Language Assistance Program Provider Training

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Language Assistance Program Provider Training

• Created by
• ICE Education and Training
  Workgroup
• 11/2008

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Background

• The CA Language Assistance Program Law
• Effective January 1, 2009 CA law (SB 853) and its
  accompanying regulations require that health
  plans establish and support a Language Assistance
  Program (LAP) for enrollees that are limited
  English proficient (LEP).
• Who is eligible?
• Enrollees under the jurisdiction of the CA of
  Department Managed Health Care (DMHC) and/or
  California Department of Insurance (CDI) are
  eligible for the CA Language Program.

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Key Definitions

• Limited English Proficient (LEP)
• An enrollee who has an inability or a limited
  ability to speak, read, write, or understand the
  English language at a level that permits that
  individual to interact effectively with health
  care providers or plan employees.

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Key Definitions, cont.

• Vital Documents
• Documents that are important to using the health
  plan and accessing benefits. They may be produced
  by the plan or the production or distribution may
  be delegated to a contracting health care service
  provider or administrative services provider.
• Examples of vital documents are Applications,
  Consent Forms, Letters, Denial notices, free
  language assistance notices and explanation of
  benefits.

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Key Definitions, cont.

• Standard Vital Document
• General documents that are not specific to a
  particular enrollee.
• Non-standard Vital Document
• A document containing enrollee-specific
  information, such as a service authorization or
  claim denial.

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Key Definitions, cont.

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

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How to Access Interpreters

• In most cases, if a provider group is not
  delegated to provide Language Assistance Program
  (LAP) services, the health plan will offer
  telephonic interpreter services.
• For health plan specific information please refer
  to the ICE Health Plan Resource Guide for
  Provider Offices http//www.iceforhealth.com/libr
  ary/documents/Healthplan_CA_LAP_Contact_Sheet_Draf
  t.xls.
• The guide also lists health plan contacts should
  you have any questions. 

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Documenting Refusal of Interpreter

• Documenting refusal of interpreter services in
  the medical record not only protects you and your
  practice, it also ensures consistency when your
  medical records are monitored through site
  reviews/audits by contracted health plans to
  ensure adequacy of the plans Language Assistance
  Program.

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Documenting Refusal of Interpreter, cont.

• It is preferable to use professionally trained
  interpreters.
• If the patient was offered an interpreter and
  refused the service, it is important to note that
  refusal in the medical record for that visit.
• Although using a family member or friend to
  interpret should be discouraged, it is
  extremely important to document this in the
  medical record if the patient insists, especially
  if the family member or friend is a minor.

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Documenting Refusal of Interpreter, cont.

• Smart Practice Tip Consider offering a
  telephonic interpreter in addition to the family
  member/friend to ensure accuracy of
  interpretation.
• For all Limited English Proficient (LEP)
  patients, it is a best practice to document the
  patients preferred language in paper and/or
  electronic medical records (EMR) in the manner
  that best fits your practice flow.
• For EMRs, contact your IT department to determine
  the best method of advising all health team
  members of a preferred spoken language.
• Source Industry Collaboration Effort (ICE)
  Tips for Communicating Across Language Barriers
  www.iceforhealth.org

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Documenting Refusal of Interpreter, cont.

• For a paper record, one way to do this is to post
  colored stickers on patients chart to flag when
  an interpreter is needed. (For example Orange
  Spanish, Yellow Vietnamese, Green Russian)
• Source Industry Collaboration Effort (ICE)
  Tips for Communicating Across
• Language Barriers www.iceforhealth.org

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Requesting Translations for Non-Standard Vital
Documents

• Objective
• Ensure Enrollees receive requested translations
  of non-standard vital documents in a timely
  manner, meeting the needs of the enrollee
  regulatory standards.
• Requirement
• The health care service plan shall have up to,
  but not to exceed, 21 days to comply with the
  enrollee's request for a written translation.

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Requesting Translations for Non-Standard Vital
Documents, cont.

• Vital documents issued in English by Plans or
  Providers with delegated claims/UM
  responsibility, will include a Notice of
  Translation informing Enrollee of the
  availability of free language assistance that
  will be provided by the health plan.
• If the Enrollees preferred language is one of
  the threshold languages, they may also receive a
  written translation of the vital document.

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Requesting Translations for Non-Standard Vital
Documents, cont.

• If the Enrollee requires help, the Notice
  instructs them to call the Plans number on their
  ID card or a toll-free number provided on the
  Notice.
• Translation requests will normally come through
  the Health Plan, but may be received by
  Providers.
• To ensure that plans are able to properly contact
  the provider, please make sure your medical group
  contact information is listed on the ICE grid.
  Insert link here
• If translation request is for a Provider-produced
  letter, the Provider will need to submit a copy
  of that letter to the Plan in a timely manner.

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LAP Notice of Translation

• Customized by each health plan to include their
  name, contact number and availability in the
  plans threshold languages.
• ICE-approved message
• IMPORTANT Can you read this letter? If not,
  we
• can have somebody help you read it. You may
  also be able to get this letter written in your
  language. For free help, please call right away
  at plans phone .

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Letter Templates for Delegated Groups

• The texts of each Plans Notice of Translation
  are available under Option 1 in the ICE UM
  Templates and Tools for LAP Regulations
  http//www.iceforhealth.com/library.asp?sfscid1
  769scid1769
• Alternatively, the group may use the revised
  letter templates under Option 2 that already have
  the notice inserted.

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Translation Timeliness
Element Minimum Policy Requirements
Request for translation of a non-standard vital document comes from the enrollee to the provider organization. Urgent 1. Forward the translation request and copy of document to the contracted health plan within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan. Non-Urgent 1. Forward the translation request and copy of document to the contracted health plan within two business days. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan.
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Translation Timeliness, cont.
Element Minimum Policy Requirements
Request for a non-standard vital document comes from the health plan to the provider organization Urgent 1. Forward a copy of document to the contracted health plan within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan. Non-Urgent 1. Forward a copy of document to the contracted health plan within two business days. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan.
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Translation Timeliness (continued)
Element Minimum Policy Requirements
Request for a plan-produced vital document comes from the member to the provider organization All Plan-produced vital documents 1. Forward enrollees request within one business day. 2. Log the date request received from the enrollee, and the date request and document were forwarded to the health plan.
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Translation Requests remember...

• When forwarding a copy of the document needing
  translation, use a secure method to protect the
  Enrollees Protected Health Information (PHI)
• FAX to a secured Health Plan location
• If by eMail, make sure youre using secure
  (encrypted) eMail.

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Independent Medical Review

• Informational notices about out how to contact a
  plan, file a complaint, obtain assistance from
  the DMHC and seek an independent medical review
  (IMR) are available in non-English languages on
  the DMHC site at www.hmohelp.ca.gov.
• IMR forms available in English, Spanish, Arabic,
  Armenian, Chinese, Farsi, Hmong, Khmer/
  Cambodian, Korean, Lao, Russian, Tagalog and
  Vietnamese.

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Provider Group Frequently Asked Questions

• 1. What is the DMHC Language Assistance Program
  (SB853)?
• 2. What is the individual providers
  responsibility for the Language Assistance
  Program?
• 3. What is a threshold language and how is it
  calculated?
• 4. Where can we find out what a Plans threshold
  language(s) is?

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Provider Group Frequently Asked Questions, cont.

• 5. What is a vital document?
• 6. What is a Language Assistance Program Notice?
  With what documents do I include the notice?
• 7. How does a Provider Group-issued vital
  document get interpreted or translated if
  requested?
• 8. How do I get an interpreter from a Plan?

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Provider Group Frequently Asked Questions, cont.

• 9. Can I use my own bilingual staff to
  interpret? 
• 10. Do these regulations prohibit family members
  from serving as interpreters for enrollees?
• 11. Which staff needs to be trained regarding the
  LAP program?

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Answers

• For answers to these questions and for more
  information, go to the ICE website at
• http//www.iceforhealth.org/library.asp?sfcid25
  5cid255

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Additional Information

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