Cultural & Linguistic Services



Policy/Procedure Number: MCLP7002 (previously MP 302)Lead Department: Health ServicesPolicy/Procedure Title: Cultural and Linguistic Services FORMCHECKBOX External Policy FORMCHECKBOX Internal PolicyOriginal Date: 02/26/1999 (MP 302)Next Review Date:03/11/2021Last Review Date:03/11/2020Applies to: FORMCHECKBOX Medi-Cal FORMCHECKBOX EmployeesReviewing Entities: FORMCHECKBOX IQI FORMCHECKBOX P & T FORMCHECKBOX QUAC FORMCHECKBOX OPerations FORMCHECKBOX Executive FORMCHECKBOX Compliance FORMCHECKBOX DepartmentApproving Entities: FORMCHECKBOX BOARD FORMCHECKBOX COMPLIANCE FORMCHECKBOX FINANCE FORMCHECKBOX PAC FORMCHECKBOX CEO FORMCHECKBOX COO FORMCHECKBOX Credentialing FORMCHECKBOX DEPT. DIRECTOR/OFFICERApproval Signature: Robert Moore, MD, MPH, MBAApproval Date: 03/11/2020RELATED POLICIES: HR509 - Bilingual StandardsCMP-10 - ConfidentialityCGA022 - Member Discrimination Grievance ProcedureMPLD7001 - Cultural and Linguistic Program Description MP PR 200 - PHC Provider Contracts MPHP8001 - Health Education ProgramMPQP1022 - Site Review Requirements and GuidelinesCMP36 – Delegation and Oversight MonitoringMPQD1001 – Quality and Performance Improvement Program DescriptionIMPACTED DEPTS: Member ServicesHealth ServicesProvider RelationsD. AdministrationDEFINITIONS: CAC – Consumer Advisory CommitteeDHCS – Department of Health Care ServicesEOC – Evidence of CoverageICE – Industry Collaboration Effort (ICE)IQI – Internal Quality ImprovementLEP – Limited English ProficiencyMMCD – Medi-Cal Managed Care DivisionOHC – Other Health CoverageSPD – Seniors and Persons with DisabilitiesTJC – The Joint CommissionLGBTQ – Lesbian, Gay, Bisexual, Transgender and Queer/QuestioningQualified interpreter – interpreter who adheres to generally accepted interpreter ethics, principles, and confidentiality. Has demonstrated proficiency in speaking and understanding both spoken English and at least one non-English language, and is able to interpret effectively, accurately, and impartially, both receptively and expressively, to and from such language(s) and English, using any necessary specialized vocabulary and phraseology.Qualified translator – translator who adheres to generally accepted translator ethics, principles, and confidentiality. Has demonstrated proficiency in writing and understanding both written English and at least one non-English language, and is able to translate effectively, accurately, and impartially to and from such language(s) and English, using any necessary specialized vocabulary, terminology, and phraseology. ATTACHMENTS: N/APURPOSE: To ensure effective communication regarding treatment, diagnosis, medical history and health education by providing cultural, linguistic, and sensory appropriate services to Members, taking into consideration Members’ beliefs, traditions, customs, and individual differences. Partnership HealthPlan of California (PHC) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. POLICY / PROCEDURE: Demographic ProfileMedi-Cal - The language code provided on the 834 file is used to determine primary languages.In accordance with PHC Policy CMP-10 Confidentiality, this information is collected, summarized and documented in a manner that enables PHC to maintain confidentiality of personal information and to disclose the information to Department of Health Care Services (DHCS), upon request for regulatory purposes, and to contracting providers on request for lawful purposes, including language assistance purposes and health care quality improvement purposes.Standards for Determining Threshold Languages and Requirements for Section 1557 of the Affordable Care Act is determined by DHCS All Plan Letter (APL) 17-011, which supersedes APL?14-008. Managed Care Plans (MCP) are required to provide translated member information to the following groups within their service areas as determined by DHCS using:a.Threshold Standard Language: A population group of mandatory eligible beneficiaries residing in the service area who indicate their primary language as other than English, and that meet a numeric threshold of 3,000 or five percent (5%) of the eligible beneficiary population whichever is lower; and, b.Concentration Standard Language: A population group of mandatory eligible beneficiaries residing in the MCP’s service area who indicate their primary language as other than English and who meet the concentration standards of 1,000 in a single zip code or 1,500 in two contiguous zip codes.Notification to Members and the Public of the Availability of Linguistic Services for California’s top 16 non-English languages spoken by LEP individuals and PHC’s compliance with nondiscrimination and applicable Federal civil rights laws. PHC notifies members and the public of the availability of linguistic services by publishing language assistance taglines and notice of non-discrimination with all major member correspondence including but not limited to: a.PHC Member Handbook/Evidence of Coverage (EOC) b.Notices in Provider Offices c.PHC External Website at d.Member newsletter e.PHC Provider DirectoryStaff Training Per MMCD APL 11-010 (Competency and Sensitivity Training Required in Serving the Needs of Seniors and Persons with Disabilities), PHC provides an annual training to all staff who have direct contact with members. This training includes the following topics:a.Review of PHC Cultural and Linguistic Services PolicyUnderstanding the needs of Limited English Proficiency (LEP) membersUnderstanding cultural differences of LEP membersInterpreter Services CriteriaHow to access interpreter servicesHow to effectively use and interact with available interpretation servicesSeniors and Persons with Disabilities sensitivity awareness training (State Approved)Other internal departmental trainings include:a.Cultural awareness and sensitivityIdentifying and communicating with LEP membersInterpreting and translations policies and proceduresUsing the TTY and California Relay SystemsServices ProvidedIn accordance with 42 CFR 438.10(d), PHC shall provide the following linguistic services at no cost to members:Access to qualified oral interpreters, signers, or bilingual providers and staff at key points of contact (medical and non-medical) for members whose language proficiency is any of California’s top 16 non-English languages spoken by LEP individuals. Medical points of contact include face-to-face or telephonic encounters with providers (physicians, physician extender, registered nurses, pharmacists (at a minimum - telephonic interpreter), or other personnel who provide medical or health care advice to members. Written Materials - All written member informing materials, including those required by the DHCS, as outlined in DHCS APL 18-016 are translated by a qualified translator in the threshold languages of PHC’s service areas and when requested by a member in any of California’s top 16 non-English languages. These materials are also available in audio, large print, and electronically for members with hearing and/or visual disabilities. Braille versions are available for members with visual disabilities. Members can make a standing request to receive all informing materials in the specific format. All written member-informing materials must be approved by Senior Health Educator, Communications Department, External and Regulatory Affairs Department, and DHCS prior to being submitted for translation services. Materials submitted for translation must be in Microsoft Word format with no images.Language Line Services - PHC contracts with Language Line services. In accordance with Title 22 CCR Section 53853(c), this service provides real time interpreting services and is available on a 24hour basis. The Language Line is used by PHC staff for languages not spoken by staff for LEP members. This service is also available to contracted providers at key points of contact, including pharmacies.As outlined in the DHCS contract, PHC shall distribute this member information no later than seven?(7) calendar days following notification of enrollment. PHC shall also distribute this member information annually to each member or family unit.To ensure the quality of written translation, PHC conducts testing for bilingual staff to qualify them to review and approve documents that have been translated by a contracted vendor. To ensure the written Member information is in a format that is easily understood, the Senior Health Educator and Communications Department will review all documents. The Communications Department is responsible for sending materials to the External and Regulatory Affairs Department for review. The External and Regulatory Affairs Department is responsible for sending materials to DHCS for review and approval. The External and Regulatory Affairs Department will send DHCS response to the Senior Health Educator, Communications Department and the developer of the written member information.In accordance with DHCS APL 18-016 (Readability and Suitability of Written Health Education Materials), all written Member information is provided to Members at a sixth grade or lower reading level and approved by DHCS. The written Member information shall ensure the Member’s understanding of the health plan Covered Services processes and ensure the Member’s ability to make informed health decisions.In accordance with MMCD Policy Letter 99-003 (Cultural and Linguistics), the member material must include information regarding the member’s rights. Member has the right to request and receive documents translated into any of California’s top 16 non-English languages. Member has the right to file grievances if linguistic needs are not met. Interpreter services are available on a 24-hour basis and at no charge when accessing health care.Discourage the use of family members or friends as interpreters, unless specifically requested by the member.Request face-to-face or telephonic interpreter services during discussion of complex medical information such as diagnoses of complex medical conditions and accompanying proposed treatment options.Grievances and Appeals The EOC provides a detailed summary of the process of filing a grievance or appeal. In?addition to this, PHC:Includes a bi-annual Member Newsletter article advising members to contact the Member Services Department to file a grievance or appeal.Provides grievance and appeal forms in the threshold languages of PHC’s services area on the PHC website at .Maintains Grievance Policies that instruct staff and providers of the requirement of providing members with appropriate grievance and appeal forms.During regularly scheduled Facility Site Review, PHC will use the Site Review Survey Tool to ensure and document that appropriate grievance and appeal forms and information on how to receive language assistance service, including how to receive these materials in an alternate format, are available to members. These forms shall be made available in all PHC threshold languages and California’s top 16 non-English languages spoken by LEP individuals upon request in compliance with requirements described under DHCS APL 17-011.Face-to-Face Medical Interpreter Services – LEP members are entitled to language or sign language interpreters when accessing medically necessary health care services. Refer to the section of this policy titled Criteria and Authorization Requirements for Interpreting Services. PHC is not required to provide face-to-face interpreter services for a member when the provider has made provision for an on-site interpreter.Inpatient and Outpatient Hospital Services – The Joint Commission (TJC) requires interpretation services be available at hospitals. It is the responsibility of hospitals to arrange for and provide these services. Hospitals are also required to provide appropriate services for hearing and visually impaired patients. If a hospital does not meet its obligation of providing interpretation services, PHC will arrange for the service to be provided.PHC will not reimburse providers who chose to provide face-to-face interpreter services or services for the hearing or visually impaired members without making arrangements for the provision of services through PHC’s Member Services Department.Auxiliary aids, Telecommunication Devices for the Deaf (TDD), Telephone Typewriters (TTY) and California Relay Service. These services are available to hearing impaired members.Primary Care Assignment – To assist all LEP members in choosing a primary care provider that speaks their language, the languages spoken at each Provider office are published in the PHC Provider Directory. Member Services bilingual staff are also available to assist LEP members with the selection process. The Provider Directory also reflects provider offices, which are wheelchair accessible.Auto Assignment – The auto assignment process is configured to use the member’s language code and resident address.PHC Member Services Staff – PHC’s goal is to staff the Member Services Department with employees who are reflective of the cultural and linguistic diversity of PHC membership.Testing Linguistic Proficiency of PHC Staff – In accordance with Human Resources policy #509, Bilingual Standards, the oral linguistic proficiency of all employees who provide interpreting services to members are tested. This is done to ensure that all the necessary linguistic requirements are met. Only those employees who pass the test are allowed to provide oral interpretation to members. A copy of the test is maintained by PHC’s Human Resources Department.Provider Network – PHC’s goal is to maintain a provider network with a sufficient number of bilingual and multilingual providers and provider staff who speak threshold languages. PHC requires that providers document the request or refusal of language/interpreter services by LEP members in their medical records.On an annual basis, PHC verifies non-English languages spoken by primary care practitioners and makes updates to the provider directories to reflect new information. As provider office staff changes are communicated to PHC, linguistic capabilities of the new staff are added to the directory.PHC continuously monitors issues related to provider interpreter capabilities through member grievance and appeal logs. Through tracking and trending, PHC will work with provider offices and when appropriate a Corrective Action Plan will be implemented. PHC uses a variety of formats and tools to ensure providers are aware of interpreter service options and cultural and linguistic (C&L) educational opportunities for their staff. Examples: Quarterly provider newsletter articles, PHC Provider Cultural and Linguistic Toolkit, links to Industry Collaboration Effort (ICE) on the PHC website, reminders at provider site in-services, and publish a list of on-line courses and community colleges that offer bilingual educational courses.Provider Training & EducationPHC educates and trains providers and their staff on the following:Cultural competencePatient communicationMember satisfaction and/or grievanceFederal and state regulations and contract requirements relating to language access and anti-discriminatory practicesProcedures for accessing PHC Interpreter Services; the Language Line; the importance of using qualified interpreters; discouraging the use of minors, friends or family members as interpreters; documenting the member’s preferred language in their chart; and documenting the offer, acceptance or refusal of interpreter services.Seniors and Persons with Disabilities (SPD) competency and sensitivity training is provided to providers, their staff and health plan staff utilizing the curriculum developed by Medi-Cal Managed Care Division (MMCD).Documentation of trainings is maintained by PHC and is available upon request in accordance to DHCS MMCD APL 11-010.Consumer Advisory Committee (CAC) - The PHC CAC provides information and recommendations with respect to PHC’s C&L Services.Criteria and Authorization Requirements for Interpreting Services Telephonic Interpreter ServicesMember or patient (non-member) is being seen at a PHC contracted provider site.Member or patient does not have other health coverage (OHC) that covers the requested/required interpreting service.Telephonic Interpreter Services do not require prior authorization through PHC’s Member Services.Sign Language InterpretersMember is enrolled in PHC at the point the service is required.Member does not have OHC that is primary to PHC that covers the requested/required interpreting service.Appointment is for a service that is covered by PHC.Member is hearing and/or speech impaired.Sign Language Interpretation services require prior authorization through PHC’s Member Services Department.Face-to-Face Interpreter ServicesMember is enrolled in PHC at the point the service is required.Member does not have OHC that is primary to PHC that covers the requested/required interpreting service.The appointment is for a service that is covered by PHC. Face-to-face interpretation services require prior authorization through PHC’s Member Services Department.Behavioral Health Treatment (BHT) services for members under 21 years of age, such as evaluations and Applied Behavior Analysis, in a therapeutic and/or home setting are a PHC benefit and fall under PHC responsibility to arrange and schedule face-to-face interpreter services. If face-to-face interpreter services are being requested at a hospital, PHC staff contacts the Patient Services Department at the hospital for these services. If the hospital refuses to provide these services, PHC arranges the service. The Provider Relations Department is notified of the hospital’s refusal to provide service.If face-to-face interpreter services are being requested for PHC Medi-Cal covered mental health services, the caller is referred to Beacon at (855) 765-9703. Beacon is responsible to provide face-to-face interpreting services. Members are advised to contact Beacon three (3) business days in advance of their appointment to arrange the service. Scheduling the Interpreting Services Requests for face-to-face interpreting services and invoicing are processed by Member Services at (800) 863-4155.Evaluation The following methods are used to assess the linguistic capacity of the PHC primary care network and the level of member satisfaction with linguistic services.PHC membership is surveyed. The results are reviewed by C&L and Health Education committee to determine if a corrective action plan is necessary.As outlined in CGA022 Member Discrimination Grievance Procedure, PHC documents and monitors Member Grievances and Appeals related to Cultural and Linguistic and discrimination issues, in accordance with Section 1557 of the Affordable Care Act (ACA) of 2010. Grievance and reports that include cultural and linguistic issues are presented to the Internal Quality Improvement (IQI) Committee on a quarterly basis for appropriate action. PHC will collect data regarding cultural, ethnic, racial and linguistic needs of its members and conduct a quantitative analysis to determine unmet needs. Data sources may include but are not limited to, US Census data, enrollment data, member surveys, member grievances, other published health statistics as well as data provided by Plan sponsors or other sources. An analysis of the data collected will be done annually. The goal is to ensure that PHC and its providers deliver services to our members that meet the needs of our culturally diverse population.In addition, every year, the Health Education team, under the direction of the C&L and Health Education committee, prepares a Population Needs Assessment (PNA) that documents member cultural and linguistic needs. The PNA includes language preferences, reported ethnicity, use of interpreters, traditional health beliefs and beliefs about health and health care utilization. The results are summarized and a report is submitted to the California Department of Health Care Services per regulatory requirements.Appropriate PHC staff drafts a corrective action plan and presents it to the appropriate committee for recommendation and approval. The corrective action plan is then returned to the appropriate person(s) for implementation or incorporation of committee recommendations.Delegation Oversight and MonitoringPHC delegates some functions related to cultural and linguistic services.A formal agreement is maintained and inclusive of all delegated functions PHC conducts an audit not less than annually to ensure the appropriate policy and procedures are in placeResults from Oversight and Monitoring activities shall be presented to the Delegation Oversight Review Sub-Committee (DORS) for review and approvalREFERENCES: DHCS MMCD Policy Letter PL 99-003 Linguistic Services (04/02/1999)DHCS MMCD All Plan Letter (APL) 11-010 Competency and Sensitivity Training Required In Serving the Needs of Seniors and Persons With Disabilities (05/11/2011)DHCS MMCD All Plan Letter (APL) 17-011 Standards for Determining Threshold Languages and Requirements for Section 1557 of The Affordable Care Act (06/30/2017)DHCS MMCD All Plan Letter (APL) 19-011 Health Education and Cultural and Linguistic Population Needs Assessment (09/30/2019)DHCS MMCD All Plan Letter (APL) 18-016 Readability and Suitability of Written Health Education Materials (10/05/2018)Document A (APL 18-016): Review and Approval Guidance for Written Health Education and Member Information MaterialsTitle 42 Code of Federal Regulations (CFR) Section 438.10(d)Title 22 CCR Section 53853(c)Section 1557 of the Affordable Care Act (ACA) of 2010National Committee for Quality Assurance (NCQA) Guidelines (Effective July 1, 2020) NET 1 Availability of Practitioners, Element A, Factors 1, 2DISTRIBUTION:PHC Department DirectorsPHC Provider Manual POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE:Senior Director, Health ServicesREVISION DATES: Medi-Cal (MCLP7002)01/18/17, *02/14/18; 08/08/18; 04/10/19; 03/11/20*Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date. Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date.PREVIOUSLY APPLIED TO:Medi-Cal (MP 302)02/26/99; 04/09/02; 09/09/04; 05/12/05; 06/21/06; 03/12/08; 09/09/08; 09/19/09; 09/14/10; 12/21/10; 01/10/12; 05/15/13; 01/07/14; 05/13/14; 09/02/14; 11/8/16; MP 302 ARCHIVED 01/18/2017Healthy Kids (MP 302) Healthy Kids program ended 12/01/201606/21/06; 03/12/08; 09/09/08; 09/19/09; 09/14/10; 12/21/10; 01/10/12; 05/15/13; 01/07/14; 05/13/14; 09/02/14; 11/8/16 to 12/01/2016PartnershipAdvantage:MP 302 – 06/2006 to 01/01/2015 ................
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