presenter David Melendez Senior Project Manager, Language Assistance Program Blue Shield of California

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2 presenter David Melendez Senior Project Manager, Language Assistance Program Blue Shield of California 2

3 Blue Shield s new Blue Shield s new Language Assistance Program Beginning January 1, 2009 Language Assistance Program Beginning January 1,

4 Introduction Today, we will discuss: 1. Requirements of SB853 for health plans 2. How the new law and regulations impact our IPA/medical groups 3. How we can work together to help our members use the services of our new language assistance program. 4

5 SB853: The California Language Assistance Law Effective January 1, 2009 CA law (Senate Bill 853) and its accompanying regulations require that health plans establish and support a Language Assistance Program (LAP) for enrollees who are limited English proficient (LEP). Who is eligible for the California Language Assistance Program? Members under the jurisdiction of the Department of Managed Health Care (DMHC) and/or California Department of Insurance (DOI) 5

6 Definition of Limited English Proficient (LEP) A Limited English Proficient (LEP) enrollee is a person who has an inability or a limited ability to speak, read, write or understand the English language on a level that permits him or her to interact effectively with health care providers or plan employees 6

7 Key Language Assistance Program (LAP) requirements for health plans 1. Determine threshold languages 2. Collect and store members preferred languages 3. Provide timely translation (written) of vital documents into threshold languages 4. Provide timely interpreter services (spoken) at each point of member contact. 5. Ensure provider compliance with LAP requirements. 7

8 Impact of new Language Assistance Program on our network IPA/medical groups Blue Shield is not delegating language assistance responsibilities to its contracted providers and IPA/medical groups. We ask that our IPA/medical groups help us provide efficient language assistance for our Blue Shield members. 8

9 LAP plan responsibility #1: Determining threshold languages Using calculations specified by CA SB853, health plans determine their threshold languages. For health plans the size of Blue Shield, threshold languages are: The top two languages preferred by its membership, plus Any other language that represents the lesser of 15,000 or 1.75% of the plan s membership. 9

10 Blue Shield s threshold languages Blue Shield has determined its threshold languages to be: Spanish Chinese (traditional) Vietnamese 10

11 LAP plan responsibility #2: Collecting and storing language preferences Collect each of its enrollees language preferences to store in the membership system. Every three years, perform a language preference assessment and update threshold language profile. Share information on language preferences with delegated medical groups, through eligibility feeds. Print language preference on each member s ID card (if preference is other than English). At a minimum, SB853 requires health plans to provide translations of vital documents into its threshold languages. 11

12 What is a vital document? They are defined as follows: Documents that are important to using the health plan and accessing benefits. They may be produced by the plan, or the production or distribution of them may be delegated to a contracting service health care service provider or administrative services provider. 12

13 LAP responsibility #3: Written translation of vital documents Blue Shield will translate standard vital documents in our threshold languages and make them available to members. Standard vital documents are general documents that are not specific to a member. Examples of standard vital documents: Applications, consent forms Notices of the right to file a grievance or appeal Benefit summaries Notice of free language assistance 13

14 LAP responsibility #3: Written translation of vital documents Blue Shield will translate non- standard vital documents in threshold languages, upon request. A non-standard vital document is a document containing enrollee-specific information. Examples of non-standard vital documents: Notices pertaining to the denial, reduction, modification or termination of services or benefits Letters containing important information about eligibility or participation criteria 14

15 DMHC notice of free language assistance Vital documents issued in English by health plans will include a Notice of Translation informing the member of the availability of free language assistance that will be provided by the plan. The DMHC notice we will use is in English and in Blue Shield s threshold languages. 15

16 DMHC notice of free language assistance 16

17 When to include the DMHC free language assistance notice IPA/medical groups need to include the notice with all vital documents distributed in English to Blue Shield members, such as denial, delay and claims-related letters. 17

18 LAP plan responsibility #4: provide timely interpreter services (spoken) At internal points of contact: Bilingual customer service representatives at Blue Shield Language Line Services (vendor used for interpretative services) when the member calls Blue Shield. 18

19 LAP plan responsibility #4: provide timely interpreter services (spoken) At external points of contact (physician office, pharmacy, etc.): Bilingual providers are identified in the provider directory. Access to Language Line Services through the provider customer services number (800) Access to in-person interpreter services for the patient by request, using Blue Shield s Language Assistance Request form (faxed to Blue Shield). 19

20 Timeliness standards for providing interpreter services for members Over-the-phone interpreter services within 10 minutes In-person interpreter services within 5 business days 20

21 LAP plan responsibility #5: Ensure compliance internally and externally Inform our contracted providers where and how they can access all the services we offer through our new LAP. Inform providers where they can get translated notices for members who wish to file grievance or request an independent medical review (IMR). Monitor the LAP needs of our members, including tracking and reporting needs or complaints. Provide timely regulatory reports to DMHC. 21

22 How can our contracted IPA/medical groups help us implement our LAP? 1. Identify limited English proficient patients An LEP patient may: Self-identify as an LEP and request language assistance Not respond to questions Simply say yes or no Give inappropriate or inconsistent answers Have trouble communicating in English 22

23 How can our contracted IPA/medical groups help us implement our LAP? 2. Inform patients that Blue Shield will provide free access to: Interpreter services over the phone In-person interpreter services The use of a professionally trained interpreter is recommended. 23

24 How can our contracted IPA/medical groups help us implement our LAP? 3. Document details on language assistance use or refusals: If an LEP patient was offered an interpreter and refused the services, it is important to note the refusal in the medical record for that visit and include details on why it was refused, e.g., patient wants to use family member or friend. It is especially important to document if the interpreter used is a minor. 24

25 Smart practice tips If an interpreter is used, document the services used (professional or other) and the language spoken. Consider offering a telephonic interpreter in addition to a patient s chosen family member or friend to ensure accuracy of the interpretation. For all LEP patients, it is a best practice to document the patient s preferred language in paper and/or electronic medical record (EMR) in the manner that best fits your practice flow. 25

26 How can our contracted IPA/medical groups help us implement our LAP? 4. Request written translation services in a timely manner. If you receive a request for a vital document translation, forward it to us within one day if it is urgent or within two days if it is not urgent. To forward the vital document to Blue Shield: Complete Blue Shield s Language Assistance Form (available at blueshieldca.com/provider). Attach a copy of the document to be translated. Fax the request to (209)

27 How can our contracted IPA/medical groups help us implement our LAP? 5. Include Blue Shield s DMHC notice of free language with non-standard vital documents issued in English. These are documents produced by the IPA/medical group, such as denial, delay or claims letters. Our version of the DMHC notice is available at blueshieldca.com/provider This notice and other health plan-specific templates with embedded LAP notices are also available at ICE s Website at 27

28 A quick review Key Language Assistance Program (LAP) requirements for health plans are: Determining threshold languages Collecting and storing members preferred languages Providing timely translation (written) of vital documents into threshold languages. Providing timely interpreter services (spoken) at each point of member contact Ensuring plan and contracted provider compliance with LAP requirements 28

29 A quick review Our contracted IPAs and medical groups can help us implement our Language Assistance Program by: Identifying limited English proficient patients Informing patients of the availability of free interpreter services Submitting (in a timely manner) standard vital documents for written translation into a Blue Shield threshold language, when necessary Including Blue Shield s DMHC notice of free language with non-standard vital documents issued in English 29

30 Timeline for implementation of LAP 07/01/08 Blue Shield s CALAP plan proposal was submitted to DMHC (approved). 11/30/08 Amendments will be mailed to affected providers. 12/01/08 Blue Shield s CALAP plan proposal was submitted to Department of Insurance (DOI). 30

31 Timeline for implementation of LAP 01/01/09 Begin providing language services for both DMHC and DOI members Providers expected to help arrange for interpreter services for all members even though DOI requirements are not required by law until 4/1/09. 01/01/09 Provider contracts that are issued, amended, delivered or renewed shall require compliance with health plans Language Assistance Programs An amendment based on the ICE model has been placed into Blue Shield s agreements. 31

32 Resources available to IPA/medical groups If you have any questions about our Language Assistance Program, contact your Blue Shield Provider Relations Representative. To request interpreter services for Blue Shield members: Access Language Line Services by calling our provider customer services representatives at (800) Fax our Language Assistance Request Form to (209)

33 Resources available for IPA/medical groups To request translation (written) services for Blue Shield members, complete and fax our Language Assistance Form to (209) Additional information on SB853 requirements, including resources for all plans language assistance program, is available at ICE s Web site at 33

34 Resources available for IPA/medical groups Informational notices for members are available in non-english languages at the DMHC s Web site, on the following topics: How to: Contact a health plan File a complaint Obtain assistance from the DMHC Seek an independent medical review (IMR) 34