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Language Assistance Programs for Health Insurance Plans Aside from Those That Serve Medicaid Beneficiaries – Cal. Code Regs. tit. 28 § 1300.67.04

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All health insurance plans excluding those that serve Medicaid beneficiaries must collect, summarize and document enrolled members’ demographic data and report the information to the Department of Health Services for language assistance and health care quality improvement purposes.  However, the health plan must maintain patient confidentiality in the collection of this data. All language assistance programs must contain four elements: standards for enrollee assessment, standards for providing language assistance services, standards for staff training, and standards for compliance monitoring.

Standards for enrollee assessment include:

      -A requirement that all plans include a demographic profile of the enrollee population to calculate and report threshold languages

      -Surveys to determine enrollees' linguistic needs

      -Maintaining confidentiality and disclosure of personal information laws

Providing language assistance services requires:

      -All points of contact must be reasonably anticipated

      -The plans must elaborate on the types of resources needed to provide effective language assistance

      -Plans cannot charge enrollees for learning about language assistance programs

      -Grievance forms and informational notices about threshold language opportunities must be avaiable to enrollees

      -Processes involved with contacting providers about language assistance programs must be made available at no cost to enrollees

     -Translational services must be available for threshold languages identified for the plan, and vital documents must be offered in the necessary languages

     -LEP enrollees should have access--at no cost to them--to interpretation services at all points of contact with plan representatives and on all plan-specific documents

Staff training involves:

     -Providing adequate training to plan employees with routine contact with enrollees needing language assistance

     -Working with interpreters through a variety of media to meet enrollee needs

     -Understanding the cultural diversity of the plan's enrollee population

Compliance monitoring standards require:

     -Every plan must monitor its language assistance programs-- and subsequently delegated programs--and make alterations to be in compliance with existing law

     -The plan as a whole must be evaluated as to its meaningful benefits to LEP enrollees based on a number of conditions

     -The plan will periodically review compliance standards and ensure that it is aware of proper medical survey practices, review of consumer grievances, and review of provider complaints 

Current as of June 2015