BILL ANALYSIS �
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THIRD READING
Bill No: AB 505
Author: Nazarian (D)
Amended: 5/19/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/12/13
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Monning, Wolk
NOES: Anderson, Nielsen
NO VOTE RECORDED: Pavley
SENATE APPROPRIATIONS COMMITTEE : 7-0, 6/24/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 72-0, 5/16/13 - See last page for vote
SUBJECT : Medi-Cal: managed care: language assistance
services
SOURCE : California Pan-Ethnic Health Network
DIGEST : This bill requires all managed care plans contracting
with the Department of Health Care Services (DHCS) to provide
Medi-Cal services, except as specified, to provide language
assistance services, which includes oral interpretation and
translation services, to limited-English-proficient (LEP)
Medi-Cal beneficiaries, as defined. Requires DHCS to determine
when a LEP population meets the requirement for translation
services, as prescribed.
Senate Floor Amendments of 5/19/14 change the threshold for when
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translation services are required for Medi-Cal beneficiaries.
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.Permits the Director of DHCS to contract, on a bid or non-bid
basis, with any qualified individual, organization, or entity
to provide services to, arrange for or case manage the care of
Medi-Cal beneficiaries; permits, at the Director's discretion,
the contract to be exclusive or non-exclusive, statewide or on
a more limited geographic basis, and includes provisions to
provide for delivery of services in a manner consistent with
managed care principles, techniques, and practices directed at
ensuring the most cost-effective and appropriate scope,
duration, and level of care.
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 require all managed care plans contracting
with DHCS that provide Medi-Cal services to provide language
assistance services to LEP beneficiaries who are mandatorily
enrolled in managed care in the following manner:
A. Oral interpretation services in any language on a
24-hour basis at key points of contact.
B. Translation services to the language groups identified
by DHCS.
1.Requires DHCS to determine when an LEP population meets the
requirement for translation services using one of the
following numeric thresholds:
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A. A population group of at least 3,000 or 5% of the
beneficiary population whichever is fewer, mandatory
Medi-Cal beneficiaries, residing in the service area, and
who indicate their primary language as other than English;
or
B. A population group of mandatory Medi-Cal beneficiaries,
residing in the service area, who indicate their primary
language as other than English, and that meet a
concentration standard of 1,000 beneficiaries in a single
ZIP Code or 1,500 beneficiaries in two contiguous ZIP
Codes.
1.Requires DHCS to make this determination if any of the
following occurs:
A. A nonmanaged care county becomes a new managed care
county;
B. A new population group becomes a mandatory Medi-Cal
managed care beneficiary population; or
C. A period of three years has passed since the last
determination.
1.Requires DHCS to instruct managed care plans of the language
groups that meet the numeric threshold by means of
incorporating this requirement into plan contracts, all-plan
letters or similar instructions.
2.Designates a person as "LEP" if an individual speaks English
less than very well.
3.Clarifies that these provisions do not apply to mental health
plans contracting with DHCS.
Background
Percentage of Californians who are LEP and current DHCS
standards . According to the U.S. Census Bureau 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." DHCS'
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Medi-Cal Managed Care Division is responsible for determining
statewide translation threshold languages and their numeric
estimate for Medi-Cal managed care counties. DHCS establishes
the thresholds through its contractual language with plans and
through DHCS-issued All Plan Letters (APLs). Through contract,
DHCS requires its Medi-Cal managed care plans to ensure equal
access to health care services for its members without regards
to a member's proficiency in the English language.
A June 2002 APL, requires plans to provide 24-hour interpreter
service for all LEP members at all provider sites within the
plans' service areas. In addition, plans are required to
provide translation services to their Medi-Cal LEP members based
on certain population levels, which this bill codifies. Plans
must provide interpreter and translation services when a LEP
member population meets a numeric threshold of 3,000 members
residing in its service area. Both services must be provided to
LEP member populations meeting concentration standards of 1,000
members in a single Zip Code, or 1,500 members in two contiguous
Zip Codes. There are currently 13 Medi-Cal threshold languages
(English, Arabic, Armenian, Cambodian, Cantonese, Farsi, Hmong,
Korean, Mandarin, Russian, Spanish, Tagalog, and Vietnamese).
DHCS' APL and contract does not define LEP. This bill defines
LEP as an individual who speaks English less than very well,
which is the definition used by the United States Census.
Prior Legislation
AB 2392 (John A. P�rez, 2012) was substantially similar to AB
1263. The bill died on the Assembly Inactive File.
SB 442 (Calderon, 2011) would have required general acute care
hospital policies for the provision of language assistance to
patients with language or communication barriers to include
procedures for discussing with the patient any cultural,
religious, or spiritual beliefs or practices that may influence
care, and to increase the ability of hospital staff to
understand and respond to the cultural needs of patients.
Additionally, would have required hospitals' policies on
language assistance services to include criteria on proficiency
similar to those that apply to health plans. The bill was
vetoed by Governor Brown.
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SB 1405 (Soto, 2006) would have required the Department of
Health Services (now DHCS) to create the Task Force on
Reimbursement for Language Services, as specified, to develop a
mechanism for seeking federal matching funds from federal
Centers for Medicare and Medicaid Services to pay for language
assistance services, as specified. The bill died on the Senate
Inactive File.
AB 800 (Yee, Chapter 313, Statutes of 2005) requires all health
facilities (hospitals, skilled nursing facilities, intermediate
care facilities, correctional treatment centers) and all primary
care clinics to include a patient's principal spoken language on
the patient's health records.
SB 853 (Escutia, Chapter 713, Statutes of 2003) requires the
Department of Managed Health Care and the Department of
Insurance to adopt regulations to ensure enrollees have access
to language assistance in obtaining health care services.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Ongoing costs likely between $40,000 and $75,000 every three
years to determine the thresholds for translating documents by
Medi-Cal managed care plans by DHCS (50% General Fund, 50%
federal funds).
No significant increased costs for providing interpretation
and translation services are expected. This bill essentially
recodifies existing law and practice.
SUPPORT : (Verified 5/20/14)
California Pan-Ethnic Health Network (source)
100% Campaign
American Civil Liberties Union of California
American Federation of State, County and Municipal Employees,
AFL-CIO
California Association of Public Authorities
California Coverage and Health Initiatives
California Immigrant Policy Center
Children Now
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Children's Defense Fund - California
Children's Partnership
Health Access California
National Association of Social Workers
National Health Law Program
PICO California
Southeast Asia Resource Action Center
Street Level Health Project
United Ways of California
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : This bill is sponsored by the
California Pan-Ethnic Health Network (CPEHN) to strengthen
consumer protections for Medi-Cal managed care enrollees who
speak English less than very well, by codifying existing
language assistance requirements in Medi-Cal managed care.
According to CPEHN, an estimated 6 to 7 million Californians are
LEP and over 1.4 million individuals will be newly eligible for
Medi-Cal, over one-third of whom will speak English less than
very well.
According to the author, this bill achieves the goals of the
federal Affordable Care Act (ACA) to increase access and
availability of health care options and strengthens consumer
protections for Medi-Cal managed care LEP enrollees by codifying
in state law the language assistance requirements in Medi-Cal
managed care. The author's office states language barriers
limit access to health care at every level, from scheduling an
appointment to receiving a medical diagnosis. This bill ensures
that necessary protections for LEP individuals are not lost in
the process of implementing the changes made by the ACA.
ASSEMBLY FLOOR : 72-0, 5/16/13
AYES: Achadjian, Alejo, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Ch�vez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray,
Hagman, Hall, Harkey, Roger Hern�ndez, Jones, Jones-Sawyer,
Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor,
Medina, Mitchell, Mullin, Muratsuchi, Nazarian, Nestande,
Olsen, Pan, Patterson, Perea, V. Manuel P�rez, Quirk,
Quirk-Silva, Rendon, Salas, Skinner, Ting, Torres, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, John A.
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P�rez
NO VOTE RECORDED: Allen, Donnelly, Grove, Holden, Melendez,
Morrell, Stone, Vacancy
JL:e 5/21/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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