The National Health Law Program

MAKING LANGUAGE SERVICES A REALITY

2005 CHILD HEALTH SERVICES RESEARCH MEETING

PART I

Current Payment Methods for Language Services

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

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

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

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

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”

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

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

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 state’s fiscal agent (EDS); providers receive a code for access

• Estimated budget – $275,000 for first year (FY O4)

Current State Reimbursement

•$30 for business hours; $40 non-business hours ** Or usual and customary fee,

whichever is less. *** 2002 data

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

Other State Reimbursement

• Massachusetts Emergency Room Interpreter Law – payments to hospitals for costs of language services; based on one hospital’s expenses compared to all MA hospitals expenses

• Covers emergency departments and in-patient psychiatric facilities

Part II

Language Services Implementation Strategies

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?

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

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

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?

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)

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

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

Part III

National Language Access Advocacy Project

Funded by The California Endowment

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

Coalition’s 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 patient’s 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.

11. 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.

Statement of Principles Endorsers

American Academy of Family PhysiciansAmerican Association of Physicians of Indian Origin American Civil Liberties UnionAmerican College of Physicians American Counseling Association American Hospital AssociationAmerican Medical Student Association Asian Pacific Islander America Health ForumAmerican Psychological AssociationAssociation of Asian Pacific Community Health Organizations Association of Community Organizations for Reform NowAssociation of Language CompaniesAssociation of University Centers on DisabilitiesBazelon Center for Mental Health LawCalifornia Association of Public Hospitals and Health SystemsCalifornia Health Care Safety Net InstituteCalifornia Healthcare AssociationCalifornia Healthcare Interpreting AssociationCatholic Charities USA

Catholic Health Association Children’s Defense FundCenter on and HealthCuban American Budget and Policy PrioritiesCenter on Disability National CouncilDistrict of Columbia Language Access CoalitionDistrict of Columbia Primary Care AssociationFamilies USAFamily VoicesGreater New York Hospital AssociationHIV Medicine AssociationInstitute for Reproductive Health AccessJoint Commission on the Accreditation of Health CareLa Clinica del PuebloLatino Coalition for a Healthy CaliforniaMedicare Rights CenterMexican American Legal Defense and Educational Fund

Statement of Principles Endorsers(cont.)

Migrant Legal Action ProgramNational Asian American Pacific Islander Mental

Health Association National Asian Pacific American Legal ConsortiumNational Association of Community Health CentersNational Association of Mental Health Planning and

Advisory CouncilsNational Association of Public Hospitals and Health

SystemsNational Association of Social Workers National Council of La RazaNational Council on Interpreting in Health CareNational Family Planning and Reproductive Health

AssociationNational Health Law ProgramNational Immigration Law CenterNational Hispanic Medical AssociationNational Latina Institute for Reproductive Health

National Mental Health Association National Partnership for Women and FamiliesNational Respite CoalitionNational Senior Citizens Law CenterNational Women’s Law CenterNorthern Virginia Area Health Education CenterPhysicians for Human RightsPresbyterian Church (U.S.A.)Society of General Internal Medicine - Washington Office Summit Health Institute for Research and EducationUSActionWelfare Law Center

Resources• NHeLP Language Access website,

http://www.healthlaw.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

Contact Information

Mara Youdelman or Steve HitovNational Health Law Program1101 14th Street NW, Suite 405Washington, DC 20005Ph: 202-289-7661Fax: 202-289-7724youdelman@healthlaw.orghitov@healthlaw.orgwww.healthlaw.org