Chapter 400 - Administration
ACOM Policy 405, Attachment A,
Cultural Competency Plan Assessment, Language Access Plan, and Family-Patient Centered Care Assessment Reporting Checklist
Contractor: / Date Received:Contractor Contact: / Phone Number:
Lines of Business: / AHCCCS Approved Date:
AHCCCS Reviewer: / AHCCCS Reviewed Date:
The Contractor must complete column ‘B’ and may complete column ‘E’ if applicable.
/ Contractor / AHCCCS / Contractor / AHCCCS /(A)
Policy/Contract Requirement / (B)
Found on Page / (C)
Yes / (D)
No / (E)
Contractor Comments / (F)
AHCCCS Comment /
Cultural Competency Plan Requirements
The submission includes all of the following:
A written Cultural Competency Plan (CCP)
A description of how care and service is delivered in a culturally competent manner to diverse cultural and ethnic backgrounds, including those with limited English Proficiency,[1] disabilities, and regardless of gender, sexual orientation or gender identity[2]?
Identification of a Contractor staff member responsible for the CCP, including notification to AHCCCS of the designated staff member.
A description of goals for the coming year
Training methods the Contractor utilizes to train staff so that services are provided effectively to all members of all cultures
A description of staff training including customized training to fit the needs of staff based on the nature of their contact with providers and/or members
A description of educational methods the Contractor will use for providers and other subcontractors with direct member contact
The Contractor’s education and training program addresses the importance of making providers and other subcontractors aware of the importance of providing services in a culturally competent manner
A description of additional/ongoing training and assistance provided to providers and subcontractors on providing cultural competent services to members
Information outlining Cultural Competency training provided to the Contractor’s staff during new employee orientation and annually
A description of how the Contractor conducts regular assessments of community health assets and how the results are used to plan, implement and assist providers in providing services that respond to the cultural and linguistic diversity of populations in their service area(s)
A description of the Contractor’s method for evaluating the cultural diversity of its membership to assess needs and priorities in order to provide culturally competent care to its membership (languages spoken and ethnicity of membership)
A description of how the Contractor evaluates its network, outreach services and other programs to improve accessibility and quality of care for its membership. It must also describe the provision and coordination needed for linguistic and disability-related services.
A description of how the Contractor makes the member, at the point of contact, aware that translation /interpretation services are available. This includes, access to oral interpretation, translation, sign language, disability-related services, and provide auxiliary aids and alternative formats on request.
A statement that all materials shall be translated when the Contractor is aware that a language is spoken by 3,000 or 10% (whichever is less) of the Contractor’s members who also have Limited English Proficiency (LEP) in that language.
That vital materials and all written materials are translated when a language is spoken by 5% or 1, 000 members (whichever is less) of the Contractor’s members who also have LEP.
Translation of written notices informing members of their right to interpretation and translation services when a languages is spoken by 5% or 1, 000 members (whichever is less) of the Contractor’s members who also have LEP.
Information outlining the Contractor’s ability to provide, upon request by a member, easy-to-understand print and member information materials, Consideration includes members with LEP or limited reading skills, those with diverse cultural and ethnic backgrounds, and those with visual or auditory limitations.
Information on available interpretation services and auxiliary aids for members who are Deaf and Hard of Hearing
The process for communicating the Contractor’s progress in implementing and sustaining the CCP’s goals to stakeholders, members and the general public
To ensure that communications with Members and their families about member health care concerns are culturally competent, the Contractor will shall[3] submit a summary statement describing the practices that health care providers are required to use when;
· Accessing language assistance services;
· Explaining member rights and protections (e.g. HIPPAA),[4]
· Eliciting descriptions of symptoms, health problems, treatment goals and preferences,
· Explaining treatment practices (e.g. medications, examinations, etc.[5]) and processes, (e.g. goal setting, assessments, treatment planning, clinical meetings, referrals to other service providers and service interventions etc.[6]) are communicated.
The statement shall[7] will also refer to source documents (e.g. policies, procedures, training curricula, clinical protocols, supervisory processes, best practices etc.[8]) that guide these practices.[9]
A description of how the Contractor is providing health care information to members in a culturally competent manner that includes:
· How rights and protections are exercised;
· What is considered to be a health problem;
· How symptoms and concerns about the problem are expressed;
· Who should provide treatment for the problem; and
· What type of treatment should be given.
Cultural Competency Assessment
The CCP was assessed for effectiveness. The assessment may, for example, focus on comparative member satisfaction surveys, outcomes for certain cultural groups, member complaints, grievances, provider feedback and/or Contractor employee surveys.
An assessment that includes a review of goals from the prior year
Tracking and trending of any identified issues
Actions taken for resolution of identified issues
The assessment includes modifications, if any, that were made to the CCP
/ Contractor / AHCCCS / Contractor / AHCCCS /
(A)
Policy/Contract Requirement / (B)
Found on Page / (C)
Yes / (D)
No / (E)
Contractor Comments / (F)
AHCCCS Comment /
For CRS the CCP Assessment shall also contain:
A description of how the Contractor ensures that the family is recognized as the primary source of support for the member’s health care decision-making process.
Information regarding the availability of service systems and personnel to support the family’s role as decision makers.
How collaboration is facilitated among recipients, families, health care providers, and policy makers at all levels that include:
Care of the member
Development, implementation, and evaluation of programs
Policy development
A description of how the CCP promotes complete exchanges of unbiased information between recipients, families, and health care professionals in a supportive manner at all times
A description of how cultural, racial, ethnic, geographic, social, spiritual, and economic diversity and individuality are recognized within and across all families
A description of practices and policies that were implemented to support the medical, developmental, educational, emotional, cultural, environmental and financial needs of members and their families
A description of the development and participation of the Contractor in Family Centered Cultural Competence Trainings
A description of how family-to-family support and networking is facilitated
A description of how the Contractor promotes available, accessible, and comprehensive community, home, and hospital support systems to meet the diverse and unique needs of the family
An acknowledgement of the importance of families as crucial allies as it applies to the member’s health and well being for quality assurance within the service delivery system, including how this is communicated to members and their families
The CCP documents how the unique nature of each member and their family is appreciated and recognized
/ Contractor / AHCCCS / Contractor / AHCCCS /
(A)
Policy/Contract Requirement / (B)
Found on Page / (C)
Yes / (D)
No / (E)
Contractor Comments / (F)
AHCCCS Comment /
Language Access Plan (see Policy for Description of each element below)
Assessment: Needs and Capacity
Oral Language Assistance Services
Written Translations
Policies and Procedures
Notification of the Availability of Language Assistance at No Cost
Staff Training
Assessment: Access and Quality
Stakeholder Consultation
Digital Information
Subcontractor Assurance and Compliance
Policy 405, Attachment A, Page 1 of 9
Effective Date: 05/01/14, 07/01/16, 07/01/17
[1] POST APC CHANGE: added “including those with limited English proficiency
[2] Added per Navigant
[3] POST APC CHANGE: editing change; replace ‘will’ with ‘shall’
[4] POST APC CHANGE:corrected spelling to HIPAA
[5] POST APC CHANGE: remove “etc.” after e.g. references
[6] POST APC CHANGE: remove “etc.” after e.g. references
[7] POST APC CHANGE: editing change; replace ‘will’ with ‘shall’
[8] POST APC CHANGE: remove “etc.” after e.g. references
[9] Reworded to clarify requirement.