BILL ANALYSIS Ó
AB 2325
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GOVERNOR'S VETO
AB 2325 (John A. Pérez)
As Amended June 12, 2014
2/3 vote
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|ASSEMBLY: |53-25|(May 28, 2014) |SENATE: |24-10|(August 28, |
| | | | | |2014) |
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|ASSEMBLY: |54-24|(August 28, | | | |
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Original Committee Reference: HEALTH
SUMMARY : Requires the California Department of Health Care
Services (DHCS) to establish the Medi-Cal Patient-Centered
Communication Program, called CommuniCal, to provide and
reimburse for medical interpretation services to Medi-Cal
beneficiaries who are limited English proficient (LEP).
Establishes a certification process and registry of CommuniCal
interpreters at DHCS and grants CommuniCal interpreters
collective bargaining rights with the state.
The Senate amendments were minor and technical.
FISCAL EFFECT : According to the Senate Appropriations Committee
this bill would have:
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 (PERB) (GF).
3)One-time costs of about $90,000 and ongoing costs of about
$50,000 per year to oversee an election by translators to
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choose a collective bargaining agent by the PERB (GF).
4)Periodic costs up to $1 million for negotiating a memorandum
of understanding with the established bargaining unit and
overseeing the implementation by the Department of Human
Resources (GF).
5)Ongoing costs of about $37 million per year to provide
translation services in fee-for-service Medi-Cal, based on
estimates of the existing Medi-Cal fee-for-service LEP
population (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 this 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. Similarly, the bill
requires in-person translation to be the preferred method of
communication in many instances. Under current practice, many
providers in the managed care system make use of telephone
interpretation services. To the extent that providers switch
to in-person translation services, costs are likely to
increase.
7)The federal financial participation rate for the costs above
may vary. Generally, the federal government pays for 50% of
Medi-Cal costs. However, the federal government pays an
increase reimbursement rate the former Health Families
population is 65%. Finally, for the Medi-Cal expansion
population, the federal government pays 100% of the cost,
declining to 90% by 2020. (Federal law allows for a 75% match
for certain costs of interpretation that are considered
administrative costs. However, DHCS indicates that the
provision of interpretation services under this bill would be
considered Medi-Cal benefits and would be subject to the
normal federal match.)
COMMENTS : According to the author, more than 40% of
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Californians speak a language other than English at home.
Almost 7 million Californians are estimated to speak English
"less than very well." Research finds language barriers
contribute to inadequate patient evaluation and diagnosis, lack
of appropriate and/or timely treatment, or other medical errors
that jeopardize patient safety and lead to unnecessary
procedures. The author notes, language assistance in medical
settings is often provided by untrained staff or by family
members or friends.
According to the United States 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."
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.
Title VI of the Civil Rights Act of 1964 provides 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. The federal Department of Health
and Human Services (HHS) Office for Civil Rights (OCR) has
responsibility for enforcing the Civil Rights Act for HHS as
well as 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.
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 Centers for
Medicare and Medicaid Services states there is no set 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.
The American Federation of State, County and Municipal Employees
argue that communication is critical to quality of care and
cultural competency in our state's Medicaid program. With the
expansion of Medi-Cal and the exchange market under the federal
Patient Protection and Affordable Care Act, the state has an
opportunity to create a program that will allow patients and
providers to communicate with each other. The United Domestic
Workers state by expanding patient access to medical
interpreters the state will improve the quality and coordination
of care in our state's Medi-Cal program. The Western Center on
Law and Poverty supports this bill because the implementation of
the CommuniCal program would create a system that provides
high-quality language assistance to beneficiaries.
The California Healthcare Interpreting Association supports this
bill because it sets minimum standards for healthcare
interpreting and provides federal funding streams and payment
mechanisms for providing language assistance in Medi-Cal. They
are concerned this bill emphasizes in-person interpreting, an
approach they argue may be unworkable at certain settings based
on frequency of need and the language required. In addition,
the association argues staff interpreters may be more
cost-effective than hiring outside contractors.
The National Right to Work Committee (NRW Committee) opposes
this bill because it will grant union bosses monopoly bargaining
powers over virtually all interpreters operating under the
program, stripping every one of these individuals of the
fundamental right to negotiate for themselves. According to the
NRW Committee, if this bill passes, independent contractors
would be forced to accept union boss representation and would
then have union dues stripped from their compensation and
transferred straight to the treasury of the big labor
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representative they didn't want.
GOVERNOR'S VETO MESSAGE :
Assembly Bill 2325 would require the Department of
Health Care Services to establish the CommuniCal
program to certify and restructure current interpreter
services provided under Medi-Cal, and afford certified
interpreters collective bargaining rights.
Last year, I vetoed these same provisions because
California had embarked on an unprecedented expansion
of our Medi-Cal program and I did not believe it wise
to introduce more complexity given the many unknowns
the state was facing. Since then, our challenges have
neither diminished in number or difficulty. We are
still in the throes of managing new enrollments, new
renewals and expanding provider networks.
In reconsidering this measure, however, it appears
that this bill contains more liabilities than were
previously known. The provisions governing collective
bargaining go above and beyond what public employees
enjoy and potentially create new scopes of
representation and litigation.
To the extent that interpretation services under
Medi-Cal are insufficient, we should work together on
appropriate cost-effective initiatives to help
patients in need. I'm weary at this time of adding
significant new costs to the Medi-Cal program when
already in the last two years Medi-Cal General Fund
spending has grown almost $2.5 billion.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0005692
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