SB 223: Health care language assistance services.

(1)Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements for health care service plans and health insurers to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, including requirements for individual access to interpretation services and requirements to conduct an assessment of the language preferences and linguistic needs of the enrollee and insured population and for the translation of vital documents. For those vital documents that are not standardized but contain enrollee or insured specific information, existing law does not require a health care service plan or health insurer to translate the documents into threshold languages identified by the needs assessment, but instead requires a written notice of availability of interpretation services in threshold languages identified by the needs assessment to be included with those vital documents.

This bill would also require this written notice to be made available, by a health care service plan or health insurer subject to the notification requirements described below, in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services. The bill, with regards to those requirements for individual access to interpretation services, would establish minimum qualification criteria that an interpreter is required to meet in order to provide interpretation services to enrollees and insureds and would prohibit the plan or health insurer from requiring an enrollee or insured with limited English proficiency to provide his or her own interpreter or rely on a staff member who is not a qualified interpreter to communicate directly with the enrollee or insured, or from requiring an enrollee or insured to rely on an adult or minor child accompanying the enrollee or insured to interpret or facilitate communication except in an emergency, as described, if a qualified interpreter is not immediately available, or if the enrollee or insured specifically requests that an accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on the accompanying adult for that assistance is appropriate under the circumstances.

The bill would require a health care service plan and a health insurer to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections available to individuals enrolled in a plan contract or health insurance policy, and would require this information to be included in a conspicuously visible location in the plans or health insurers evidence of coverage, on materials that are routinely disseminated to enrollees or insureds, and to be posted on the Internet Web site maintained by the plan or health insurer. The bill would authorize a specialized health care service plan and a specialized health insurance policy that is not a covered entity, as defined, subject to a specified provision of the federal Patient Protection and Affordable Care Act to request an exemption or a waiver, respectively, from these notification requirements, as specified.

Because a willful violation of these requirements by a health care service plan would be a crime, this bill would impose a state-mandated local program.

(2)Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans. Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services, including oral interpretation services and translation services, to LEP Medi-Cal beneficiaries, as defined. Existing law exempts mental health plans from these language assistance services requirements.

This bill would require managed care plans, mental health plans, and the State Department of Health Care Services to provide written notice of the availability of free language assistance services in English and in the top 15 languages spoken by LEP individuals in California, as determined by the State Department of Health Care Services, and consistent with specified provisions of federal law. The bill would require oral interpretation services, provided by managed care plans and mental health plans, to be provided by an interpreter who meets specified minimum qualification criteria. The bill would prohibit a Medi-Cal managed care plan and a mental health plan from requiring a Medi-Cal beneficiary with limited English proficiency to provide his or her own interpreter or rely on a staff member who is not a qualified interpreter to communicate directly with the beneficiary, and would prohibit a managed care plan and a mental health plan from relying on an adult or minor child accompanying the beneficiary to interpret or facilitate communication except in an emergency, as defined by the department, and a qualified interpreter is not immediately available, or if the beneficiary specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances. The bill would require the State Department of Health Care Services, managed care plans, and mental health plans to notify Medi-Cal beneficiaries, prospective beneficiaries, and members of the public of the availability of language assistance services and of certain nondiscrimination protections available to Medi-Cal beneficiaries, and would require this information to be included in specified materials distributed to beneficiaries, to be posted in conspicuous physical locations, and on the departments Internet Web site and on the Internet Web site maintained by the managed care plan or mental health plan, as specified. The bill would provide that these provisions are to be implemented only to the extent that federal financial participation is available and is not otherwise jeopardized.

(3)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.