Amended IN Assembly June 21, 2017 Amended IN Senate April 26, 2017 Amended IN Senate April 05, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Senate Bill No. 223Introduced by Senator AtkinsFebruary 02, 2017 An act to amend Section 1367.04 of, and to add Sections 1367.032 and 1367.042 to, the Health and Safety Code, to amend Section 10133.8 of, and to add Section 10133.11 to, the Insurance Code, and to amend Sections 14029.91 and 14684 of, and to add Sections 14029.92 and 14727 to, the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 223, as amended, Atkins. Health care language assistance services. (1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements for health care service plans and health insurers to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, including requirements for individual access to interpretation services and requirements to conduct an assessment of the language preferences and linguistic needs of the enrollee and insured population and for the translation of vital documents. For those vital documents that are not standardized but contain enrollee or insured specific information, existing law does not require a health care service plan or health insurer to translate the documents into threshold languages identified by the needs assessment, but instead requires a written notice of availability of interpretation services in threshold languages identified by the needs assessment to be included with those vital documents.This bill would also require this written notice to be made available available, by a health care service plan or health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives, in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau. The bill, with regards to those requirements for individual access to interpretation services, would establish minimum qualification and education criteria that an interpreter is required to meet in order to provide interpretation services to enrollees and insureds and would prohibit the plan or health insurer from requiring an enrollee or insured to provide his or her own interpreter or to rely on an adult or minor child accompanying the enrollee or insured, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for interpretation services unless the enrollee or insured, after being informed of the availability of interpretation services, provides written consent to receive those services from an individual other than adult accompanying the enrollee or insured or staff member who is not a qualified interpreter.The bill would require a health care service plan, including a Medi-Cal managed care plan, and a health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections available to individuals enrolled in a plan contract or health insurance policy, and would require this information to be included in a separate section of the plans or health insurers evidence of coverage, on materials that are routinely disseminated to enrollees or insureds, and to be posted on the Internet Web site maintained by the plan or health insurer.The bill would require a health care service plan to include in a specified annual report to the Department of Managed Health Care data regarding the ability of enrollees to receive interpretation services with scheduled appointments for health care services, as specified. Because a willful violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.(2) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans. Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services, including oral interpretation services and translation services, to LEP Medi-Cal beneficiaries, as defined. Existing law exempts mental health plans from these language assistance services requirements.This bill would delete the exemption for mental health plans, thereby extending these language assistance services requirements to mental health plans, and would make conforming changes. The bill would also require those managed care plans and mental health plans to provide written notice of the availability of interpretation services in language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau. The bill would require oral interpretation services to be provided by an interpreter that who meets specified minimum qualification and education criteria. The bill would prohibit a Medi-Cal managed care plan or a mental health plan from requiring a Medi-Cal beneficiary to provide his or her own interpreter or to rely on an adult or minor child accompanying the beneficiary, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for oral interpretation services unless the beneficiary, after being informed of the availability of oral interpretation services, provides written consent to receive those services from an individual other than adult accompanying the beneficiary or staff member who is not a qualified interpreter. The bill would require the State Department of Health Care Services and mental health plans to notify Medi-Cal beneficiaries of the availability of language assistance services and of certain nondiscrimination protections available to Medi-Cal beneficiaries, and would require this information to be included in a separate section of the beneficiary handbook, on materials that are routinely disseminated to beneficiaries, and to be posted on the departments Internet Web site and on the Internet Web site maintained by the mental health plan.(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.032 is added to the Health and Safety Code, immediately following Section 1367.031, to read:1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.SEC. 2. Section 1367.04 of the Health and Safety Code is amended to read:1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.SEC. 3. Section 1367.042 is added to the Health and Safety Code, to read:1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 4. Section 10133.8 of the Insurance Code is amended to read:10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.SEC. 5. Section 10133.11 is added to the Insurance Code, to read:10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.SEC. 6. Section 14029.91 of the Welfare and Institutions Code is amended to read:14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.SEC. 7. Section 14029.92 is added to the Welfare and Institutions Code, to read:14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.SEC. 8. Section 14684 of the Welfare and Institutions Code is amended to read:14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.SEC. 9. Section 14727 is added to the Welfare and Institutions Code, to read:14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.SEC. 10. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
Amended IN Assembly June 21, 2017 Amended IN Senate April 26, 2017 Amended IN Senate April 05, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Senate Bill No. 223Introduced by Senator AtkinsFebruary 02, 2017 An act to amend Section 1367.04 of, and to add Sections 1367.032 and 1367.042 to, the Health and Safety Code, to amend Section 10133.8 of, and to add Section 10133.11 to, the Insurance Code, and to amend Sections 14029.91 and 14684 of, and to add Sections 14029.92 and 14727 to, the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 223, as amended, Atkins. Health care language assistance services. (1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements for health care service plans and health insurers to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, including requirements for individual access to interpretation services and requirements to conduct an assessment of the language preferences and linguistic needs of the enrollee and insured population and for the translation of vital documents. For those vital documents that are not standardized but contain enrollee or insured specific information, existing law does not require a health care service plan or health insurer to translate the documents into threshold languages identified by the needs assessment, but instead requires a written notice of availability of interpretation services in threshold languages identified by the needs assessment to be included with those vital documents.This bill would also require this written notice to be made available available, by a health care service plan or health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives, in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau. The bill, with regards to those requirements for individual access to interpretation services, would establish minimum qualification and education criteria that an interpreter is required to meet in order to provide interpretation services to enrollees and insureds and would prohibit the plan or health insurer from requiring an enrollee or insured to provide his or her own interpreter or to rely on an adult or minor child accompanying the enrollee or insured, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for interpretation services unless the enrollee or insured, after being informed of the availability of interpretation services, provides written consent to receive those services from an individual other than adult accompanying the enrollee or insured or staff member who is not a qualified interpreter.The bill would require a health care service plan, including a Medi-Cal managed care plan, and a health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections available to individuals enrolled in a plan contract or health insurance policy, and would require this information to be included in a separate section of the plans or health insurers evidence of coverage, on materials that are routinely disseminated to enrollees or insureds, and to be posted on the Internet Web site maintained by the plan or health insurer.The bill would require a health care service plan to include in a specified annual report to the Department of Managed Health Care data regarding the ability of enrollees to receive interpretation services with scheduled appointments for health care services, as specified. Because a willful violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.(2) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans. Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services, including oral interpretation services and translation services, to LEP Medi-Cal beneficiaries, as defined. Existing law exempts mental health plans from these language assistance services requirements.This bill would delete the exemption for mental health plans, thereby extending these language assistance services requirements to mental health plans, and would make conforming changes. The bill would also require those managed care plans and mental health plans to provide written notice of the availability of interpretation services in language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau. The bill would require oral interpretation services to be provided by an interpreter that who meets specified minimum qualification and education criteria. The bill would prohibit a Medi-Cal managed care plan or a mental health plan from requiring a Medi-Cal beneficiary to provide his or her own interpreter or to rely on an adult or minor child accompanying the beneficiary, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for oral interpretation services unless the beneficiary, after being informed of the availability of oral interpretation services, provides written consent to receive those services from an individual other than adult accompanying the beneficiary or staff member who is not a qualified interpreter. The bill would require the State Department of Health Care Services and mental health plans to notify Medi-Cal beneficiaries of the availability of language assistance services and of certain nondiscrimination protections available to Medi-Cal beneficiaries, and would require this information to be included in a separate section of the beneficiary handbook, on materials that are routinely disseminated to beneficiaries, and to be posted on the departments Internet Web site and on the Internet Web site maintained by the mental health plan.(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
Amended IN Assembly June 21, 2017 Amended IN Senate April 26, 2017 Amended IN Senate April 05, 2017
Amended IN Assembly June 21, 2017
Amended IN Senate April 26, 2017
Amended IN Senate April 05, 2017
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Senate Bill No. 223
Introduced by Senator AtkinsFebruary 02, 2017
Introduced by Senator Atkins
February 02, 2017
An act to amend Section 1367.04 of, and to add Sections 1367.032 and 1367.042 to, the Health and Safety Code, to amend Section 10133.8 of, and to add Section 10133.11 to, the Insurance Code, and to amend Sections 14029.91 and 14684 of, and to add Sections 14029.92 and 14727 to, the Welfare and Institutions Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
SB 223, as amended, Atkins. Health care language assistance services.
(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements for health care service plans and health insurers to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, including requirements for individual access to interpretation services and requirements to conduct an assessment of the language preferences and linguistic needs of the enrollee and insured population and for the translation of vital documents. For those vital documents that are not standardized but contain enrollee or insured specific information, existing law does not require a health care service plan or health insurer to translate the documents into threshold languages identified by the needs assessment, but instead requires a written notice of availability of interpretation services in threshold languages identified by the needs assessment to be included with those vital documents.This bill would also require this written notice to be made available available, by a health care service plan or health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives, in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau. The bill, with regards to those requirements for individual access to interpretation services, would establish minimum qualification and education criteria that an interpreter is required to meet in order to provide interpretation services to enrollees and insureds and would prohibit the plan or health insurer from requiring an enrollee or insured to provide his or her own interpreter or to rely on an adult or minor child accompanying the enrollee or insured, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for interpretation services unless the enrollee or insured, after being informed of the availability of interpretation services, provides written consent to receive those services from an individual other than adult accompanying the enrollee or insured or staff member who is not a qualified interpreter.The bill would require a health care service plan, including a Medi-Cal managed care plan, and a health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections available to individuals enrolled in a plan contract or health insurance policy, and would require this information to be included in a separate section of the plans or health insurers evidence of coverage, on materials that are routinely disseminated to enrollees or insureds, and to be posted on the Internet Web site maintained by the plan or health insurer.The bill would require a health care service plan to include in a specified annual report to the Department of Managed Health Care data regarding the ability of enrollees to receive interpretation services with scheduled appointments for health care services, as specified. Because a willful violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.(2) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans. Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services, including oral interpretation services and translation services, to LEP Medi-Cal beneficiaries, as defined. Existing law exempts mental health plans from these language assistance services requirements.This bill would delete the exemption for mental health plans, thereby extending these language assistance services requirements to mental health plans, and would make conforming changes. The bill would also require those managed care plans and mental health plans to provide written notice of the availability of interpretation services in language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau. The bill would require oral interpretation services to be provided by an interpreter that who meets specified minimum qualification and education criteria. The bill would prohibit a Medi-Cal managed care plan or a mental health plan from requiring a Medi-Cal beneficiary to provide his or her own interpreter or to rely on an adult or minor child accompanying the beneficiary, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for oral interpretation services unless the beneficiary, after being informed of the availability of oral interpretation services, provides written consent to receive those services from an individual other than adult accompanying the beneficiary or staff member who is not a qualified interpreter. The bill would require the State Department of Health Care Services and mental health plans to notify Medi-Cal beneficiaries of the availability of language assistance services and of certain nondiscrimination protections available to Medi-Cal beneficiaries, and would require this information to be included in a separate section of the beneficiary handbook, on materials that are routinely disseminated to beneficiaries, and to be posted on the departments Internet Web site and on the Internet Web site maintained by the mental health plan.(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements for health care service plans and health insurers to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, including requirements for individual access to interpretation services and requirements to conduct an assessment of the language preferences and linguistic needs of the enrollee and insured population and for the translation of vital documents. For those vital documents that are not standardized but contain enrollee or insured specific information, existing law does not require a health care service plan or health insurer to translate the documents into threshold languages identified by the needs assessment, but instead requires a written notice of availability of interpretation services in threshold languages identified by the needs assessment to be included with those vital documents.
This bill would also require this written notice to be made available available, by a health care service plan or health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives, in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau. The bill, with regards to those requirements for individual access to interpretation services, would establish minimum qualification and education criteria that an interpreter is required to meet in order to provide interpretation services to enrollees and insureds and would prohibit the plan or health insurer from requiring an enrollee or insured to provide his or her own interpreter or to rely on an adult or minor child accompanying the enrollee or insured, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for interpretation services unless the enrollee or insured, after being informed of the availability of interpretation services, provides written consent to receive those services from an individual other than adult accompanying the enrollee or insured or staff member who is not a qualified interpreter.
The bill would require a health care service plan, including a Medi-Cal managed care plan, and a health insurer that offers essential health benefits, as defined, and with an enrollment of 50,000 or more covered lives to notify enrollees or insureds upon initial enrollment and in the annual renewal materials of the availability of language assistance services and of certain nondiscrimination protections available to individuals enrolled in a plan contract or health insurance policy, and would require this information to be included in a separate section of the plans or health insurers evidence of coverage, on materials that are routinely disseminated to enrollees or insureds, and to be posted on the Internet Web site maintained by the plan or health insurer.
The bill would require a health care service plan to include in a specified annual report to the Department of Managed Health Care data regarding the ability of enrollees to receive interpretation services with scheduled appointments for health care services, as specified.
Because a willful violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.
(2) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans. Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services, including oral interpretation services and translation services, to LEP Medi-Cal beneficiaries, as defined. Existing law exempts mental health plans from these language assistance services requirements.
This bill would delete the exemption for mental health plans, thereby extending these language assistance services requirements to mental health plans, and would make conforming changes. The bill would also require those managed care plans and mental health plans to provide written notice of the availability of interpretation services in language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau. The bill would require oral interpretation services to be provided by an interpreter that who meets specified minimum qualification and education criteria. The bill would prohibit a Medi-Cal managed care plan or a mental health plan from requiring a Medi-Cal beneficiary to provide his or her own interpreter or to rely on an adult or minor child accompanying the beneficiary, except when there is an emergency medical condition, as defined, and a qualified interpreter is not available, or a staff member who is not a qualified interpreter for oral interpretation services unless the beneficiary, after being informed of the availability of oral interpretation services, provides written consent to receive those services from an individual other than adult accompanying the beneficiary or staff member who is not a qualified interpreter. The bill would require the State Department of Health Care Services and mental health plans to notify Medi-Cal beneficiaries of the availability of language assistance services and of certain nondiscrimination protections available to Medi-Cal beneficiaries, and would require this information to be included in a separate section of the beneficiary handbook, on materials that are routinely disseminated to beneficiaries, and to be posted on the departments Internet Web site and on the Internet Web site maintained by the mental health plan.
(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1367.032 is added to the Health and Safety Code, immediately following Section 1367.031, to read:1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.SEC. 2. Section 1367.04 of the Health and Safety Code is amended to read:1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.SEC. 3. Section 1367.042 is added to the Health and Safety Code, to read:1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 4. Section 10133.8 of the Insurance Code is amended to read:10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.SEC. 5. Section 10133.11 is added to the Insurance Code, to read:10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.SEC. 6. Section 14029.91 of the Welfare and Institutions Code is amended to read:14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.SEC. 7. Section 14029.92 is added to the Welfare and Institutions Code, to read:14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.SEC. 8. Section 14684 of the Welfare and Institutions Code is amended to read:14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.SEC. 9. Section 14727 is added to the Welfare and Institutions Code, to read:14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.SEC. 10. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1367.032 is added to the Health and Safety Code, immediately following Section 1367.031, to read:1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.
SECTION 1. Section 1367.032 is added to the Health and Safety Code, immediately following Section 1367.031, to read:
### SECTION 1.
1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.
1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.
1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.
1367.032. As part of the report submitted to the department pursuant to paragraph (2) of subdivision (f) of Section 1367.03, a health care service plan shall submit to the department data regarding the ability of enrollees to receive interpreter services with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment.
SEC. 2. Section 1367.04 of the Health and Safety Code is amended to read:1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
SEC. 2. Section 1367.04 of the Health and Safety Code is amended to read:
### SEC. 2.
1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:(1) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility and participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.(4) Requirements for individual enrollee access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the enrollee shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.(c) In developing the regulations, standards, and requirements, the department shall consider the following:(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.
(b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (1). The regulations shall include the following:
(1) Requirements for the translation of vital documents that include the following:
(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:
(i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.
(ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.
(iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.
(B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:
(i) Applications.
(ii) Consent forms.
(iii) Letters containing important information regarding eligibility and participation criteria.
(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.
(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees.
(vi) Translated documents shall not include a health care service plans explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.
(C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.
(ii) 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 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 care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plans issuance of the translated document.
(iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral interpretation services.
(D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.
(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.
(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.
(4) Requirements for individual enrollee access to interpretation services that include the following:
(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:
(i) Demonstrated proficiency in both English and the target language.
(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.
(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.
(B) A requirement that the enrollee shall not be required to:
(i) Provide his or her own interpreter.
(ii) Rely on an adult or minor child accompanying the enrollee with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1, and an interpreter who meets the qualifications described in subparagraph (A) is not available.
(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.
(C) After being informed of the availability of interpretation services, an enrollee may rely on an adult or minor child accompanying the enrollee, enrollee or other staff for interpretation services if the enrollee provides written consent.
(5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.
(c) In developing the regulations, standards, and requirements, the department shall consider the following:
(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).
(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.
(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.
(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.
(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business and Professions Code.
(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.
(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.
(8) The cost of compliance and the availability of translation and interpretation services and professionals.
(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation services.
(d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.
(e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.
(f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance.
(g) The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase-in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.
(h) (1) Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.
(2) The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.
(3) The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.
(i) Nothing in this section shall prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
SEC. 3. Section 1367.042 is added to the Health and Safety Code, to read:1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 3. Section 1367.042 is added to the Health and Safety Code, to read:
### SEC. 3.
1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.042. (a) A health care service plan that offers essential health benefits, as defined in Section 1367.005, and with an enrollment of 50,000 or more covered lives shall notify enrollees and members of the public of all of the following information:
(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.
(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.
(3) The health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 1365.5. If there is a concern of discrimination on these bases, the department should be contacted.
(4) The availability of the grievance procedure described in Section 1368 and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.
(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
(b) The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following manner:
(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.
(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plans enrollees.
(3) On the Internet Web site published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.
(c) This section shall apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 4. Section 10133.8 of the Insurance Code is amended to read:10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
SEC. 4. Section 10133.8 of the Insurance Code is amended to read:
### SEC. 4.
10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).(b) The regulations described in subdivision (a) shall include the following:(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.(3) Requirements for the translation of vital documents that include the following:(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:(i) Applications.(ii) Consent forms.(iii) Letters containing important information regarding eligibility or participation criteria.(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.(5) Requirements for individual access to interpretation services that include the following:(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A requirement that the insured shall not be required to:(i) Provide his or her own interpreter.(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.(8) The cost of compliance and the availability of translation and interpretation services and professionals.(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
10133.8. (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits. A health insurer that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its population for purposes of subparagraph (A) of paragraph (3) of subdivision (b). An insurer that chooses to separate its Healthy Families Program enrollment from the remainder of its population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (A) of paragraph (3) of subdivision (b) is applicable and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (A) of paragraph (3) of subdivision (b).
(b) The regulations described in subdivision (a) shall include the following:
(1) A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.
(2) Requirements for surveying the language preferences and assessment of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than three years if the commissioner determines that the results are unlikely to affect the translation requirements.
(3) Requirements for the translation of vital documents that include the following:
(A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:
(i) A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.
(ii) A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) of subdivision (b) and any additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.
(iii) A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) of subdivision (b) a preference for written materials in that language.
(B) Specification of vital documents produced by the insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:
(i) Applications.
(ii) Consent forms.
(iii) Letters containing important information regarding eligibility or participation criteria.
(iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, the right to file a complaint or appeal.
(v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to insureds.
(vi) Translated documents shall not include an insurers explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.
(C) For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b) but rather shall include with the document a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau and in the threshold languages identified by the needs assessment pursuant to paragraph (2) of subdivision (b). A health insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California identified annually by the United States Census Bureau.
(i) Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insureds request for a written translation. If an enrollee requests a translated document, all timeframes and deadlines requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurers issuance of the translated document.
(ii) For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by providing notice of the availability and access to oral interpretation services.
(D) A requirement that health insurers advise limited-English-proficient insureds of the availability of interpreter services.
(4) Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.
(5) Requirements for individual access to interpretation services that include the following:
(A) A requirement that an interpreter meets, at a minimum, all of the following qualifications:
(i) Demonstrated proficiency in both English and the target language.
(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.
(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept health insurer standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.
(B) A requirement that the insured shall not be required to:
(i) Provide his or her own interpreter.
(ii) Rely on an adult or minor child accompanying the insured with limited-English proficiency for interpretation services. services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1317.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.
(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) for interpretation services.
(C) After being informed of the availability of interpretation services, an insured may rely on an adult or minor child accompanying the insured, insured or other staff for interpretation services if the insured provides written consent.
(6) Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.
(c) In developing the regulations, standards, and requirements described in this section, the commissioner shall consider the following:
(1) Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).
(2) Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health insurers that contract to provide services in the Healthy Families Program.
(3) Standards adopted by other states pertaining to language assistance requirements for health insurers.
(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.
(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Office of Patient Advocate and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.
(6) Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.
(7) Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.
(8) The cost of compliance and the availability of translation and interpretation services and professionals.
(9) Flexibility to accommodate variations in networks and method of service delivery. The commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.
(d) In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.
(e) Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.
(f) Beginning on January 1, 2008, the department shall report biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.
(g) Nothing in this section shall prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
SEC. 5. Section 10133.11 is added to the Insurance Code, to read:10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
SEC. 5. Section 10133.11 is added to the Insurance Code, to read:
### SEC. 5.
10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
10133.11. (a) An insurer that offers essential health benefits, as defined in Section 10112.27, and with an enrollment of 50,000 or more covered lives shall notify insureds and members of the public of all of the following information:
(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, and how to access these services. This information shall be available in the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau.
(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.
(3) An insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age pursuant to Section 10140. If there is a concern of discrimination on these bases, the department should be contacted.
(4) The availability of the grievance procedure and how to file a grievance, including the name of the health insurer representative and the telephone number, address, and email address of the health insurer representative who may be contacted about the grievance.
(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
(b) The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. An insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:
(1) In a separate section of the evidence of coverage titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.
(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurers insureds.
(3) On the Internet Web site published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
SEC. 6. Section 14029.91 of the Welfare and Institutions Code is amended to read:14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.
SEC. 6. Section 14029.91 of the Welfare and Institutions Code is amended to read:
### SEC. 6.
14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.
14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.
14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:(i) Demonstrated proficiency in both English and the target language.(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.(B) A managed care plan shall not require a beneficiary to provide do any of the following: (i) Provide his or her own interpreter or to rely interpreter. (ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available. (iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services. (C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.(2) Translation services shall be provided to the language groups identified by the department.(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.(c) The department shall make this determination if any of the following occurs:(1) A nonmanaged care county becomes a new managed care county.(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.(3) A period of three years has passed since the last determination.(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.
14029.91. (a) The department shall require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to limited-English-proficient (LEP) Medi-Cal beneficiaries who are mandatorily enrolled in managed care in the following manner:
(1) (A) Oral interpretation services shall be provided in any language on a 24-hour basis at key points of contact and shall be provided by an interpreter that, at a minimum, meets all of the following qualifications:
(i) Demonstrated proficiency in both English and the target language.
(ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems.
(iii) Education in ethics, conduct, and confidentiality for interpreters. The department shall accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care.
(B) A managed care plan shall not require a beneficiary to provide do any of the following:
(i) Provide his or her own interpreter or to rely interpreter.
(ii) Rely on an adult or minor child accompanying the beneficiary, or beneficiary with limited-English proficiency for interpretation services, except when there is an emergency medical condition, as defined in subdivision (b) of Section 1371.1 of the Health and Safety Code, and an interpreter who meets the qualifications described in subparagraph (A) is not available.
(iii) Rely on a staff member who does not meet the qualifications described in subparagraph (A) to provide for oral interpretation services, unless the beneficiary, after services.
(C) After being informed of the availability of oral interpretation services, a beneficiary may rely on an adult accompanying the beneficiary or other staff for oral interpretation services if the beneficiary provides written consent to receive oral interpretation services from an individual other than an interpreter who meets the qualifications described in subparagraph (A). consent.
(2) Translation services shall be provided to the language groups identified by the department.
(3) Written notice of the availability of interpretation services in the language groups identified by the department and in the top 15 languages spoken by LEP individuals in California identified annually by the United States Census Bureau.
(b) The department shall determine when an LEP population meets the requirement for translation services using one of the following numeric thresholds:
(1) A population group of at least 3,000 or 5 percent of the beneficiary population, whichever is fewer, mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English.
(2) A population group of mandatory managed care Medi-Cal beneficiaries, residing in the service area, who indicate their primary language as other than English, and that meet a concentration standard of 1,000 beneficiaries in a single ZIP Code or 1,500 beneficiaries in two contiguous ZIP Codes.
(c) The department shall make this determination if any of the following occurs:
(1) A nonmanaged care county becomes a new managed care county.
(2) A new population group becomes a mandatory Medi-Cal managed care beneficiary population.
(3) A period of three years has passed since the last determination.
(d) The department shall instruct managed care plans, by means of incorporating the requirement into plan contracts, all-plan letters, or similar instructions, of the language groups that meet the numeric thresholds.
(e) For purposes of this section, a person is limited-English-proficient if he or she speaks English less than very well.
SEC. 7. Section 14029.92 is added to the Welfare and Institutions Code, to read:14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
SEC. 7. Section 14029.92 is added to the Welfare and Institutions Code, to read:
### SEC. 7.
14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14029.92. (a) The department shall notify Medi-Cal beneficiaries and members of the public of all of the following information:
(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14029.91, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and in the languages identified by the department pursuant to Section 14029.91.
(2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.
(3) The department does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.
(4) (A) The availability of the grievance procedure and how to file a grievance, including the name of the department representative and the telephone number, address, and email address of the department representative who may be contacted about the grievance.
(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.
(5) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
(b) The information described in subdivision (a) shall be provided in the following manner:
(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.
(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to Medi-Cal beneficiaries.
(3) On the departments Internet Web site, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
SEC. 8. Section 14684 of the Welfare and Institutions Code is amended to read:14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.
SEC. 8. Section 14684 of the Welfare and Institutions Code is amended to read:
### SEC. 8.
14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.
14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.
14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.
14684. Notwithstanding any other state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines:
(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.
(b) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.
(c) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.
(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.
(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiarys home community, or as close as possible to the beneficiarys home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.
(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.
(g) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 21 years of age pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code.
(h) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.
(i) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. age appropriate.
(j) Each mental health plan shall provide language assistance services to limited-English-proficient eligible Medi-Cal beneficiaries consistent with the requirements established in Section 14029.91.
SEC. 9. Section 14727 is added to the Welfare and Institutions Code, to read:14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
SEC. 9. Section 14727 is added to the Welfare and Institutions Code, to read:
### SEC. 9.
14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.(b) The information described in subdivision (a) shall be provided in the following manner:(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
14727. (a) A mental health plan shall notify beneficiaries and members of the public of all of the following information:
(1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 14684, and how to access these services. This information shall be available in at least the top 15 languages spoken by limited-English-proficient individuals in California identified annually by the United States Census Bureau and languages identified by the department pursuant to Section 14029.91.
(2) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, or age. If there is a concern of discrimination on these bases, the department should be contacted.
(3) (A) The availability of the grievance procedure and how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance.
(B) The availability of a state fair hearing and how to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2.
(4) How to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
(5) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner.
(b) The information described in subdivision (a) shall be provided in the following manner:
(1) In a separate section of the beneficiary handbook titled Nondiscrimination Policy, Language Access, and Accessibility Requirements.
(2) At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the mental health plans beneficiaries.
(3) On the Internet Web site published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information.
SEC. 10. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 10. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 10. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
### SEC. 10.