCal shall offer medical
interpreter services to Medi-Cal providers serving Medi-Cal
beneficiaries on either a fee-for-service or managed care basis
pursuant to this article.
(c) A health care provider or entity entering into a Medi-Cal
provider agreement or a Medi-Cal managed care contract with the
state, including MMCOs and their subcontracting plans, and
fee-for-service providers, may utilize CommuniCal to provide medical
interpreter services to Medi-Cal beneficiaries.
(d) All contracts between MMCOs and their subcontractors,
including health providers and other health plans, shall include
provisions describing access to CommuniCal medical interpreter
services.
(e) The department shall pursue all available sources of federal
funding to establish and operate CommuniCal and shall seek any
federal approvals necessary to implement this article.
14146.11. CommuniCal shall include the provision of in-person,
telephonic, and video medical interpretation services. To meet
language access requirements and ensure patient safety, in-person
interpreter services shall be the preferred mode of medical
interpretation in the following instances whenever possible:
(a) Family meetings regarding medical care.
(b) Medical encounters involving difficult or agitated patients.
(c) Medical encounters to make treatment decisions.
(d) Obtaining informed consent involving review of documents.
(e) Any medical encounter that, in the physician's judgment,
requires in-person interpretation for the health, safety, or
well-being of the patient.
(f) Psychiatric encounters.
(g) End-of-life discussions.
14146.12. (a) CommuniCal shall be administered by a
patient-centered communication broker.
(b) The department shall create and administer a competitive
Request for Proposals (RFP), and shall execute the resulting
contract.
(c) The broker shall be responsible for all of the following
duties:
(1) Registering CCMIs with Medi-Cal.
(2) Verifying CCMI certification with the State Personnel Board.
(3) Verifying Medi-Cal eligibility for interpreter services
utilizing the state's Medi-Cal Eligibility Data System (MEDS).
(4) Submitting billing summaries to Medi-Cal, aggregating the cost
for services provided.
(5) Ensuring compliance with all Medi-Cal and applicable
CommuniCal reporting requirements.
(6) Making payments to CCMIs, including any dues and service fee
deductions.
(7) Scheduling CCMI appointments with Medi-Cal providers.
(8) Monitoring the quality of CommuniCal interpreter services and
complying with state oversight requirements of the program.
(9) Creating CommuniCal promotional materials for distribution to
Medi-Cal providers, MMCOs, and beneficiaries.
(d) The department shall make all applicable Medi-Cal reporting
requirements known to the broker and shall be responsible for the
broker's compliance with these requirements.
14146.13. (a) Notwithstanding any other law, only interpreters
certified pursuant to Article 1 (commencing with Section 3599.50) of
Chapter 13 of Division 4 of Title 1 of the Government Code may
participate in CommuniCal.
(b) CCMIs shall be responsible for all of the following:
(1) Performing interpreter services independent of other policies,
rules, or procedures of conduct, except as provided by this article
or by applicable law.
(2) Performing interpreter services independent of direction,
except as otherwise provided by this article and applicable law.
(3) Preparing and submitting documentation to the broker in
support of time worked or other services rendered.
(4) Directing and controlling the manner and means of
interpretation services, except as otherwise provided in this
article.
(c) Unless otherwise prohibited by this article or applicable law,
CCMIs may do any of the following:
(1) Advertise, promote, or otherwise communicate availability for
services to clients and the general public.
(2) Provide office space, equipment, support services, forms,
supplies, and business cards, except as otherwise provided in this
article.
14146.14. The department shall issue guidance on the
administration of the CommuniCal program to ensure compliance with
this article and all applicable state and federal laws by all
contractors and subcontractors of the program.
14146.15. (a) The CommuniCal Program Fund is hereby created in
the State Treasury. Notwithstanding Section 16305.7 of the Government
Code, any interest and dividends earned on deposits in the fund
shall be retained in the fund for purposes specified in subdivision
(c).
(b) Moneys in the fund shall consist of any funds dedicated to the
CommuniCal program.
(c) Moneys in the fund shall, upon appropriation by the
Legislature to the department, be used solely to fund the CommuniCal
program.
SECTION 1. It is the intent of the Legislature
to do all of the following:
(a) Create a program that shall provide reliable access to
language interpretation for Medi-Cal beneficiaries who are limited
English proficient.
(b) Establish a mechanism for accessing federal Medicaid matching
funds to provide funding for the program.
(c) Enable trained and qualified interpreters to meet the demand
for language services for a significant portion of Medi-Cal
beneficiaries with limited English proficiency.
(d) Facilitate accurate and timely communication between limited
English proficient patients and their health care providers, which
will improve quality of care, reduce medical errors, increase patient
understanding and compliance with health diagnoses and care plans,
and reduce the cost of health care by eliminating unnecessary tests
and other care.
SEC. 2. Article 4.6 (commencing with Section
14146) is added to Chapter 7 of Part 3 of Division 9 of the Welfare
and Institutions Code, to read:
Article 4.6. Medi-Cal Medical Interpretation Services
14146. (a) The department shall 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.
(b) The program shall offer medical interpreter services to
Medi-Cal providers serving Medi-Cal beneficiaries on either a
fee-for-service or managed care basis pursuant to this article.
(c) A health care provider or entity entering into a Medi-Cal
provider agreement or a Medi-Cal managed care contract with the
state, including Medi-Cal managed care organizations (MMCOs) and
their subcontracting plans, and fee-for-service providers, may
utilize the program to provide medical interpreter services to
Medi-Cal beneficiaries.
(d) All contracts between MMCOs and their subcontractors,
including health providers and other health plans, shall include
provisions describing access to medical interpreter services under
this program.
(e) The department shall pursue all available sources of federal
funding to establish and administer the program and shall seek any
federal approvals necessary to implement this article.
(f) For purposes of this article, the department shall develop a
mechanism to leverage existing sources of funding associated with
medical interpretation services, in order to fully offset state
General Fund costs for the provision of medical interpretation
services and program administration.