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Language Assistance Frequently Asked Questions
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The material contained in this website (the "Website") has been produced by the Department of Managed Health Care Division of Plan Surveys ("Department") in accordance with its current practices and policies, and with the benefit of information currently available. The Department regularly reviews the Website and updates pages to reflect changes and/or enhancements to previous responses in consideration of new information and/or to post new questions.
Readers should consider and apply the answers to the FAQs as advice of general applicability only. The answers to FAQs should not be considered as compliance determinations as the Department's response may be different when just a few facts are changed. When in doubt, readers are encouraged to request Department review of their specific facts and circumstances if additional clarification is needed.
Table of Contents
1. Translation of Documents:
1.1 Are Plans to have all vital documents translated into the threshold languages indicated by our survey process ready to hand out?
Response 1.1 28 CCR Section 1300.67.04(e)(2) "By July 1, 2008, every plan shall file, in accordance with Section 1352 of the Act, an amendment to its quality assurance program . . ., together with information and documents sufficient to demonstrate compliance with the requirements and standards of Section 1367.04 of the Act and this section. All materials filed with the Department that contain documents in non-English languages shall include an English version of each non-English document and an attestation by the translator consistent with Section 1300.67.04(e)(2)(ii).
Section 1300.67.04(e)(3) "By January 1, 2009 every plan shall have established and implemented a language assistance program in compliance with the requirements of Section 1367.04 of the Act and this section."
1.2 According to H&S Code Section 1367.04 (b)(1)(C)(ii), are we required to provide a translation of the documents referenced into any language upon request? (Upon request, the enrollee shall receive a written translation of the documents described in clause (i). The health care service plan shall have up to, but not to exceed, 21 days to comply with the enrollee's request for a written translation.)
Response 1.2 Plans are required to translate vital documents into threshold languages. Plans may, but are not required to, translate vital documents into additional languages. Plans may, but are not required to, translate non vital documents.
Section 1300.67.04(c)(F)(v) ". . . with respect to vital documents that are not standardized, but which contain enrollee-specific information, a plan shall provide the English version together with the Department-approved written notice of the availability of interpretation and translation services and, if a translation is requested , the plan shall provide the requested translation within 21 days."
1.3 Health plans are planning to translate standardized documents as templates via the ICE work group in order to streamline the process for providers. Plans will implement the following method for meeting the requirements of SB 853 for translating documents and related timeliness requirements for member letters: Preparation of template letters in the threshold languages with the "enrollee specific" information in English, but available upon request in the threshold languages. This is the method allowed by DHS for Medi-Cal plans. Please confirm that this is acceptable.
Response 1.3 Yes, the Department's regulations differ slightly from Medi-cal, however, the Department feels the Medi-cal alternative is consistent with the intent of the regulation. The Department's regulations stipulate that vital documents must be provided in threshold languages; however, documents containing enrollee-specific information may be issued in English, accompanied by the notice of the availability of interpretation and translation services. If the enrollee requests a translation of the document, the Plan must provide the translated version within 21 days of the request. 28 CCR Section 1300.67.04(c)(F)(v)
1.4 Would DMHC provide their input regarding translation of DMHC IMR form in several threshold languages and also comment on making the form available on DMHC website.
Response 1.4 DMHC provides the IMR application in the following threshold languages: Arabic, Armenian, Chinese, Farsi, Hmong, Khmer/Cambodian, Korean, Lao, Russian, Tagalog, and Vietnamese.
1.5 When evaluating standardized vs. non-standardized letters that are sent to enrollees, it is our understanding that a mail-merged letter is considered enrollee-specific and non-standardized (therefore needing the insert advising of translation services) and that a mailing that included standard material with a customized cover letter is also considered a non-standardized mailing. Please confirm.
Response 1.5 A standard or vital document that contains enrollee specific information is still considered a vital document, and the notification of interpretation and translation services would be required. In the case of a vital document with a customized cover letter, presumably containing enrollee-specific information, the same notice of assistance would be required and the Plan would be required to translate the document in the threshold language if requested by the enrollee, within 21 days. 28 CCR Section 1300.67.04(c)(F)(v)
1.6A Can the plan's set timeframes of which enrollee's can request translation of documents? Example: When the plan sends the enrollee a written response in English and cites the enrollee is entitled to request translation in threshold language, can the plans dictate a time frame of which the enrollee should respond? (i.e. within 30 calendar days).
Response 1.6A H&S Code Section 1367.04 (b)(1)(C)(ii) The Plan cannot dictate a time frame in which the enrollee must respond to its offer of a translated document. Pursuant to Section 1367.04 et.al., enrollees shall receive written translations of documents upon request.
1.6B When does the compliance clock start ticking?
Response 1.6B H&S Code Section 1367.04(b)(C)(ii) Health Plan's shall have up to, but not to exceed, 21 days (from date request is received) to comply with enrollees request for a written translation.
"If an enrollee requests a translated document, all timeframes and deadline requirements related to the document that apply to the health plan and enrollee . . . shall begin to run upon the health care services plan's issuance of the translated document."
1.6C Is the DMHC going to establish industry standards by which an enrollee can request translated documents?
Response 1.6C No. The DMHC will not establish industry standards by which an enrollee can request translated documents. The regulation provides the enrollee the ability to request a translation of a vital document into a threshold language upon request. H&S Code Section 1367.04(b)(C)(ii).
1.7A Does this statutory reference to timeframes supersede other timeframes in Knox-Keene, such as those outlined in H&S Code Section 1357.06 or 1373.6(e)?
Response 1.7A No, it does not supersede H&S Code Section 1357.06 that refers to pre-existing conditions and waiting periods for effective dates of coverage. However, the statute may supersede an application deadline of 63 days for conversion coverage. See response to 17.B.
1.7B H&S Code Section 1373.6(e) requires that applications for conversion coverage be received within 63 days of termination from the group. Does Section 1367.04 supersede that so that potentially an enrollee who requests a translated letter would get longer than 63 days to apply for Conversion coverage?
Response 1.7B Section 1367.04(b)(C)(ii) stipulates that . . . "all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees under the provisions of this chapter . . . shall begin to run upon the health care service plan's issuance of the translated document. In the event a request and the provision of a translated document potentially exceeds the 63 day deadline, the Department would expect the Plan to adjust the submission deadline in accordance with the enrollee's receipt and understanding of the translated letter such that the enrollee would be allowed to submit their application for conversion coverage.
1.8A Can Health Plan require enrollees to request a written translation within a particular time window or are we obligated to give enrollees an indefinite period of time to request translation and then accommodate those requests?
Response 1.8A No, Plans cannot dictate a specific time in which enrollees can request a written translation. Pursuant to Section 1367.04 et.al., enrollees shall receive written translations of documents for relevant services upon request.
1.8B What about for communications involving concurrent review of an enrollee's clinical condition? Say an enrollee is hospitalized out-of-plan and has been stabilized and we as Health Plan want to transfer the enrollee to a Plan facility and sends the enrollee a "Notice of Non-Coverage" that states that the stay at the non-Plan hospital will be covered for only 2 more days. In such a situation, can we require the enrollee to contact us for language assistance within a specific timeframe, or could we possibly end up having to cover more than 2 days in the hospital because the clock has to reset due to the enrollee's request for a written translation?
Response 1.8B H&S Code Section 1367.04(b)(1)(C)(ii) The regulation does not require an Enrollee to contact the Plan within a specified time frame for language translation or interpreter services, however, the Plan can emphasize the importance of notifying the Plan quickly in an attempt to ensure important information is relayed to the enrollee. The health plan shall have up to, but not to exceed, 21 days to comply with the enrollee's translation request. Hence, timely notice of the availability of language services and swift translation (in less than 21 days, if possible) is important in the above situation. ."If an enrollee requests translated document, all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees . . . shall begin to run upon the health care service plan's issuance of the translated document."
1.9 Does a document from Claims requesting further information from the enrollee to adjudicate a claim fall under Section 1367.04(B)(vi) so that it must be translated, or does (C)(i) apply since it is a document with enrollee-specific material, and therefore it can just include the notice of language assistance services?
Response 1.9 H&S Section 1300.67.04(c)(2)(F)(ii) The DMHC would need to review the document from Claims in order to make the determination on whether it falls within a standardized vital document required to be automatically translated into threshold languages, or whether it falls within a "non-standard" vital document, containing enrollee specific information, hence could be provided in English along with the notice of availability of language assistance services.
1.10A Enrollees who are enrolled in deductible products receive a statement of accumulation when the receive services that impact their deductible. The deductible accumulation status documents can be likened to an Explanation of Benefits (EOB) because their purpose is to provide information about where the member is in connection with the deductible and out of pocket maximum (OOP) it is not a member bill. Based on that interpretation, we have assumed that we would not have to translate the deductible accumulation status documents and we can send them out in English with just the notice of language assistance. Does the Department agree with the above interpretation?
Response 1.10A The DMHC would need to review the document. It is reasonable to assume based on the similarity in purpose between the Explanation of Benefits and the deductible accumulation status documents that language translation would not be required, and that the written "notice of the availability of language services" would suffice. However, the DMHC would need to review the deductible accumulation status documents to make a firm determination.
1.10B What is the expectation when it comes to departments who periodically send out communications to enrollees? Will the DMHC have an expectation that once we have the request in the system, we should be able to proactively anticipate future requests for translation?
Response 1.10B Yes, that is one of the expectations of providing appropriate language access to all plan enrollees.
1.10C Will the DMHC have the same expectation across departments-if Utilization Management processes a request for written translation, do they have to tell all other departments so that any future communication must be translated proactively since we have the information somewhere in the organization?
Response 1.10C Yes - The DMHC recommends that Health Plans function proactively by informing other departments, that disseminate information to enrollees, of the need to provide written translations in the identified threshold languages. The Department suggests Plans also communicate this information to the enrollee's assigned medical group/ IPA and other contractors that provide services at the point of care.as another means to ensure preferred language services are available.
1.11 There are several communications that are mailed to the subscriber only, not to every individual in the household. For example, the quarterly newsletter is mailed one per household. Is the Department's expectation that if the subscriber's preferred language is a threshold language, the Health Plan will mail both an English and non-English version of the document to those households.
Response 1.11 28 CCR Section 1300.67.04(b)(7) A quarterly newsletter is not among those designated as a vital document that requires translation, however, the Plan may translate the newsletter into the health plans threshold languages or other languages. If the Plan translated the newsletter into threshold languages, and the subscriber notified the Plan of his preferred threshold language, the Department would expect the Plan to distribute the newsletter in the preferred threshold language. If other members in the household preferred English or different a threshold language, the Department would expect the newsletter to be mailed based on those preferences. However, if the Plan provided a newsletter in English only, a notice in English and threshold languages, about the availability of free language assistance services and how to access them should be included with newsletters and other outreach materials. 28 CCR Section 1300.67.04(c)(2)(C)(iii).
1.12 Communications that go to enrollees related to provider terminations are customized and describe when the provider contract will terminate. If an enrollee requests a translated version of the letter, then does the requirement to reset timeframes require the Plan to continue paying for services at the terminating provider past the contract termination date to account for the delay in getting the translated letter out to the enrollee?
Response 1.12 H&S Code Section 1367.04(b)(1)(C)(ii) The regulation does not require an Enrollee to contact the Plan within a specified time frame for language translation or interpreter services, however, the Plan can emphasize the importance of notifying the Plan quickly in an attempt to ensure important information is relayed to the enrollee. "If an enrollee requests a translated document, all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees . . . shall begin to run upon the health care service plan's issuance of the translated document." The Plan would be required to absorb the cost of services and yes, reset timeframes based on the issuance of the translated document.
2. Language Assessment:
2.1 How does a plan determine its threshold language under California Health & Safety Code §1367.04(b)(1)(A)(iii)?
Response 2.1 Section 1367.04(b)(1)(A)(iii) outlines criteria to determine when the translation of documents into threshold languages is required. However, the regulation, 28 CCR Section 1300.67.04(c)(1)(A) provides guidance on how to determine threshold languages. "Each plan shall develop a demographic profile of the plan's enrollee population for the purposes of calculating the threshold languages. . . All plans shall apply statistically valid methods for population analysis . . . and plans may utilize a variety of methods for collecting demographic data for this purpose, including census data, client utilization data from third parties, data from community agencies and third party enrollment processes."
2.2 We have a workgroup formed to make sure we are in compliance with the new Language Assistance regulations (SB 853). We are wondering whether there is a sample or model enrollee survey that has been developed, either by the DMHC or by another health plan that we can use as a starting point. Are you aware of any?
Response 2.2 The Department does not have any specific language assessment tools to offer plans at this time. However, collaborative plan work groups have been formed through the Industry Collaboration Effort (ICE) and they are working through compliance approaches and strategies.
The Department attends the monthly ICE Agency Leadership work group, with the purpose of providing feedback on the "issues" logs created from the different work groups.
2.3 How should plans assess enrollee populations who offer Healthy Kids and AIM products?
Response 2.3 The DMHC regulations provide for all "non-Medi-Cal" products. These products are not Medi-Cal and require licensure by the DMHC. So, the Plan can choose to assess these populations for the threshold languages separately, or aggregate with assessment of the commercial population.
2.4 A certain percentage of our health plan membership we directly enroll. But for a further significant percentage, we're actually providing services on a carve-out basis to other Knox-Keene plans. Is it permissible for us to have those plans send us their survey findings on language preference with their eligibility files, and not survey those enrollees twice?
Response 2.4 Yes. The full-service plan may coordinate with its contractors and share information on enrollee assessments as feasible and to avoid duplication of the survey process. It is permissible to have the full-service plans send survey findings on language preference. However, for the enrollee population that directly contracts with the plan, the health plan will be responsible to complete an enrollee language survey in order to have language information on the entire population served by the health plan.
2.5 Plans are developing their survey assessment plans and would like the flexibility to store responses to language preference surveys at the subscriber level because of system limitations and costs associated with adding fields at the enrollee level. Due to the expectation that the subscriber language preference is highly likely to be the same as the other dependents, this is a cost effective way to gather assessment data to determine the plans threshold languages (primary purpose of the assessment). Please confirm that this is acceptable.
Response 2.5 H&S Code Section 1300.67.04(c)(1), (A, B) The regulation includes the two part approach: 1) development of a demographic profile in order to calculate threshold languages and 2) survey enrollees in a manner designed to identify the linguistic needs of each of the plan's enrollees. Not all enrollees will respond to the linguistic needs survey. The plans' respective databases regarding individual language needs will develop over time. Because the regulation references the identification of linguistic needs for each enrollee, it would not be sufficient for the Plan to rely solely on the subscriber preference and have no ability to capture or record instances in which other languages are spoken and preferred by the remaining enrollees in the household.
The Department would be available to discuss projected plan system limitations and costs. The Plan may request approval for the Plan's preferred alternative approach through the Plan's filings; however, a request for variation from the regulations must be supported by meaningful data.
3. Demographic Profile:
3.1. While the definition of "demographic profile" includes the elements of "race" and "ethnicity," the rest of the regulation appears to be focused strictly on language needs. What is the regulatory goal of collecting race and ethnicity data?
Response 3.1 Pursuant to H&S Code Section 1367.07, Section 1367.07(e) the health plan must report to the Department internal policies and procedures related to cultural appropriateness and in regard to providers, the Plan's provision of information regarding ethnic diversity and related strategies. In addition, the Department is charged with biennial reports to the legislature which will include information on plan compliance with standards, results of compliance audits and other reviews. The purpose of these reports is to provide DMHC information to make recommendations for changes that further enhance standards pursuant to the provision of SB 853.
3.2. If the need should arise to disclose the results of the health plan survey data pertaining to the ethnic diversity of the plan's enrollee population, would you be looking for aggregated data, or individual files?
Response 3.2 Aggregate data
3.3. The regulations define Demographic profile to mean, at a minimum, identification of an enrollee's preferred spoken and written language, race and ethnicity. Please clarify whether race and ethnicity are to be treated as two different demographic characteristics.
Response 3.3 Race and ethnicity should be considered as two different demographic characteristics.
3.4 Can the demographic profile reflect either the state's population or the plan's population? Does it matter? Is there a preference?
Response 3.4 The demographic profile must reflect the Plan's population.
3.5 Plans have been doing much work through a workgroup (and ICE) to standardize the collection of race and ethnicity data. The workgroup has developed the flexibility to collect race and ethnicity in either one field or two, as needed by the plan in standardized coding sets. This aligns with data sets used by other government agencies. Please confirm that this is acceptable.
Response 3.5 The Department considers race and ethnicity as two different demographic characteristics. The Plan should be able to report on both demographic characteristics.
3.6 ICE's collaborative workgroup has identified coding specific to race and ethnicity. One code identified for race and one code identified for ethnicity. Will the DMHC require data collection and reporting is by each single code or can it be combined?
Response 3.6 28 CCR Section 1300.67.04 (b)(1) The definition of "demographic profile" includes both race and ethnicity. The Department considers race and ethnicity as two different demographic characteristics. Therefore, it requires data collection and reporting by each individual code.
3.7 How will the plans determine demographic profiles and calculate threshold languages? It's difficult for plan's to know specifically what is required.
Response 3.7 The Department encourages the Plan to review 28 CCR Section 1300.67.04(c)(1)(A), which provides the Plans guidance on how to complete the demographic profile. Section 1300.67.04(c)(1)(A) speaks to the Plan's requirement to assess the Plan's population for the purpose of calculating threshold languages spoken by Plan enrollees. The section advises the Plans to utilize a statistically valid method when developing the demographic profile and may utilize a variety of methods, including census data, data from third parties. The Department provided a certain amount of flexibility with suggested information sources for Plan's to use in completing the demographic profile.
Once the demographic profile is established, the Plan has determined the preferred spoken and written languages and the capture of race and ethnicity, the Plan must then consider the threshold languages for the purpose of translation of vital documents. H&S Code Section 1367.04(b)(1)(A)(i-iii) provides criteria to determine when the translation of documents into threshold languages is required.
4. Language Needs:
4.1 The following passage almost seems to suggest that we could essentially substitute a notice for the required survey: (c)(1)(B). A plan may demonstrate compliance with the survey requirement by distributing to all subscribers, including all individual subscribers under group contracts, a disclosure explaining, in English and in the plan's threshold languages, the availability of free language assistance services and how to inform the plan and relevant providers regarding the preferred spoken and written languages of the subscriber and other enrollees under the subscriber contract. Now that section is immediately followed by one that discusses collecting, summarizing, and documenting enrollee demographic profile data, although a & "disclosure" wouldn't necessarily trigger our receiving such data. Can you clarify?
Response 4.1 H&S Code Section 1300.67.04(c)(1)(B) speaks to the Plan's requirement to survey all enrollees to determine linguistic needs, and record the information provided in the enrollee's file. This section provides an acceptable method in lieu of a survey to inform the enrollee of the availability of free language services and how to inform the Plan regarding the enrollee's language preference and as well as those preferred languages spoken/ written by other enrollees under the subscriber contract.
Section 1300.67.04(c)(1)(A) speaks to the Plan's requirement to develop a demographic profile and Section 1300.67.04(c)(1)(C) references the requirement to collect, summarize and document the demographic profile in a specific manner.
4.2 In 28 CCR Section 1300.67.04 (d)(9)(A) there's a reference to a "language capability disclosure form." Is this a form developed by the Department or developed by the plan?
Response 4.2 The disclosure form would be developed and used by the Plan. The Department would suggest the disclosure form attest to the capability of the interpreters in the adherence to proficiency standards established pursuant to Section 1300.67.04(c)(2)(H)(i-iii).
4.3 28 CCR Section 1300.67.04 (c)(1)(B) permits a plan to demonstrate compliance with the linguistic needs survey requirement by distributing to all subscribers under a group contract a disclosure explaining the availability of language assistance services and how to inform the plan of language preferences. What language (other than English) should a plan use when the plan falls under California Health & Safety Code Section 1367.04(b)(1)(A)(iii)?
Response 4.3 The Plan must translate documents into an indicated language pursuant to Section1367.04(b)(1)(A)(iii) when 3,000 or more or 5 percent of the enrollee population, whichever is less, (emphasis added.) . . . indicates in the needs assessment . . . a preference for written materials in that language.
28 CCR Section 1300.67.04(c)(1)(B) refers to the requirement by any Plan regardless of size or specialty to inform enrollees of the availability of free language services and how to inform the Plan of the language preference.
4.4 Many purchasers maintain internal websites on which they post information that is contained in the plan's benefit matrices. For these purchasers, the contract is negotiated so that the purchaser retains the responsibility for informing members about changes in benefits, copayments, etc. In such cases, will the Plan have to require the purchaser to post the information in threshold languages as well?
Response 4.4 28 CCR Section 1300.67.04(c)(B) The Plan is expected to act proactively in informing Purchasers of the need to post information on its website that informs enrollees of the availability of information in threshold languages. Enrollee specific information must be posted in the subscribers preferred language.
5. Language Interpretation:
5.1 Are we only required to provide or arrange for interpretation services in our established threshold languages or into any language?
Response 5.1 Section 1300.67(c)(2)(G)((iv) ". . . Full service plans shall have reasonable processes in place to ensure that LEP enrollees can obtain the plan's assistance in arranging for the provision of timely interpretation services. . ." Interpretation services are not limited to threshold languages or vital documents, and plans must provide those services timely, e.g., when the enrollee calls with questions.
5.2 Would the Department provide guidance on what criteria a plan must apply in order to demonstrate proficiency in both English and the other language under 28 CCR Section 1300.67.04 (c)(1)(H)(i)? Whether or not the Department provides guidance, is it permissible for a plan to have different criteria for a bilingual person providing interpretation services in his/her native language? Could proficiency be demonstrated for such persons in the same manner as outlined in 28 CCR Section 1300.67.04 (d)(9)(A)?
Response 5.2 Section 1300.67.04(c)(2)(H) ". . . A plan may develop and apply appropriate criteria for ensuring the proficiency of translation and interpretation services. . . "
Sub-sections (ii and iii) provides the foundation for "demonstrating proficiency" such as: 1) the fundamental knowledge of both languages, 2) knowledge of health terminology and concepts relevant to health care systems, and 3) education and training in interpreter ethics or if the plan adopts and applies in full, Standards from the CA Healthcare Interpreter Association or National Council on Interpreters in Healthcare.
Section 1300.67.04(d)(9)(A) is limited to the identification of bilingual providers and office staff and an attestation of fluency. The Department directs the Plan to 28 CCR Section 1300.67.04(c)(2)(H)(i-iii) for proficiency requirements.
6. Language Assessment / Vendor Certification:
6.1 As a vendor, our company's services support Health Plan enrollee assessment initiatives in regard to Language Assistance Programs. Do our services have to be approved by DMHC? If so, how do we go about it? Is there a particular department or person(s) we need to contact and speak further regarding our solutions? Any direction you could give me regarding this matter would be appreciated.
Response 6.1 28 CCR Section 1300.67.04 (c)(1)(A,B) The Department recognizes the regulations contain standards for performing the enrollee language assessment, that is, by statistically valid methods of population analysis. The Department, however, is not in the position to "approve" a particular vendor of population assessment services.
If a plan wants to engage such a vendor to assist in the plan's assessment process, the plan will need to determine whether the vendor's services meet the standards and requirements of the statute and regulation. The plan's filing per the regulation should include an explanation of how the plan performed the assessment, and if it engages the vendor for this administrative service, the plan should also file that Administrative Services contract with the Department under Exhibit N.
6.2 Is there a certification process to get pre-approval for development of demographic profiles and/or enrollee assessments? How should a vendor respond to a plan that asks the question "is your solution certified by the DMHC?
Response 6.2 The DMHC does not certify vendors for use by Plans. The Plan must assess and evaluate the requirements under the regulations and make their own decisions of how to comply. Some Plans may use the services of vendors to carry out requirements; however, the Department would not approve the use of or certify the work of the vendor.
7. Statistically Valid:
7.1 Does the State define "statistically valid methods?"
Response 7.1 Currently, the State does not have a method to offer health plans that we consider acceptable. However, we encourage participation in ICE Cultural and Linguistic Work Groups in order to work through these questions with the other Plans.
8. Plan Trainings:
8.1 Will DMHC provide or participate in one or more webinars, seminars etc to help plans understand the timelines and requirements of the new regulation? If not, how will plans ask specific questions?
Response 8. 1 The Department will gather contact information of those posing questions directly in order to respond. We will also work through various work groups and organizations to be in a position to receive and respond to questions. In the months to come, the option of Plan trainings may be considered. Most recently, the Department has planned for and executed information exchange through teleconferences allowing multiple Plans access to the Department for questions and answers.
9. Enrollee Points of Contact:
9.1. Point of Contact is defined to include administrative and clinical services, and telephonic and in-person contacts. Should we read that to exclude web contacts?
Response 9.1 28 CCR Section 1300.67.04(c)(4(d)The department's determination regarding whether a particular web-based administrative service should be considered a point of contact and subject to translation or oral interpretation requirements will be determined pursuant to subsection (d) and the departments consideration of relevant factors, including but not limited to the nature of the web-based services, whether an enrollee has meaningful access to the services through non-web-based methods, cost of compliance, etc. We will look at these issues on a case by case basis.
9.2 Plans would like to discuss the Department's intentions for plan websites considering there is no legal requirement that plans have or maintain websites.
Response 9.2 Section 1300.67.04(c)(4)(d) The Department would expect the Plan to provide meaningful access to administrative services through a variety of mechanisms that make sense to the Plan's product lines and size. The Department will evaluate on a case by case basis. The choice to offer a web-based administrative service or the decision not to offer a web option will be considered in the context of the overall communication plan, assessing alternative options offered the enrollee that afford access to administrative and clinical services.
10. On-Line Enrollment:
10.1 Is it a reasonable interpretation of the language assistance regulation that a plan is permitted to provide on-line enrollment in English only, with enrollment forms in other languages available in PDF format which the applicant can download, manually complete and mail to the health plan?
Response 10.1 28 CCR Section 1300.67.04(c)(2)(G)(v) The plan provision of interpretation services will include a description of the arrangements the plan will make to provide or arrange for the provision of timely interpretation of services at no charge to LEP enrollees at all points of contact where language assistance is needed. The Department would expect a notice of availability of customer assistance in completion of the on-line enrollment form, and availability of language assistance in completing the PDF forms in other languages.
11. Staff Training:
11.1 The regulations permit and promote flexibility in staff training and compliance monitoring. Due to plans having different capabilities in house and through contracted vendors, training and monitoring will vary from plan to plan. Please confirm that the Department does not have expectations concerning how the plans comply with these requirements, so long as plans have a program that can meet the regulatory requirement.
Response 11.1 - The Department confirms that the Plan is required to comply with staff training requirements outlined in section 28 CCR Section 1300.67.04.(c)(3)(A-D) and does not prescribe or have specific expectations as to how the Plans structure the training program.
12. Quality Assurance:
12.1 The language assistance program is to be filed as an amendment to the quality assurance program. As plans evaluate their internal and external capabilities, incorporating language assistance arrangements and monitoring may be incorporated in the overall QA program or be done separately through a devoted language access program. Please confirm that either approach is acceptable.
Response 12.1 Section 1300.67.04(e)(2) The goal of incorporating language assistance into the Plan's quality assurance program is to ensure ongoing assessment and adherence to program requirements through a continuous improvement forum. The Plan may choose to organize the language assistance program separately; however, the Department would expect results of ongoing program monitoring and audits to be reported to the Plan's QA program. A link to the Plan's QA program serves to integrate the Plan's administrative functions, in similar fashion as reports of utilization management or network adequacy through the QA program, to ensure focused review and corrective action to improve performance.
A third option entails the Plan's decision to delegate certain responsibilities related to the language requirements to a third party. In these circumstances, the Department would expect a system of Plan oversight, typically involving the Plan's QA Program as well, to monitor and communicate with the Plan to ensure the delegate is performing the required functions, maintaining ultimate accountability with the Plan.
12.2 The regulations require health plan policies and procedures to list the type of documents that will be translated. Plans anticipate that the Department will audit this requirement by taking a sample of the documents. Please confirm.
Response 12.2 The Department's Plan Survey Division will develop appropriate audit tools and survey approach to validate the Plan's compliance with requirements set forth in H&S Code Section 1367.04 and associated regulations. It is reasonable to expect the survey of translated documents will include, but may not be limited to, samples of translated documents referenced in the Plan's policies and procedures.
13. Medi-Cal v. DMHC Requirements:
13.1 Plans seek specific guidance on the process and documentation required for Medi-Cal deeming under 28 CCR Section 1300.67.04(2). Perhaps coordination with DHCS is needed for this item.
Response 13.1 The Department has initiated a Joint Work Group with DHCS to compare requirements set forth in Section 1367.04 et.al. and the Medi-Cal requirements. The Department anticipates a cross -walk to compare the various requirements and expectations. The Department will update the plans as the work proceeds.
14. Hours of Operation:
14.1 Should the plans include the hours of operation in the correspondence to enrollees citing language interpretation services?
Response 14.1 28 CCR Section 1300.67.04 (c)(2)(C) Hours of operation (including days of the week) should be included in the correspondence as part of the Plan's processes for informing enrollees of the time frame for accessing language assistance services.
15. Vital Documents:
15.1 When the plan sends the enrollee an explanation of benefits (EOB) requesting action on a claim, does the DMHC consider this a vital document?
Response 15.1 H&S Code Section 1367.04(B)(vi) A plan's explanation of benefits or similar claim processing information that is sent to an enrollee is considered a vital document if the document requires a response from the enrollee.
15.2 Will the DMHC provide further clarification on what constitutes a vital document?
Response 15.2 28 CCR Section 1300.67.04(7)(A-G) Provides a fairly comprehensive listing of vital documents; The Department can provide clarity on documents that aren't included in this listing on a case-by-case basis.
15.3 If a single household as multiple threshold languages, is the plan required sending material in multiple languages? Examples would include: quarterly newsletters, member guide books.
Response 15.3 If within a household, multiple threshold languages are spoken, and the Plan has successfully identified and captured these language preferences in their systems, the Plan would be required to issue vital documents to these individuals in each of their preferred threshold language.
The Department refers the Plan to 28 CCR Section 1300.67.04(b)(7)(A-G) for a list of vital documents subject to translation requirements. Plans may, however, but are not required to translate quarterly newsletters in threshold languages. The Plan is not required to translate subscriber contracts, evidences of coverage and other large disclosure forms and enrollee handbooks in their entirety, but may excerpt from large documents specified disclosures as long as there is no loss of accuracy or meaning. (H&S Code Section 1367.04(c)(2)(F)(ii)).
16. Aging into Medicare:
16.1 When a member is converting from being a commercial member to a Medicare member, what are the requirements around communication? At what point is the Language Assistance Program in effect and at what point is it not?
Response 16.1 Once the enrollee's conversion to Medicare is complete, the Knox-Keene Language Assistance regulations no long apply to this enrollee. Federal standards for the provision of language services would take effect.
17. CPT/HCPC:
17.1 Please provide the CPT and/or HCPC's code that reflects translation of documents. I have been unable to locate a nationally recognized code.
Response 17.1 Medicare CPT code 99080 may be used to identify the translation of documents. The use of Modifier 22 is also attached to special circumstances.
18. Language Capability Disclosure Form:
18.1 The regulation states that all contracting offices are required to submit a new Language Capability Disclosure Form on a quarterly basis regarding any changes. If there are no changes in the office staff for a particular office from quarter to quarter or no changes in the languages spoken by the office staff of a particular office from quarter to quarter, are they still required to submit a new Language Capability Disclosure Form? Can the office only submit a new Language Capability Disclosure Form only when there are changes?
Response 18.1 The Department suggests the Plan require a quarterly update disclosure form be submitted by provider offices, regardless of whether or not changes have occurred. The disclosure form and the information it represents, availability of bilingual interpreters, should be considered in the Plan's audit and compliance monitoring plans. The submission of quarterly disclosure forms on a regular basis, allows the Plan to oversee the availability of interpreter services, and update its provider directory consistent with Section 1367.26 of the Act.