BILL ANALYSIS Ó
AB 1263
Page 1
GOVERNOR'S VETO
AB 1263 (John A. Pérez)
As Amended July 10, 2013
2/3 vote
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|ASSEMBLY: |55-23|(May 29, 2013) |SENATE: |25-9 |(September 11, |
| | | | | |2013) |
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|ASSEMBLY: |53-24|(September 11, | | | |
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Original Committee Reference: HEALTH
SUMMARY : Establishes the Medi-Cal Patient Centered
Communication (CommuniCal) program at the Department of Health
Care Services (DHCS) to provide and reimburse for certified
medical interpretation services to limited English proficient
(LEP) Medi-Cal enrollees. Establishes a certification process
and registry of CommuniCal medical interpreters (CCMI) at DHCS
and grants collective bargaining rights with the state.
The Senate amendments :
1)Revise the certifying body to be DHCS instead of the
California Department of Human Resources (CalHR).
2)Require DHCS to establish a Community Advisory Committee as
specified
3)Require DHCS to, by September 1, 2014, in consultation with
the Community Advisory Committee, approve an examination and
certification process to test and certify the competency of
medical interpreters and delete the requirement that CalHR
select an examination within 120 days of implementation of
this bill.
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4)Require DHCS to develop, monitor, and evaluate interpreter
competency, qualifications, training, certification, and
continuing education requirements for medical interpreters.
5)Add the following options as a condition of certification, in
addition to an examination administered by a nonprofit
organization:
a) Pass an examination developed by a state-established
language testing and certification program with a written
and oral component that meets specified standards;
b) Achieve the designation of Certified Healthcare
Interpreter from the Certification Commission for
Healthcare Interpreters;
c) Achieve the designation of Certified Medical Interpreter
from the National Board of Certification for Medical
Interpreters; or,
d) Hold a current interpreter's certification under
existing provisions.
6)Add a process for authorizing CommuniCal services to be
provided by an interpreter of languages of lesser diffusion or
languages for which a CCMI examination has not been created.
7)Revise requirements for a provisional authorization that allow
interpreters to be authorized prior to the development of the
full testing and certification program at DHCS and require the
person meet the full standards by December 31, 2016.
8)Delete the requirement that the base reimbursement rate be set
at $60 per hour and instead provide that it be subject to
collective bargaining.
9)Make other technical and clarifying changes.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
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1)One-time costs of $1.4 million to develop program guidelines,
seek necessary federal approvals, and develop billing systems
(50% General Fund (GF), 50% federal funds).
2)One-time costs of about $50,000 to develop regulations
relating to collective bargaining of translators by the Public
Employment Relations Board (GF).
3)One-time costs of about $90,000 and ongoing costs of about
$50,000 to oversee an election by translators to choose a
collective bargaining agent (GF).
4)Periodic costs up to $1 million for negotiating a memorandum
of understanding with the established bargaining unit and
overseeing the implementation by CalHR (GF).
5)Ongoing costs of about $30 million per year to provide
translation services in fee-for-service Medi-Cal (GF and
federal funds).
6)Unknown costs in Medi-Cal managed care (GF and federal funds).
Under current law, health plans are required to provide
interpretation services, including managed care plans that
contract with DHCS. It is unclear whether the bill's
requirement to provide "certified medical interpretation
services" at reimbursement rates subject to collective
bargaining would increase costs for translation services,
above the costs already being incurred.
7)The federal financial participation rate for the costs above
may vary. For interpretive services provided to children and
their family members, the state can claim a 75% federal
financial participation rate. However, those costs are only
eligible for a 75% federal cost share if they are billed as
administrative costs (as opposed to benefits). For childless
adults, the rate is generally 50%.
COMMENTS : According to the author, this bill is to establish a
program to provide and reimburse for medical interpretation
services to LEP Medi-Cal enrollees and to allow for collective
bargaining for certified medical interpreters. The author cites
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data that show more than 40% of Californians speak a language
other than English at home. In addition, almost seven million
Californians are estimated to speak English "less than very
well." Other research finds that language barriers can
contribute to inadequate patient evaluation and diagnosis, lack
of appropriate and/or timely treatment, or other medical errors
that can jeopardize patient safety and lead to unnecessary
procedures and costs. The author argues that today, language
assistance in medical settings is provided by trained or
untrained staff or in an informal manner by family members or
friends. In conclusion, the author states that California has
an opportunity to develop a more comprehensive language
assistance program by seeking additional federal funding for
medical interpreter services in the Medi-Cal program.
Supporters such as Interpreting for California, The Low-Income
Self-Help Center and Catholic Charities of Santa Clara County,
write that this bill address the need for interpreters in
Medi-Cal as the state will experience greater demand when 35% of
the newly eligible enrollees speak English less than well.
These supporters state that this bill will make it possible for
the 2.5 million Medi-Cal enrollees who are LEP to communicate
with healthcare providers, reducing medical errors and improving
the standard of care by providing access to trained
interpreters. Other supporters such as The American Federation
of State, County and Municipal Employees, AFL-CIO and Somos
Mayfair writes in support 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.
According to these supporters, in 2003 California passed the
strongest law in the country requiring all private health plans
to provide language assistance services to LEP individuals
beginning in 2009. However, the supporters assert, patient
interpretation needs remain unmet despite these laws and
explicit policy directives to Medi-Cal managed care plans to
provide interpreter services. According to the Transnational
Institute for Grassroots Research and Action (TIGRA), LEP
Californians frequently reported problems related to their
experience of care. TIGRA asserts that LEP enrollees of the
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state's seven largest health plans were more likely than English
proficient enrollees to report problems understanding their
physician (1.2% versus 2.6%) and believe they would have
received better care if they were of a different race/ethnicity
(14% versus 3.2%).
GOVERNOR'S VETO MESSAGE :
"The bill would require the Department of Health Care Services
to establish the CommuniCal program to certify and restructure
current interpreter services provided under Medi-Cal.
"California has embarked on an unprecedented expansion to add
more than a million people to our Medi-Cal program. Given the
challenges and the many unknowns the state faces in this
endeavor, I don't believe it would be wise to introduce yet
another complex element."
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0002914