The National Health Law Program

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The National Health Law Program

• MAKING LANGUAGE SERVICES A REALITY
• 2005 CHILD HEALTH SERVICES RESEARCH MEETING

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PART I

• Current Payment Methods for Language Services

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What Funding Is Available for Providing
Linguistic Access?

• Federal Sources
• Offices of Refugee Resettlement
• State/County Departments of Health/Social
  Services
• Local foundations
• Non-profit organizations

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What Funding Is Available Federal Sources?

• Medicaid/SCHIP CMS Letter 8/20/00
• OMH Bilingual/Bicultural Demonstration Program
• HRSA Models that Work Campaign
• HRSA HIV/AIDS Bureau

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CMS Letter to State Officials

• Reimbursement is available for language
  assistance including translation and interpreters
  to Medicaid/SCHIP enrollees
• States can draw down federal funds at either
  their administrative match rate (50) or their
  covered service match rate (50-77 Medicaid,
  65-84 SCHIP) depending on how language services
  are provided

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Statewide Medicaid/SCHIP Programs

• Only a handful of states have set up programs to
  provide direct reimbursement using federal
  matching funds to pay for language services
• Four models
• contract with language service agencies
• reimburse providers for hiring interpreters
• certify interpreters as Medicaid providers
• provide access to language line

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Model 1 Language Service Agencies

• HI, WA and UT contract with interpreter
  organizations providers schedule interpreters
  who bill the state
• WA offers testing and certification
  interpreters must be certified (7 prominent
  languages) or qualified (other languages)
• HI UT reimbursed as covered service

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Model 2 Provider Reimbursement

• ME and MN require providers to pay for
  interpreters and then reimburse providers
• Providers have discretion on who to hire
• ME interpreters must sign code of ethics
  cannot use family members/friends
• Considerations state oversight quality of
  interpreters provider concerns

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Model 3 Payments to Interpreters

• NH requires interpreters to become Medicaid
  providers
• Interpreters submit bills directly to the state
• Considerations requirements of becoming a
  provider low reimbursement rates

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Model 4 Language Line

• Kansas state pays for a telephonic language line
  which fee-for-service providers can access for
  Medicaid/SCHIP patients
• Coordinated through the states fiscal agent
  (EDS) providers receive a code for access
• Estimated budget 275,000 for first year (FY O4)

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Current State Reimbursement
State Enrollees Covered Providers Covered Who the State Pays Reimbursement Rate Admin or Service
HI FFS FFS Lang. agencies 36/hr Service
ID FFS FFS Providers 7/hr Service
MA All Hospitals Hospitals Varies Admin
ME FFS FFS Providers 30-40/hr Service
MN FFS FFS Providers 50/hr Admin
MT All Medicaid All Interpreters 6.25/15 minutes Admin
NH FFS FFS Interpreters 15/hr Admin
UT FFS FFS Lang. agencies 22 (phone) 39 (in-person) Service
VA FFS FFS Area Health Ed. Ctr. 3 Health Depts. Still undetermined Admin
WA FFS FFS Brokers up to 36/hr Admin
WA FFS Public entities Public entities 50 expenses Admin

• 30 for business hours 40 non-business hours
  Or usual and customary fee,
• whichever is less. 2002 data

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Other State Reimbursement

• Massachusetts Emergency Room Interpreter Law
  payments to hospitals for costs of language
  services based on one hospitals expenses
  compared to all MA hospitals expenses
• Covers emergency departments and in-patient
  psychiatric facilities

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Part II

• Language Services Implementation Strategies

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Issues to Consider

• How can providers work with advocates and policy
  makers to improve language access and funding?
• What model would be most appropriate in your
  state?
• What data can providers collect to augment
  advocacy for improved language access and
  funding?
• Is legislative or administrative action needed?
• What are actual costs and estimated cost savings?
• How do we improve the workforce number of and
  training for interpreters?

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Medicaid and SCHIP Reimbursement Considerations

• Discuss what model would be most appropriate
• Identify related issues
• Training/assessment of interpreters
• Contract amendments between state and providers
• Determine whether legislative and/or
  administrative action is needed
• Analyze cost implications actual costs and
  estimated cost savings
• Formulate action plan for advocacy efforts

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Medicaid and SCHIP Reimbursement Considerations

• Who will be covered?
• Enrollees FFS, managed care, hospitals
• Providers FFS, managed care, hospitals
• Which model should be used?
• What is the reimbursement rate?
• Must be sufficient to attract interpreters
• Travel time, waiting time, administrative time

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Medicaid and SCHIP Reimbursement Considerations

• Managed Care Plans
• does current capitation rate include language
  services? if so, is consideration sufficient?
• should managed care plans receive specific
  reimbursement on top of capitation rate?
• Hospitals
• should hospitals receive specific reimbursement
  separate from administrative expenses?
• does current rate sufficiently address language
  services?
• direct reimbursement or inter-local/government
  agreement?

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Gather Available Data

• Collect information on the need for language
  services
• State agencies and departments
• Community based organizations providing health
  and human services
• Data on primary language spoken in local schools
• Local institutions (health, financial, etc)

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Identify Potential Allies

• Who might support the expansion of language
  services in the medical setting?
• Diverse Populations
• Health Human Service Providers
• Civic Leaders
• Education Leaders

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Link Language Services toQuality and Patient
Safety

• Build the Business Case for Patient Safety
• Attracting new patients
• Avoiding costly lawsuits
• Joint Commission on Accreditation of Healthcare
  Organizations standards, training for surveyors

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Part III

• National Language Access Advocacy Project
• Funded by The California Endowment

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National Activities

• Coalition -- convened by NHeLP in partnership
  with APIAHF, MALDEF, NAPALC, NCLR, NILC
• Participants -- health care provider
  organizations, advocates, language companies,
  interpreters and interpreter organizations,
  accrediting organizations
• Goals -- heighten language access awareness among
  providers, policymakers and LEP communities
  identify issues, solutions, funding sources and
  effective strategies for engaging others

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Coalitions Statement of Principles

• 1.  Effective communication between health care
  providers and patients is essential to
  facilitating access to care, reducing health
  disparities and medical errors, and assuring a
  patients ability to adhere to treatment plans.
• 2.  Competent health care language services are
  essential elements of an effective public health
  and health care delivery system in a pluralistic
  society.
• 3.  The responsibility to fund language services
  for LEP individuals in health care settings is a
  societal one that cannot fairly be visited upon
  any one segment of the public health or health
  care community.
• 4.  Federal, state and local governments and
  health care insurers should establish and fund
  mechanisms through which appropriate language
  services are available where and when they are
  needed.
• 5. Because it is important for providing all
  patients the environment most conducive to
  positive health outcomes, linguistic diversity in
  the health care workforce should be encouraged,
  especially for individuals in direct patient
  contact positions
• 6. All members of the health care community
  should continue to educate their staff and
  constituents about LEP issues and help them
  identify resources to improve access to quality
  care for LEP patients.

• 7. Access to English as a Second Language
  instruction is an additional mechanism for
  eliminating the language barriers that impede
  access to health care and should be made
  available on a timely basis to meet the needs of
  LEP individuals, including LEP health care
  workers.
• 8. Quality improvement processes should assess
  the adequacy of language services provided when
  evaluating the care of LEP patients, particularly
  with respect to outcome disparities and medical
  errors.
• 9. Mechanisms should be developed to establish
  the competency of those providing language
  services, including interpreters, translators and
  bilingual staff/clinicians.
• 10. Continued efforts to improve primary
  language data collection are essential to enhance
  both services for, and research identifying the
  needs of, the LEP population.
• Language services in health care settings must be
  available as a matter of course, and all
  stakeholders including government agencies that
  fund, administer or oversee health care programs
  must be accountable for providing or
  facilitating the provision of those services.

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Statement of Principles Endorsers

• American Academy of Family Physicians
• American Association of Physicians of Indian
  Origin
• American Civil Liberties Union
• American College of Physicians
• American Counseling Association
• American Hospital Association
• American Medical Student Association
• Asian Pacific Islander America Health Forum
• American Psychological Association
• Association of Asian Pacific Community Health
  Organizations
• Association of Community Organizations for
  Reform Now
• Association of Language Companies
• Association of University Centers on
  Disabilities
• Bazelon Center for Mental Health Law
• California Association of Public Hospitals and
  Health Systems
• California Health Care Safety Net Institute
• California Healthcare Association
• California Healthcare Interpreting Association

• Catholic Health Association
• Childrens Defense Fund
• Center on and Health
• Cuban American Budget and Policy Priorities
• Center on Disability National Council
• District of Columbia Language Access Coalition
• District of Columbia Primary Care Association
• Families USA
• Family Voices
• Greater New York Hospital Association
• HIV Medicine Association
• Institute for Reproductive Health Access
• Joint Commission on the Accreditation of Health
  Care
• La Clinica del Pueblo
• Latino Coalition for a Healthy California
• Medicare Rights Center
• Mexican American Legal Defense and Educational
  Fund

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Statement of Principles Endorsers(cont.)

• Migrant Legal Action Program
• National Asian American Pacific Islander Mental
  Health Association
• National Asian Pacific American Legal
  Consortium
• National Association of Community Health Centers
• National Association of Mental Health Planning
  and Advisory Councils
• National Association of Public Hospitals and
  Health Systems
• National Association of Social Workers
• National Council of La Raza
• National Council on Interpreting in Health Care
• National Family Planning and Reproductive Health
  Association
• National Health Law Program
• National Immigration Law Center
• National Hispanic Medical Association
• National Latina Institute for Reproductive
  Health

• National Mental Health Association
• National Partnership for Women and Families
• National Respite Coalition
• National Senior Citizens Law Center
• National Womens Law Center
• Northern Virginia Area Health Education Center
• Physicians for Human Rights
• Presbyterian Church (U.S.A.)
• Society of General Internal Medicine -
  Washington Office
• Summit Health Institute for Research and
  Education
• USAction
• Welfare Law Center

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Resources

• NHeLP Language Access website, http//www.healthla
  w.org/langaccess/index.shtml
• NHeLP, Promising Practices for Providing Language
  Services in Health Care Settings Examples from
  the Field, (May 2002), www.healthlaw.org or
  www.cmwf.org
• NHeLP, Promising Practices for Providing Language
  Services in Small Health Care Settings Examples
  from the Field (forthcoming early 2005),
  www.healthlaw.org or www.cmwf.org
• NHeLP, Ensuring Linguistic Access Legal Rights
  and Responsibilities (2004), www.healthlaw.org
• NHeLP The Access Project, The Language Services
  Action Kit (2004), www.healthlaw.org or
  www.accessproject.org

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Contact Information

• Mara Youdelman or Steve Hitov
• National Health Law Program
• 1101 14th Street NW, Suite 405
• Washington, DC 20005
• Ph 202-289-7661
• Fax [phone]
• youdelman_at_healthlaw.org
• hitov_at_healthlaw.org
• www.healthlaw.org