BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 2392
Author: John A. Pérez (D)
Amended: 8/21/12 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 6/27/12
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio, Wolk
NOES: Harman, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 5-2, 8/16/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton
ASSEMBLY FLOOR : 52-24, 5/30/12 - See last page for vote
SUBJECT : Medi-Cal: interpreter services
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to 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 (LEP).
Senate Floor Amendments of 8/21/12 establish the State
Personnel Board (SPB) as the certifying body for the
CommuniCal certified medical interpreter (CCMI) program
established by this bill, and require the DHCS to establish
the CommuniCal program to provide and reimburse for
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certified medical interpretation services to Medi-Cal
beneficiaries who are LEP.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, which is administered
by DHCS, under which qualified low-income individuals
receive health care services.
2. Provides, under federal law, increased federal matching
funding for translation and interpretation services
provided in connection with the enrollment, retention,
and use of services under Medicaid (Medicaid is known as
Medi-Cal in California) and the Children's Health
Insurance Program (CHIP is known as the Healthy Families
Program in California).
3. 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.
This bill:
1. Requires DHCS to seek federal funding to establish a
program to provide and reimburse for certified medical
interpretation services to Medi-Cal beneficiaries who
are LEP.
2. Requires the program to offer medical interpreter
services to Medi-Cal providers serving Medi-Cal
beneficiaries on either a fee-for-service (FFS) or
managed care basis, pursuant to this bill.
3. Permits 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), MMCO subcontracting plans, and
FFS providers, to utilize the program to provide medical
interpreter services to Medi-Cal beneficiaries.
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4. Requires all contracts between MMCOs and their
subcontractors, including health providers and other
health plans, to include provisions describing access to
medical interpreter services under this program.
5. Requires DHCS to pursue all available sources of federal
funding to establish and administer the medical
interpretation program and to seek any federal approvals
necessary to implement this bill.
6. Requires DHCS to develop a mechanism to leverage
existing sources of funding associated with medical
interpretation services, in order to fully offset state
General Fund (GF) costs for the provision of medical
interpretation services and program administration.
7. Establishes the SPB as the certifying body for the CCMI
program established by this bill, and requires the DHCS
to establish the CommuniCal program to provide and
reimburse for certified medical interpretation services
to Medi-Cal beneficiaries who are LEP.
8. States legislative intent to do all of the following:
A. Create a program that provides reliable access to
language interpretation for Medi-Cal beneficiaries
who are LEP;
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 LEP Medi-Cal beneficiaries; and
D. Facilitate accurate and timely communication
between LEP 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.
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Background
Enhanced federal matching funds for translation and
interpretation services . Children's Health Insurance
Program Reauthorization Act of 2009 (CHIPRA), Public Law
111-3, enacted on February 4, 2009, contains provisions
that affect both CHIP and Medicaid. In July 2010, the
Centers for Medicare and Medicaid Services (CMS) provided
guidance on the implementation of Section 201(b) of CHIPRA,
which provides increased administrative funding for
translation or interpretation services provided under CHIP
and Medicaid. Under Medicaid, increased federal funding
for translation and interpretation services available under
CHIPRA is limited to children and family members of those
children. Under CHIP, increased federal funding for
translation and interpretation services is not just limited
to children, and includes pregnant women receiving CHIP
coverage.
Prior to CHIPRA, states could claim federal matching funds
for translation or interpretation costs as either an
administration expense or as a medical assistance-related
expense, and were reimbursed at the standard Federal
Medical Assistance Percentage (regular FMAP) rate (which is
typically 50% in California for Medi-Cal and 65% for the
Healthy Families Program).
CHIPRA provides increased federal matching funding for
translation or interpretation services provided to eligible
individuals for whom English is not their primary language.
The increased federal match for translation or
interpretation services differs for Medicaid and CHIP. For
Medicaid, the increased match is 75% of allowable
expenditures. For CHIP, the increased match is 75%, or the
state's enhanced FMAP plus 5%, whichever is higher (in
California, it would be 75%). However, the increased
federal match is only available for eligible expenditures
claimed as administration of the Medicaid or CHIP plan, not
expenditures claimed for benefits (which are matched at the
state's usual FMAP rate of 50% for Medi-Cal and 65% for
CHIP). In addition, the expenditures that qualify for the
increased match under CHIP are subject to the 10% cap on
administrative expenditures.
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Federal anti-discrimination law . Title VI of the Civil
Rights Act of 1964 and its implementing regulations provide
that no person shall be subject to discrimination on the
basis of race, color, or national origin under any program
or activity that receives federal financial assistance.
Each federal department has a civil rights office that is
charged with ensuring that its programs are free of
discrimination. The federal Department of Health and Human
Services (HHS) Office for Civil Rights (OCR)
responsibilities include enforcing the Civil Rights Act,
the Americans with Disabilities Act, and the Age
Discrimination Act. Any organization or individual who
receives monies through HHS-health departments, health
plans, social service agencies, nonprofits, hospitals,
clinics, and physicians-is subject to OCR oversight. The
OCR has the authority to investigate complaints related to
linguistic barriers, to initiate its own reviews, and to
withhold federal funds for noncompliance.
OCR policy guidance . CMS issued a State Medicaid Director
letter on August 31, 2000, that informed states of the
policy guidance that the OCR had issued on the prohibition
against national origin discrimination as it affects
persons with LEP, pursuant to Title VI of the Civil Rights
Act of 1964.
OCR Policy Guidance requires recipients of federal
assistance to take reasonable steps to ensure meaningful
access to their programs and activities by LEP persons.
The Guidance explains that the obligation to provide
meaningful access is fact-dependent and starts with an
individualized assessment that balances four factors: (1)
the number or proportion of LEP persons eligible to be
served or likely to be encountered by the program or
grantee; (2) the frequency with which LEP individuals come
into contact with the program; (3) the nature and
importance of the program, activity or service provided by
the recipient to its beneficiaries; and (4) the resources
available to the grantee/recipient and the costs of
interpretation/ translation services. CMS states there is
no "one size fits all" solution for Title VI compliance
with respect to LEP persons, and what constitutes
"reasonable steps" for large providers may not be
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reasonable where small providers are concerned.
Data on language in California . According to the U.S.
Census' 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/27/12)(per Senate Health Committee
analysis)
AFSCME, AFL-CIO
California Academy of Family Physicians
California Communities United Institute
California Pan-Ethnic Health Network (in concept)
Children Now
Children's Defense Fund - California
Congress of California Seniors
Disability Rights California
Health Access California
Latino Coalition for a Healthy California
National Association of Social Workers - California Chapter
The Children's Partnership
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : Western Center on Law and Poverty
states this bill assists California in drawing down
additional federal funds for the interpreter services
Medi-Cal providers and plans are required to provide.
While Medi-Cal managed care plan rates include funds for
interpreter services and some providers draw down federal
funds for language services (such as hospitals), California
is leaving federal dollars on the table that it could use
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to provide these critical services.
AFSCME, AFL-CIO writes that, with the expansion of Medi-Cal
and the implementation of the California Health Benefit
Exchange under federal health care reform, the state has a
clear opportunity to create an interpreters' program that
will allow patients and providers to clearly communicate
with each other. AFSCME states that, during these
difficult fiscal times, the state should seek to maximize
all federal dollars to help the Medi-Cal program, and
matching funds for health care interpretation will help our
state respond to the needs of LEP Californians.
Health Access California writes that professional
interpreters trained in medical interpretation are critical
as medical terminology is not readily translated, cultural
sensitivity is lost, and avoidable medical errors occur.
ASSEMBLY FLOOR : 52-24, 5/30/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Dickinson, Eng, Feuer, Fong, Fuentes, Furutani,
Galgiani, Gatto, Gordon, Hall, Hayashi, Roger Hernández,
Hill, Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma,
Mendoza, Mitchell, Monning, Nestande, Pan, Perea, V.
Manuel Pérez, Portantino, Skinner, Solorio, Swanson,
Torres, Wieckowski, Williams, Yamada, John A. Pérez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Beth Gaines, Garrick, Gorell, Grove, Hagman, Harkey,
Jeffries, Jones, Knight, Logue, Mansoor, Miller, Morrell,
Nielsen, Norby, Olsen, Silva, Smyth, Wagner
NO VOTE RECORDED: Davis, Fletcher, Halderman, Valadao
CTW:k 8/22/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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