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California Health and Safety Code Section 1367.04

Legal Research Home > California Laws > Health and Safety Code > California Health and Safety Code Section 1367.04

1367.04.  (a) Not later than January 1, 2006, the department shall
develop and adopt regulations establishing standards and requirements
to provide health care service plan enrollees with appropriate
access to language assistance in obtaining health care services.
   (b) In developing the regulations, the department shall require
every health care service plan and specialized health care service
plan to assess the linguistic needs of the enrollee population,
excluding Medi-Cal enrollees, and to provide for translation and
interpretation for medical services, as indicated. A health care
service plan that participates in the Healthy Families Program may
assess the Healthy Families Program enrollee population separately
from the remainder of its enrollee population for purposes of
subparagraph (A) of paragraph (1). A health care service plan that
chooses to separate its Healthy Families Program enrollment from the
remainder of its enrollee population shall treat the Healthy Families
Program population separately for purposes of determining whether
subparagraph (A) of paragraph (1) is applicable, and shall also treat
the Healthy Families Program population separately for purposes of
applying the percentage and numerical thresholds in subparagraph (A)
of paragraph (1). The regulations shall include the following:
   (1) Requirements for the translation of vital documents that
include the following:
   (A) A requirement that all vital documents, as defined pursuant to
subparagraph (B), be translated into an indicated language, as
follows:
   (i) A health care service plan with an enrollment of 1,000,000 or
more shall translate vital documents into the top two languages other
than English as determined by the needs assessment as required by
this subdivision and any additional languages when 0.75 percent or
15,000 of the enrollee population, whichever number is less,
excluding Medi-Cal enrollment and treating Healthy Families Program
enrollment separately indicates in the needs assessment as required
by this subdivision a preference for written materials in that
language.
   (ii) A health care service plan with an enrollment of 300,000 or
more but less than 1,000,000 shall translate vital documents into the
top one language other than English as determined by the needs
assessment as required by this subdivision and any additional
languages when 1 percent or 6,000 of the enrollee population,
whichever number is less, excluding Medi-Cal enrollment and treating
Healthy Families Program enrollment separately indicates in the needs
assessment as required by this subdivision a preference for written
materials in that language.
   (iii) A health care service plan with an enrollment of less than
300,000 shall translate vital documents into a language other than
English when 3,000 or more or 5 percent of the enrollee population,
whichever number is less, excluding Medi-Cal enrollment and treating
Healthy Families Program enrollment separately indicates in the needs
assessment as required by this subdivision a preference for written
materials in that language.
   (B) Specification of vital documents produced by the plan that are
required to be translated. The specification of vital documents
shall not exceed that of the Department of Health and Human Services
(HHS) Office of Civil Rights (OCR) Policy Guidance (65 Federal
Register 52762 (August 30, 2000)), but shall include all of the
following:
   (i) Applications.
   (ii) Consent forms.
   (iii) Letters containing important information regarding
eligibility and participation criteria.
   (iv) Notices pertaining to the denial, reduction, modification, or
termination of services and benefits, and the right to file a
grievance or appeal.
   (v) Notices advising limited-English-proficient persons of the
availability of free language assistance and other outreach materials
that are provided to enrollees.
   (vi) Translated documents shall not include a health care service
plan's explanation of benefits or similar claim processing
information that is sent to enrollees, unless the document requires a
response by the enrollee.
   (C) (i) For those documents described in subparagraph (B) that are
not standardized but contain enrollee specific information, health
care service plans shall not be required to translate the documents
into the threshold languages identified by the needs assessment as
required by this subdivision, but rather shall include with the
documents a written notice of the availability of interpretation
services in the threshold languages identified by the needs
assessment as required by this subdivision.
   (ii) Upon request, the enrollee shall receive a written
translation of the documents described in clause (i). The health care
service plan shall have up to, but not to exceed, 21 days to comply
with the enrollee's request for a written translation. If an enrollee
requests a translated document, all timeframes and deadline
requirements related to the document that apply to the health care
service plan and enrollees under the provisions of this chapter and
under any regulations adopted pursuant to this chapter shall begin to
run upon the health care service plan's issuance of the translated
document.
   (iii) For grievances that require expedited plan review and
response in accordance with subdivision (b) of Section 1368.01, the
health care service plan may satisfy this requirement by providing
notice of the availability and access to oral interpretation
services.
   (D) A requirement that health care service plans advise
limited-English-proficient enrollees of the availability of
interpreter services.
   (2) Standards to ensure the quality and accuracy of the written
translations and that a translated document meets the same standards
required for the English language version of the document. The
English language documents shall determine the rights and obligations
of the parties, and the translated documents shall be admissible in
evidence only if there is a dispute regarding a substantial
difference in the material terms and conditions of the English
language document and the translated document.
   (3) Requirements for surveying the language preferences and needs
assessments of health care service plan enrollees within one year of
the effective date of the regulations that permit health care service
plans to utilize various survey methods, including, but not limited
to, the use of existing enrollment and renewal processes, subscriber
newsletters, or other mailings. Health care service plans shall
update the needs assessment, demographic profile, and language
translation requirements every three years.
   (4) Requirements for individual enrollee access to interpretation
services.
   (5) Standards to ensure the quality and timeliness of oral
interpretation services provided by health care service plans.
   (c) In developing the regulations, standards, and requirements,
the department shall consider the following:
   (1) Publications and standards issued by federal agencies, such as
the Culturally and Linguistically Appropriate Services (CLAS) in
Health Care issued by the United States Department of Health and
Human Services Office of Minority Health in December 2000, and the
Department of Health and Human Services (HHS) Office of Civil Rights
(OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).
   (2) Other cultural and linguistic requirements under state
programs, such as Medi-Cal Managed Care Policy Letters, cultural and
linguistic requirements imposed by the State Department of Health
Services on health care service plans that contract to provide
Medi-Cal managed care services, and cultural and linguistic
requirements imposed by the Managed Risk Medical Insurance Board on
health care service plans that contract to provide services in the
Healthy Families Program.
   (3) Standards adopted by other states pertaining to language
assistance requirements for health care service plans.
   (4) Standards established by California or nationally recognized
accrediting, certifying, or licensing organizations and medical and
health care interpreter professional associations regarding
interpretation services.
   (5) Publications, guidelines, reports, and recommendations issued
by state agencies or advisory committees, such as the report card to
the public on the comparative performance of plans and reports on
cultural and linguistic services issued by the Office of Patient
Advocate and the report to the Legislature from the Task Force on
Culturally and Linguistically Competent Physicians and Dentists
established by Section 852 of the Business and Professions Code.
   (6) Examples of best practices relating to language assistance
services by health care providers and health care service plans,
including existing practices.
   (7) Information gathered from complaints to the HMO Helpline and
consumer assistance centers regarding language assistance services.
   (8) The cost of compliance and the availability of translation and
interpretation services and professionals.
   (9) Flexibility to accommodate variations in plan networks and
method of service delivery. The department shall allow for health
care service plan flexibility in determining compliance with the
standards for oral and written interpretation services.
   (d) The department shall work to ensure that the biennial reports
required by this section, and the data collected for those reports,
are consistent with reports required by government-sponsored programs
and do not require duplicative or conflicting data collection or
reporting.
   (e) The department shall seek public input from a wide range of
interested parties through advisory bodies established by the
director.
   (f) A contract between a health care service plan and a health
care provider shall require compliance with the standards developed
under this section. In furtherance of this section, the contract
shall require providers to cooperate with the plan by providing any
information necessary to assess compliance.
   (g) The department shall report biennially to the Legislature and
advisory bodies established by the director regarding plan compliance
with the standards, including results of compliance audits made in
conjunction with other audits and reviews. The reported information
shall also be included in the publication required under subparagraph
(B) of paragraph (3) of subdivision (c) of Section 1368.02. The
department shall also utilize the reported information to make
recommendations for changes that further enhance standards pursuant
to this section. The department may also delay or otherwise phase-in
implementation of standards and requirements in recognition of costs
and availability of translation and interpretation services and
professionals.
   (h) (1) Except for contracts with the State Department of Health
Services Medi-Cal program, the standards developed under this section
shall be considered the minimum required for compliance.
   (2) The regulations shall provide that a health plan is in
compliance if the plan is required to meet the same or similar
standards by the Medi-Cal program, either by contract or state law,
if the standards provide as much access to cultural and linguistic
services as the standards established by this section for an equal or
higher number of enrollees and therefore meet or exceed the
standards of the regulations established pursuant to this section,
and the department determines that the health care service plan is in
compliance with the standards required by the Medi-Cal program. To
meet this requirement, the department shall not be required to
perform individual audits. The department shall, to the extent
feasible, rely on audits, reports, or other oversight and enforcement
methods used by the State Department of Health Services.
   (3) The determination pursuant to paragraph (2) shall only apply
to the enrollees covered by the Medi-Cal program standards. A health
care service plan subject to paragraph (2) shall comply with the
standards established by this section with regard to enrollees not
covered by the Medi-Cal program.
   (i) Nothing in this section shall prohibit a government purchaser
from including in their contracts additional translation or
interpretation requirements, to meet linguistic or cultural needs,
beyond those set forth pursuant to this section.

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Last modified: March 17, 2014