Language Assistance Program Provider Training

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Language Assistance Program Provider Training

• ICE Education and Training Workgroup

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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 Continued

• Vital Documents- Documents produced by the plan
  including when the production or distribution is
  delegated by a plan to a contracting health care
  service provider or administrative services
  provider.
• Examples are Applications, Consent Forms,
  Letters, Denial notices, free language assistance
  notices, explanation of benefits
• Non-Vital Documents

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Key Definitions Continued

• 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 Officeshttp//www.iceforhealth.org/libra
  ry/documents/Healthplan_CA_LAP_Contact_Sheet.xls.
  
• The guide also lists health plan contacts should
  you have any questions. 

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Documenting Refusal of Interpreter

• Documenting refusal of interpretive 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
• and to document the use of the interpreter in
  the
• patients medical record.
• 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, if the patient insists
  on using a
• family member or friend, it is extremely
  important to
• document this in the medical record, especially
  if the
• chosen interpreter 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.
• 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 color
• stickers on patients chart to flag when an
  interpreter is
• needed. (For example Orange Spanish, Yellow
  
• Vietnamese, Green Russian)
• For EMRs, contact your IT department to
  determine the
• best method of advising all health care 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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DMHC LAP Notice of Translation

• AKA Short Notice
• Accompanies English vital documents
• Denial letters
• Delay letters
• Claims letters
• Health plan-specific threshold languages
• 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 phone .

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CDI LAP Notice

• Approved by the CDI, OPA
• Must accompany all vital documents
• Modifications
• DMHC
• Health Plan-specific (logos, footers)
• Must contain all 13 languages
• English, Spanish, Chinese, Korean, Tagalog,
  Armenian, Russian, Japanese, Persian, Punjabi,
  Khmer, Arabic, Hmong

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CDI Message in Threshold Languages

• No Cost Language Services. You can get an
  interpreter. You can get documents read to you
  and some sent to you in your language. For help,
  call us at the number listed on your ID card or
  XXX-XXX-XXXX. For more help call the CA Dept. of
  Insurance at 1-800-927-4357.

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CDI Message in Non-Threshold Languages

• No Cost Language Services. You can get an
  interpreter and get documents read to you in your
  language. For help, call us at the number listed
  on your ID card or XXX-XXX-XXXX. For more help
  call the CA Dept. of Insurance at 1-800-927-4357

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Independent Medical Review- IMR

• Fully insured HMO members can request a State IMR
  if they disagree with their Plans IMR category
  specific decision.
• IMR Categories
• Medical Necessity The disputed treatment was
  either delayed, denied or modified by the HMO
  based on medical necessity.
• Experimental/Investigational The disputed
  treatment was denied by the HMO as being
  experimental or investigational
• Web link to down load an IMR Application
  form http//www.hmohelp.ca.gov/dmhc_consumer/pc/pc
  _imrapp.asp
• Download, fill out and sign the IMR request
  form and mail / FAX it to the Department of
  Managed Health Care (DMHC) with relevant
  supporting documentation
• IMR forms are available in English, Spanish
  and Chinese

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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?

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Provider Group Frequently Asked Questions (cont.)

• 4. Where can we find out what a Plans threshold
  language(s) is?
• 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?

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Provider Group Frequently Asked Questions (cont.)

• 8. How do I get an interpreter from a Plan?
• 9. Can I use my own bilingual staff to
  interpret? 
• 10. Do these regulations prohibit family members
  from serving as interpreters for enrollees?
• Which staff needs training regarding the LAP
  program?

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Answers

• For answers to these question and much more
  information, go to the ICE Website at the link
  below.
• http//www.iceforhealth.org/library.asp?sfcid25
  5cid255

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Template Letters

• Utilization Templates and Tools
• https//www.iceforhealth.org/library.asp?sfcid3
  37cid337
• Instructions and Information READ FIRST
• Option 1 LAP Notice of Translation     
• Option 2 Health Plan-Specific Templates (CSDN
  Commercial Delay-Extension) with LAP Notice
  Translation