Language Assistance Program Provider Training

Transcription

1 Language Assistance Program Provider Training Created by ICE Education and Training Workgroup 4/14/2009

2 Role of ICE To establish, coordinate and oversee a multi-disciplinary team of volunteers from health care industry stakeholders to work collaboratively to develop educational and best practice materials designed to streamline, simplify, and standardize all regulatory policies and procedures that govern the provision of health care services and require collaboration between health plans and their provider partners. To seek a standardized implementation interpretation by health plans and relay standardized requirements to the provider community regarding those requirements; To seek clarification from regulating agencies, collaboratively working to resolve issues surrounding operations and compliance; To seek ways to simplify implementation and improve compliance through standardized reporting mechanisms, provider communications, and training; To realize cost savings for health care industry stakeholders by working collaboratively to find a consistent way to implement regulations with the minimal amount of impact and the maximum amount of return. 3

3 Background The CA Language Assistance Program Law Effective January 1, 2009 CA law (SB 853) and its accompanying regulations require that health plans establish and support a Language Assistance Program (LAP) for enrollees that are limited English proficient (LEP). Who is eligible? Enrollees under the jurisdiction of the CA of Department Managed Health Care (DMHC) and/or California Department of Insurance (CDI) are eligible for the CA Language Program. 4

4 Key Definitions Limited English Proficient (LEP) An enrollee who has an inability or a limited ability to speak, read, write, or understand the English language at a level that permits that individual to interact effectively with health care providers or plan employees. 5

5 Key Definitions, cont. 6 Vital Documents Documents that are important to using the health plan and accessing benefits. They may be produced by the plan, or the production or distribution may be delegated to a contracting health care service provider or administrative services provider. Examples of vital documents are: Applications, Consent Forms, Letters, Denial notices, free language assistance notices and explanation of benefits.

6 Key Definitions, cont. Standard Vital Document General documents that are not specific to a particular enrollee. Non-standard Vital Document A document containing enrollee-specific information, such as a service authorization or claim denial. What is not considered a vital document? A document that is not covered under the regulation i.e. authorization approval letter 7

7 Key Definitions, cont. How to identify a LEP Patient Patient self identifies as LEP by requesting language assistance Patient brings family member or friend to interpret for them Patient may have trouble communicating in English or you may have a very difficult time understanding what they are trying to communicate Patient simply says yes or no, or gives inappropriate or inconsistent answers to your questions Patient is quiet or does not respond to questions 8

8 How to Access Interpreters In most cases, if a provider group is not delegated to provide Language Assistance Program (LAP) services, the health plan will offer telephonic interpreter services. For health plan specific information please refer to the ICE Health Plan Resource Guide for Provider Offices: an_ca_lap_contact_sheet_draft.xls. The guide also lists health plan contacts should you have any questions. 9

9 Documenting Refusal of Interpreter Best Practice: Documenting refusal of interpreter services in the medical record not only protects you and your practice, it also ensures consistency when your medical records are monitored through site reviews/audits by contracted health plans to ensure adequacy of the plan s Language Assistance Program. 10

10 Documenting Refusal of Interpreter, cont. It is preferable to use professionally trained interpreters. If the patient was offered an interpreter and refused the service, it is important to note that refusal in the medical record for that visit. Although using a family member or friend to interpret should be discouraged, it is extremely important to document this in the medical record if the patient insists, especially if the family member or friend is a minor. 11

11 Documenting Refusal of Interpreter: Smart Practice Tips Consider offering a telephonic interpreter in addition to the family member/friend to ensure accuracy of interpretation. For all Limited English Proficient (LEP) patients, it is a best practice to document the patient s preferred language in paper and/or electronic medical records (EMR) in the manner that best fits your practice flow. For EMRs, contact your IT department to determine the best method of advising all health team members of a preferred spoken language. For a paper record, one way to do this is to post colored stickers on patient s chart to flag when an interpreter is needed. (For example: Orange = Spanish, Yellow = Vietnamese, Green = Russian) Enter refusal for each visit or indicate in chart/file that proficient bilingual staff/provider will always provide interpreter services 12

12 Requesting Translations for Non-Standard Vital Documents Objective: Ensure Enrollees receive requested translations of non-standard vital documents in a timely manner, meeting the needs of the enrollee & regulatory standards Requirement: The health care service plan shall have up to, but not to exceed, 21 calendar days to comply with the enrollee's request for a written translation 13

13 Requesting Translations for Non-Standard Vital Documents, cont. Vital documents issued in English by Plans or Providers with delegated claims/um responsibility, will include a Notice of Translation informing Enrollee of the availability of free language assistance that will be provided by the health plan. If the Enrollee s preferred language is one of the threshold languages offered by the Plan, they may also receive a written translation of the vital document. 14

14 Translation Requests from Plans Translation requests will normally come through the Health Plan If the Enrollee requires help, the Notice instructs them to call the Plan s number on their ID card or a toll-free number provided on the Notice If translation request is for a Provider-produced letter, the Provider will need to submit a copy of that letter to the Plan in a timely manner To ensure that Plans are able to properly contact the provider, please make sure your medical group contact information is listed on the ICE grid at the following link: act_worksheet_12_08_approved.xls Send your updated contact information to: Admin@iceforhealth.org 15

15 Translation Requests Directly from Member/Patient If Providers receive a translation request directly from a patient/member, contact the Plan on behalf of the member to request the translation Refer to the ICE website for Plan translation contact: an_ca_lap_contact_sheet_12_08_approved.xls 16

16 LAP Notice of Translation Each Plan has customized the notice of translation to include their name, contact number and availability in the Plan s threshold languages. ICE-approved message: IMPORTANT: Can you read this letter? If not, we can have somebody help you read it. You may also be able to get this letter written in your language. For free help, please call right away at {plan s phone #}. 17

17 Notice of Translation Insert Each Plan s specific Notice of Translation in the Plan s threshold language(s) is available on the ICE website: d=1768#scid

18 UM/Claim Template Letters with Imbedded Health Plan Notice Health Plan Specific UM templates, with the Plan specific notice imbedded in the document, are available on the ICE website at: #scid1770 Claim denial letter templates with Plan specific notice imbedded in the document are available on the ICE website at: scid

19 ICE Recommended Translation Timelines Element Minimum Policy Requirements 20 Request for translation of a non-standard vital document comes from the enrollee to the provider organization. Definitions: Urgent: i.e. pre-service UM denial for procedures scheduled within 30 days with immediate medical necessity. Non-urgent: i.e. Claim issues where the services have already been rendered or there is NO medical urgency Urgent: 1. Forward the translation request and copy of document to the contracted health plan within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan. Non-Urgent: 1. Forward the translation request and copy of document to the contracted health plan within two business days. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan.

20 Translation Timeliness, cont. 21 Element Request for a non-standard vital document comes from the health plan to the provider organization Minimum Policy Requirements Urgent: 1. Forward a copy of document to the contracted health plan within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan. Non-Urgent: 1. Forward a copy of document to the contracted health plan within two business days. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan.

21 Translation Timeliness (continued) Element Request for a planproduced vital document comes from the member to the provider organization Minimum Policy Requirements All Plan-produced vital documents: 1. Forward enrollee s request within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan. 22

22 Translation Requests remember... When forwarding a copy of the document needing translation, use a secure method to protect the Enrollee s Protected Health Information (PHI): FAX to a secured Health Plan location If by , make sure you re using secure (encrypted) . 23

23 Independent Medical Review Informational notices about how to contact a plan, file a complaint, obtain assistance from the DMHC and seek an independent medical review (IMR) are available in non-english languages on the DMHC site at 24 IMR forms are available in English, Spanish, Arabic, Armenian, Chinese, Farsi, Hmong, Khmer/ Cambodian, Korean, Lao, Russian, Tagalog and Vietnamese.

24 Need Answers? For answers to Frequently Asked Questions go to the ICE website at id1618 For additional information, please check out the Industry Collaboration Effort (ICE) website: or contact your contracted health plan 25