Policy/Procedure Title: Cultural and Linguistic Services / ☒External Policy
☐Internal Policy /
Original Date: 02/26/1999 (MP 302) / Next Review Date: 02/14/2019
Last Review Date: 02/14/2018 /
Applies to: / ☒ Medi-Cal / ☐ Employees /
Policy/Procedure Number: MCLP7002 (previously MP 302) / Lead Department: Health Services /
Policy/Procedure Title: Cultural and Linguistic Services / External Policy
Internal Policy /
Original Date: 02/26/1999 (MP 302) / Next Review Date: 02/14/2019
Last Review Date: 02/14/2018 /
Applies to: / Medi-Cal / Employees /
Reviewing Entities: / IQI / P & T / QUAC /
OPerations / Executive / Compliance / Department /
Approving Entities: / BOARD / COMPLIANCE / FINANCE / PAC
CEO / COO / Credentialing / DEPT. DIRECTOR/OFFICER
Approval Signature: Robert Moore, MD, MPH, MBA / Approval Date: 02/14/2018
I. RELATED POLICIES:
A. HR509 - Bilingual Standards
B. CMP-10 - Confidentiality
C. CGA022 - Member Discrimination Grievance Procedure
D. MPLD7002 - Cultural and Linguistics Program Description
E. MP PR 200 - PHC Provider Contracts
II. IMPACTED DEPTS.:
A. Member Services
B. Health Services
C. Provider Relations
III. DEFINITIONS:
A. CAC – Consumer Advisory Committee
B. DHCS – Department of Health Care Services
C. EOC – Evidence of Coverage
D. ICE – Industry Collaboration Effort (ICE)
E. IQI – Internal Quality Improvement
F. LEP – Limited English Proficiency
G. MMCD – Medi-Cal Managed Care Division
H. OHC – Other Health Coverage
I. SPD – Seniors and Persons with Disabilities
J. TJC – The Joint Commission
K. LGBTQ – Lesbian, Gay, Bisexual, Transgender and Queer/Questioning
L. Qualified interpreter – interpreter who adheres to generally accepted interpreter ethics, principles, and confidentiality. Has demonstrated proficiency in speaking and understanding both spoken English and at least one non-English language, and is able to interpret effectively, accurately, and impartially, both receptively and expressively, to and from such language(s) and English, using any necessary specialized vocabulary and phraseology.
M. Qualified translator – translator who adheres to generally accepted translator ethics, principles, and confidentiality. Has demonstrated proficiency in writing and understanding both written English and at least one non-English language, and is able to translate effectively, accurately, and impartially to and from such language(s) and English, using any necessary specialized vocabulary, terminology, and phraseology.
IV. ATTACHMENTS:
A. Interpreting Services Log
B. List of vendors who provide Interpreting Services
V. PURPOSE:
To ensure effective communication regarding treatment, diagnosis, medical history and health education by providing cultural, linguistic, and sensory appropriate services to Members, taking into consideration Members’ beliefs, traditions, customs, and individual differences. Partnership HealthPlan of California (PHC) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
VI. POLICY / PROCEDURE:
A. Demographic Profile
1. Medi-Cal - The language code provided on the 834 file is used to determine primary languages.
2. In accordance with PHC Policy CMP-10, Confidentiality, this information is collected, summarized and documented in a manner that enables PHC to maintain confidentiality of personal information and to disclose the information to Department of Health Care Services (DHCS), upon request for regulatory purposes and to contracting providers on request for lawful purposes, including language assistance purposes and health care quality improvement purposes.
Standards for Determining Threshold Languages and Requirements for Section 1557 of the Affordable Care Act determined by DHCS All Plan Letter (APL) 17-011, which supersedes APL14-008. Managed Care Plans (MCP) are required to provide translated member information to the following groups within their service areas as determined by DHCS using:
a. Threshold Standard Language: A population group of mandatory eligible beneficiaries residing in the service area who indicate their primary language as other than English, and that meet a numeric threshold of 3,000 or five percent (5%) of the eligible beneficiary population whichever is lower; and,
b. Concentration Standard Language: A population group of mandatory eligible beneficiaries residing in the (MCP’s service area who indicate their primary language as other than English and who meet the concentration standards of 1,000 in a single zip code or 1,500 in two contiguous zip codes.
B. Notification to Members, Potential Members, and Public of the Availability of Linguistic Services for California’s top 16 non-English languages spoken by LEP individuals and PHC’s compliance with nondiscrimination and applicable Federal civil rights laws.
a. PHC notifies members, potential members, and public of the availability of these services by publishing language assistance taglines and a notice of non-discrimination with all major member correspondence including but not limited to: PHC Member Handbook/Evidence of Coverage (EOC)
b. Notices in Provider Offices
c. PHC External Website at www.partnershiphp.org
d. Member newsletter
e. PHC Provider Directory.
C. Staff Training
1. PHC provides an annual training to all staff who have direct contact with members. This training includes the following topics:
a. Review of PHC Cultural and Linguistic Services Policy
b. Understanding the needs of Limited English Proficiency (LEP) members
c. Understanding cultural differences of LEP members
d. Interpreter Services Criteria
e. How to access interpreter services
f. How to effectively use and interact with available interpretation services
g. Seniors and Persons with Disabilities sensitivity awareness training (State Approved)
2. Other internal departmental trainings include:
a. Cultural awareness and sensitivity
b. Identifying and communicating with LEP members
c. Interpreting and translations policies and procedures
d. Using the TTY and California Relay Systems
e. Referrals to culturally and linguistically appropriate services
f. Information and resources to help address the needs of LGBTQ members
D. Services Provided
1. In accordance with 42 CFR 438.10(d), PHC shall provide the following linguistic services at no cost to members:
a. Access to qualified oral interpreters, signers, or bilingual providers and staff at key points of contact (medical and non-medical) for members whose language proficiency is any of California’s top 16 non-English languages spoken by LEP individuals. Medical points of contact include face-to-face or telephonic encounters with providers (physicians, physician extender, registered nurses, pharmacists (at a minimum - telephonic interpreter), or other personnel who provide medical or health care advice to members.
b. Written Materials - All written member informing materials, including those required by the DHCS, as outlined in are translated by a qualified translator in the threshold languages of PHC’s service area and when requested by a member, any of California’s top 16 non-English languages. These materials are also available in audio, large print, and electronically such as CD or diskettes for members with hearing and/or visual disabilities. Braille versions are available for members with visual disabilities. Members can make a standing request to receive all informing materials in the specific format.
2. Language Line Services - PHC contracts with Language Line services. In accordance with Title 22 CCR Section 53853(c), this service provides real time interpreting services and is available on a 24hour basis. The Language Line is used by PHC staff for languages not spoken by staff for LEP members. This service is also available to contracted providers at key points of contact, including pharmacies.
3. As outlined in the DHCS contract, PHC shall distribute this member information no later than seven(7) calendar days following notification of enrollment. PHC shall also distribute this member information annually to each member or family unit.
4. To ensure the quality of written translation, PHC conducts testing for bilingual staff to qualify them to review and approve documents that have been translated by a contracted vendor. As required in the DHCS contract, PHC shall ensure that all written Member information is provided to Members at a sixth grade or lower reading level and approved by DHCS. The written Member information shall ensure the Member’s understanding of the health plan Covered Services processes and ensure the Member’s ability to make informed health decisions.
5. In accordance with MMCD Policy Letter 99-003, the member material must include information regarding the member’s rights.
6. Interpreter services at no charge when accessing health care
a. Discourage the use of family members or friends as interpreters, unless specifically requested by the member.
b. Request face-to-face or telephonic interpreter services during discussion of complex medical information such as diagnoses of complex medical conditions and accompanying proposed treatment options.
c. Member has the right to receive documents translated into any of California’s top 16 non-English languages.
d. Member has the right to file grievances or complaints if linguistic needs are not met.
7. Appeals and Complaints
a. The EOC provides a detailed summary of the process of filing a complaint or appeal. Inaddition to this, PHC:
1) Includes a bi-annual Member Newsletter article advising members to contact the Member Services Department to file a complaint or appeal.
2) Provides complaint and appeal forms in the threshold languages of PHC’s services area on the PHC website at www.partnershiphp.org.
3) Maintains Grievance Policies that instruct staff and providers of the requirement of providing members with appropriate complaint and appeal forms.
4) Conducts on-site audits at Provider sites to ensure that appropriate complaint and appeal forms are available to members in all threshold languages.
8. Face-to-Face Medical Interpreter Services – LEP members are entitled to language or sign language interpreters when accessing medically necessary health care services. Refer to the section of this policy titled Criteria and Authorization Requirements for Interpreting Services. PHC is not required to provide face-to-face interpreter services for a member when the provider has made provision for an on-site interpreter.
9. Inpatient and Outpatient Hospital Services – The Joint Commission (TJC) requires these services be available at hospitals. It is the responsibility of hospitals to arrange for and provide these services. Hospitals are also required to provide appropriate services for hearing and visually impaired patients. If a hospital does not meet its obligation of providing interpretation services, PHC will arrange for the service to be provided.
10. PHC will not reimburse providers who chose to provide face-to-face interpreter services or services for the hearing or visually impaired members without making arrangements for the provision of services through PHC’s Member Services. Department.
11. Auxiliary aids, Telecommunication Devices for the Deaf (TDD), Telephone Typewriters (TTY) and California Relay Service – These services are available to hearing impaired members.
12. Primary Care Assignment – To assist all LEP members in choosing a primary care provider that speaks their language, the languages spoken at each Provider office are published in the PHC Provider Directory. Member Services bilingual staff are also available to assist LEP members with the selection process. The Provider Directory reflects those provider offices which are wheelchair accessible.
13. Auto Assignment – The auto assignment process is configured to use the member’s language code and resident address.
14. PHC Member Services Staff – PHC’s goal is to staff the Member Services Department with employees who are reflective of the cultural and linguistic diversity of PHC membership.
15. Testing Linguistic Proficiency of PHC Staff – In accordance with Human Resources policy #509, Bilingual Standards, the oral linguistic proficiency of all employees who provide interpreting services to members are tested. This is done to ensure that all the necessary linguistic requirements are met. Only those employees who pass the test are allowed to provide oral interpretation to members. A copy of the test is maintained by PHC’s Human Resources Department.
16. Provider Network – PHC’s goal is to maintain a provider network with a sufficient number of bilingual and multilingual providers and provider staff who speak threshold languages. PHC requires that providers document the request or refusal of language/interpreter services by LEP members in their medical records.
17. On an annual basis, PHC conducts provider self-reporting surveys to identify specific bilingual staff at the provider sites. The survey questionnaire includes the following questions:
a. Is the language spoken the employee’s first language spoken at home?
b. Is the Employee a certified/ or qualified medical interpreter?
c. Has the employee had formal classroom education in the language?
d. Does your office assess employee interpretation ability?
18. The data collected from the survey is audited against the provider directory. The directories are updated to reflect new information.
19. As provider office staff changes are communicated to PHC, linguistic capabilities of the new staff are added to the directory.
20. PHC continuously monitors issues related to provider interpreter capabilities through member complaint and grievance logs. Corrective Action Plans are developed with provider sites if issues are identified. PHC uses a variety of formats and tools to ensure providers are aware of interpreter service options and educational opportunities for their staff. Examples: Quarterly provider newsletter articles, PHC Provider Cultural and Linguistic Toolkit; links to Industry Collaboration Effort (ICE) on the PHC website, reminders at provider site in-services, and publish a list of on-line courses and community colleges that offer bilingual educational courses.
E. Provider Training & Education
1. PHC educates and trains providers and their staff on the following:
a. Cultural competence
b. Patient communication
c. Member satisfaction and/or complaints
d. Federal and state regulations and contract requirements relating to language access and anti-discriminatory practices
e. Procedures for accessing PHC Interpreter Services, and the Language Line, the importance of using qualified interpreters, discouraging the use of minors, friends or family members as interpreters, documenting the member’s preferred language in their chart, and documenting the offer, acceptance or refusal of interpreter services.
2. Seniors and Persons with Disabilities (SPD) competency and sensitivity training is provided to providers, their staff and health plan staff utilizing the curriculum developed by Medi-Cal Managed Care Division (MMCD).
3. Documentation of trainings is maintained by PHC and is available upon request in accordance to DHCS MMCD APL 11-010.
F. Provider Language Capability