1. Language Assistance Program Provider Training Created by ICE Education and Training Workgroup 12/2008

2. 2 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.

3. 3 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.

4. 4 Key Definitions, cont. 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.

5. 5 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.

6. 6 Key Definitions, cont. How to identify a LEP Patient – Patient is quiet or does not respond to questions – Patient simply says yes or no, or gives inappropriate or inconsistent answers to your questions – Patient may have trouble communicating in English or you may have a very difficult time understanding what they are trying to communicate – Patient self identifies as LEP by requesting language assistance.

7. 7 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: http://www.iceforhealth.com/library/documents/Healthpl an_CA_LAP_Contact_Sheet_Draft.xls. http://www.iceforhealth.com/library/documents/Healthpl an_CA_LAP_Contact_Sheet_Draft.xls The guide also lists health plan contacts should you have any questions.

8. 8 Documenting Refusal of Interpreter 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.

9. 9 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.

10. 10 Documenting Refusal of Interpreter, cont. Smart Practice Tip: 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. * Source: Industry Collaboration Effort (ICE) Tips for Communicating Across Language Barriers; www.iceforhealth.orgwww.iceforhealth.org

11. 11 Documenting Refusal of Interpreter, cont. 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)* * Source: Industry Collaboration Effort (ICE) Tips for Communicating Across Language Barriers; www.iceforhealth.orgwww.iceforhealth.org

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 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, they may also receive a written translation of the vital document.

14. 14 Requesting Translations for Non-Standard Vital Documents, cont. 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. Translation requests will normally come through the Health Plan, but may be received by Providers. 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. Insert link here… 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.

15. 15 LAP Notice of Translation Customized by each health plan 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 #}.”

16. 16 Letter Templates for Delegated Groups The texts of each Plan’s Notice of Translation are available under Option 1 in the ICE UM Templates and Tools for LAP Regulations: http://www.iceforhealth.com/library.asp?sf=&sci d=1769#scid1769 http://www.iceforhealth.com/library.asp?sf=&sci d=1769#scid1769 Alternatively, the group may use the revised letter templates under Option 2 that already have the notice inserted.

17. 17 Claims Denial Notices Template inserts have been created for each health plan to be attached to Claims Denial Notices and are available under Option 1 in the ICE Claims Approved Documents: http://www.iceforhealth.org/library.asp?sf=&cid=268#cid268http://www.iceforhealth.org/library.asp?sf=&cid=268#cid268 Alternatively, groups may chose to utilize the template letters for each health plan under Option 2.

18. 18 Translation Timeliness ElementMinimum Policy Requirements Request for translation of a non-standard vital document comes from the enrollee to the provider organization. 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.

19. 19 Translation Timeliness, cont. ElementMinimum Policy Requirements Request for a non-standard vital document comes from the health plan to the provider organization 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.

20. 20 Translation Timeliness (continued) ElementMinimum Policy Requirements Request for a plan- produced vital document comes from the member to the provider organization 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.

21. 21 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 eMail, make sure you’re using secure (encrypted) eMail.

22. 22 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 www.hmohelp.ca.gov.www.hmohelp.ca.gov IMR forms available in English, Spanish, Arabic, Armenian, Chinese, Farsi, Hmong, Khmer/ Cambodian, Korean, Lao, Russian, Tagalog and Vietnamese.

23. 23 Need Answers? For answers to Frequently Asked Questions go to the ICE website at http://www.iceforhealth.org/library.asp?sf=&scid= 1618#scid1618

24. 24 Additional Information For additional information, please check out the Industry Collaboration Effort (ICE) website: www.iceforhealth.org or contact your contracted health plan