Action Alerts

Action Alert on AB 154

Support letters needed for AB 154 -Cultural and Linguistic Competency in Medi-Cal and Healthy Families

(click here for a draft of this California Assembly Bill)
(click here for a Fact Sheet on AB 154)

This bill, introduced into the California State Assembly by Assemblywoman Wilma Chan would require health plans participating in the Healthy Families Program and Medi-Cal to report on their compliance with language assistance and cultural competency policies.

Action Required: Please fax a letter of support on your organization's letterhead.
Click here for a sample letter for your use.
 

 Background:

From: Ernest Tai [mailto:ETai@apiahf.org]
Policy Director, Asian & Pacific Islander American Health Forum
Sent: Tuesday, February 25, 2003 3:06 PM

Hello Advocates,

I found out yesterday that the Health Forum's new bill, A.B. 154, is being heard by the Assembly Health Committee this coming Tuesday, March 4th, at 1:30 p.m. in Room 4202 of the Capitol.  Your respective interests and possible support of this bill would be much appreciated.

By way of background, the Health Forum's bill last year, A.B. 2739, was vetoed by the Governor.  In his "veto message," Gov. Davis indicated that he did not see why the cultural / linguistic requirements in the Medi-Cal and Healthy Families Programs needed to be codified in law.  Thus, the Health Forum's bill this year, A.B. 154, does not touch the existing C/L requirements.  Rather, it would require the health plans to report their compliance with the C/L requirements.  For more information, please see the
Fact Sheet, attached below with the bill.

If you're inclined to support A.B 154, I would very much appreciate your "me too's" at Tuesday's hearing (A.B. 154 is scheduled 5th of 11 bills) and your letter-of-support.  For your ready reference, I attach a prototype letter-of-support.

Thank you for your consideration,

Ernie

PLEASE NOTE THAT THE HEALTH FORUM IS MOVING THIS WEEK.  We will not be able
to send / receive e-mails or telephone calls from Tuesday, February 25th,
through Sunday, March 2nd.

On March 3rd, our new address will be:

450 Sutter Street
Suite 600
San Francisco, CA 94108

Ernest Tai, Esq.
Policy Director
Asian & Pacific Islander American Health Forum
etai@apiahf.org
phone: 415 954-9973
Main Phone:  415 954-9988
Fax:    415- 954-9999

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Action on
Centers for Medicare and Medicaid Services

Email:
From: youdelman@healthlaw.org
Sent: Friday, December 13, 2002 3:38 PM
To: distribution list
Subject: [Health Advocates] sign on letter -- deadline Dec 18th, 12 noon EST

Dear Friends,

Attached is a sign-on letter (also pasted below) requesting that the Centers for Medicare and Medicaid Services provide additional guidance and technical assistance to states regarding reimbursement for language services through Medicaid and the State Children's Health Insurance Program.

We hope to bring this letter to the CMS Open Door -- Diversity meeting to demonstrate the widespread interest in this issue. We have previously requested that CMS add this issue to the agenda for the meeting. The meeting is
December 19 at 10am EST (call in number is 1-800-837-1935 and conference ID is 6804395. Please call in at least 10 -15 minutes before the conference begins).

Please consider signing on and joining the call. To sign-on to the letter, please send your name, organization's name, and contact information (address, telephone and email) to youdelman@healthlaw.org  or fax to 202-289-7724. If you have any questions, please call Mara Youdelman at 202-289-7661.

The sign-on deadline is 12 noon EST on Wednesday, December 18th.We will
only be accepting organizational sign-ons. And feel free to distribute the letter.



Thank you!
 

DRAFT LETTER

December 18, 2002

Thomas A. Scully
Administrator
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building, Room 314G
200 Independence Avenue, S.W.
Washington, D. C. 20201

Dear Mr. Scully:

The National Health Law Program, on behalf of the undersigned organizations, writes to express our support for the Centers for Medicare & Medicaid Services' (CMS) "Dear State Medicaid Director" letter (August 31, 2000) outlining the availability of federal matching funds for state expenditures related to providing oral interpretation
and written translation services to Medicaid and State Child Health Insurance Program (SCHIP) enrollees. Given the low number of states accessing these funds, however, we request that CMS provide further clarification as well as technical assistance to state officials.

We know that CMS is already aware of the growing need to provide language services to the more than 44 million people living in the United States who speak a language other than English at home. In addition to the letter referenced above, CMS has recognized the importance of providing language assistance in Medicaid, SCHIP and other federally funded programs by including the non-discrimination requirements of Title VI in all its contracts with states, thereby prompting states to mandate that Providers to do so as well.

Not surprisingly, language barriers are a primary reason why non-English speaking populations disproportionately underutilize cost-effective care. The provision of language services is one key factor necessary to providing quality and cost-effective health care to limited English speaking individuals. Evidence suggests that there are cost-savings associated with providing interpreters in the health care setting from
which CMS in particular, and the nation as a whole, can ultimately benefit. For instance, when interpreters are provided, fewer diagnostic tests may be necessary due to a better understanding of the patient's medical condition by both the patient and provider. Similarly, the existence of medical errors based on misunderstanding will decrease, thus resulting in fewer malpractice claims and fewer problems associated
with obtaining informed consent. Finally, increased use of cost-effective preventive care can also be expected, thereby reducing visits to emergency rooms. Indeed, a study released in the Archives of Pediatrics and Adolescent Medicine earlier this month found that non-English-speaking pediatric patients undergo more routine testing and incur higher medical costs in emergency rooms, largely because of language barriers and limited access to interpreters. To the extent that more cost-effective care can be provided, CMS would benefit from states encouraging the use of interpreters for Medicaid and SCHIP enrollees. This encouragement can be facilitated by reimbursing providers for their costs.

To date, only a few states have mechanisms in place to receive federal reimbursement, despite the distribution of the "Dear State Medicaid Director" letter. We believe this is due, in part, to the lack of specific examples that states can use to evaluate what methods of interpreter payments are most suitable for them. After the National
Health Law Program and The Access Project issued reports addressing the possibility of Medicaid/SCHIP reimbursement for language interpretation, these organizations received numerous calls seeking more information about what states are currently doing and what options exist. Unfortunately, too little public information and technical assistance exists to assist them in assessing their options. We believe, based on conversations with state officials, policymakers, providers (including hospitals, community health centers, and sole practitioners), advocates and others, that states need additional information about how best to establish these mechanisms.

For example, some officials have asked whether states can receive reimbursement for providing language services as a covered/medical service. The "Dear State Medicaid Director" letter is somewhat ambiguous on this point, yet states including Hawaii, Idaho, Maine, and Utah already receive reimbursement from CMS at the covered service rate. We also hope that CMS will clarify other issues related to the reimbursement of language services, including:
- Are there other options for Medicaid/SCHIP payments for language services?
- If a state wishes to cover language assistance as a medical service, would a state plan amendment be required?
- What flexibility do states have to decide the method of paying for language services (e.g. direct payment to interpreters or language service agencies, reimbursing providers, utilizing contract brokers)?
- Can states reimburse managed care organizations separately for language services on top of the capitation rate? Is it dependent on whether they carve out this service?
- In what ways can states offer hospitals funding for language services - direct reimbursement and/or reimbursing hospitals directly for administrative expenses including language services?
- How does a state's use of a DRG, prospective payment system, or similar per-case rate impact its options to reimburse hospitals, health centers and/or managed care plans?
- Can a state reimburse federally qualified health centers for language services through Medicaid/SCHIP?
- What other requirements must be met to obtain the federal matching funds?
- What reimbursement is available in Medicare and other federal health programs?

Further, we believe CMS should offer states specific examples of the available options to assist them in evaluating what methods of payment would best suit their state. This information should include the different ways states can structure reimbursements for language services.

In the end, effective reimbursement of language services will ensure that providers have a necessary tool to ensure equal quality care for LEP individuals, thus taking a major step forward in the effort to eliminate health disparities based on race and national origin. The results will also increase LEP patients' access to and use of preventive care, and allow them to better understand medical diagnoses and conditions, to make more informed decisions about treatment options and to increase compliance with recommended treatments.

Thank you considering our concerns in this matter. We hope that once you have evaluated all of the financial and ethical benefits that can be achieved through meaningful interpretation services you will have CMS issue further guidance clarifying how states can best avail themselves of funding for such services. If you have additional questions, please contact Mara Youdelman at 202-289-7661.

Sincerely,

The National Health Law Program

cc: Anthony Campinelli, Director, Office for Civil Rights

Mara K. Youdelman
Staff Attorney
National Health Law Program
1101 14th Street NW, Suite 405
Washington, DC 20005
youdelman@healthlaw.org
ph: (202) 289-7661
fax: (202) 289-7724
www.healthlaw.org
 

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California Assembly Bill AB 2739
VETOED by Governor GRAY DAVIS
(Sept. 23, 2002)
Click here for Veto message from Governor Davis

(down to draft sample letter)

CHIA wrote a letter of support for AB2739 and asks for your support for this bill. 

Write California Governor Davis and urge him to reconsider and sign A.B 2739 into law!!

Had AB2739 been signed into law, for the first time in California legislation, there would have been a definition of an "interpreter" and a "healthcare interpreter:"

"(3) ‘‘Interpreter’’ means a person who speaks English and another language fluently. Fluency includes an understanding of nonverbal and cultural patterns necessary to communicate effectively. An interpreter enables beneficiaries subscribers and medical or health care providers to communicate effectively with each other. A health care interpreter is one who has been trained in health care interpretation, is knowledgeable about medical terminology, and can accurately and completely render communication from one language to another. A health care interpreter may include a bilingual or multilingual provider or medical staff."

The bill would have supported CHIA's Healthcare Interpreter Standards of Practice:             (See the section on the CHIA standards)

"(H) Develop and implement standards for the provision of interpretation services and shall assess, identify, and report the linguistic capabilities of interpreters or bilingual contracting plan and contracted staff. and performance requirements for interpreters, and assess, identify, and report the linguistic capabilities of interpreters, bilingual and multilingual contracting plan staff, and subcontracted bilingual and multilingual providers and medical staff."

These requirements are currently included in a combination of state statute (Insurance Code Section 12693.30), contracts between the participating managed care health plans and the Department of Health Services (DHS) and/or Managed Risk Medical Insurance Board (MRMIB) that administer the programs, and DHS Policy Letters. The bill also requires the participating health plans to submit an annual report to DHS/MRMIB, reporting on how they have provided culturally and linguistically appropriate services in the Medi-Cal managed care and the Healthy Families programs. Finally, the bill requires that DHS and MRMIB summarize those reports submitted by the health plans and report the summary to the California Legislature once a year.

Copies of the CHIA letter of support and the amended bill are available on the Public Letters page. 

(Thanks to Ignatius Bau, Deputy Director for Policy and Programs of the
Asian-Pacific Islander American Health Forum for this heads up!)

September 23, 2002 (By fax transmission 916 445-4633)

The Honorable Gray Davis

Governor of California

State Capitol Building

Sacramento, California 95814

Re: Assembly Bill 2739 (Chan) - Support

Dear Governor Davis:

[Your organization's full name] urges you to reconsider and sign Assembly Bill 2739. [Describe your organization, your constituency and your work] A.B. 2739 would ensure access to medical care by all Californians enrolled in the Healthy Families Program and in the Medi-Cal managed care program. Almost half of the Healthy Families Program subscribers, and nearly 45% of the Medi-Cal managed care program beneficiaries, speak a language other than English. A.B. 2739 will codify these two programs' now existing language access and cultural competency policies, ensuring that all Californians enrolled in these two programs receive culturally and linguistically appropriate medical care, leading to the more appropriate utilization of services and a healthier California.

Assembly Bill 2739's cost to the State is nominal. In addition, the bill has been amended to incorporate the suggestions made by the two State agencies affected by the bill, the Managed Risk Medical Insurance Board and the Department of Health Services.

In addition to [your organization's name] support, A.B. 2739 enjoys the support of a host of organizations, representing community-based organizations, civil rights groups, health plans (the Local Health Plans of California), and providers (the California Medical Association).

[Your organization's name] urges your signature of this important bill.

_________________________________

You can find out the current status of AB2739, by clicking on the
California Assembly link and enter "AB2739" in the "Bill Number" search term and click on searching  "Both" the Senate and the Assembly before clicking the "Search" box.

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