Federal Updates on Language Access

Mara Youdelman, youdelman@healthlaw.org Managing Attorney (DC Office)

Chair, CCHI

CHIA ConferenceMarch 9, 2012

“Securing Health Rights for Those in Need” 1

NHeLP

• National non-profit law firm committed to improving healthcare access and quality for limited-income individuals

• Offices in Washington D.C., Los Angeles, and North Carolina

• Visit our website at: www.healthlaw.org

2

Today’s Presentation Topics

• Health Insurance is changing!• Nondiscrimination• Language Access• Data Collection• Opportunities

3

Health Insurance is Changing!

• 2009 – CHIPRA & Health IT laws enactedCHIPRA gave states more $ for language services

in Medicaid/CHIP

• 2010 – major health reform enacted• 2014 – it all comes together (we think)!

4

Health Insurance is Changing!

• Total uninsured who get insurance: 32 million Individual mandate (with limited exceptions) Medicaid expansion (16 million) State health exchanges created (24 million) Immigrants?

• Insurance Market Reforms No pre-existing condition exclusions No annual or lifetime limits Additional reforms

5

Nondiscrimination

• Extends including Title VI (and other federal civil rights laws) prohibiting discrimination on basis of race, color, national origin to: any health program or activity receiving federal financial

assistance; any program or activity administered by a federal

Executive agency; and Exchanges and other entities established under ACA Tit. 1

• Includes cause of action

• HHS is enforcing this now – can file complaints

6

Language Access – The Asks

• Translate application, all vital documents and notices using 5%/500 threshold for enrollees (NOT county thresholds)

• Include taglines in at least 15 languages on all termination and other notices or adequate notice requirements may not be met

• Provide oral assistance in all languages to assist with filing application, complaints and follow-up

Exchanges

• Culturally and Linguistically Appropriate Services explicitly required for: appeals notices Summary of Benefits and Coverage patient navigators

• Language services required in Exchanges/QHPs pursuant to Title VI and sec. 1557 because: Federal funds for cost-sharing/premium assistance Exchanges created under Tit. I of the ACA

Recommendations for Exchanges & Medicaid/CHIP

• Ensure all oral communication (including consumer assistance) and call center has bilingual staff/interpreters for all languages

• Ensure website has portal for LEP individuals and taglines• Translate vital documents and website into Spanish and any

other frequently encountered languages Use 5%/500 threshold for translating materials Include taglines in 15 languages on all notices

• Conduct outreach & education, open enrollment in culturally and linguistically appropriate manner

• Collect language needs on application to help with identifying needs and planning

Appeals & Notices Amended IFR

• Specifically requires consideration of C&L• Language access requirements:

Tagline (1 sentence) on a notice in a non-English language that meets a 10% threshold for a “county” evaluation

ORAL assistance (i.e. thru customer service lines) in the non-English languages that meet the 10% threshold

Participant can request translated notice in threshold languages

County threshold

10

Summary of Benefits & Coverage

• Specifically requires consideration of C&L

• Adopts same standard from appeals/notices

11

The Impact – 10% v. 5%/500

10% 5% 500# Counties 255 565 1,284# States 23 37 50 states plus

DC, PR

12

A 10% threshold leaves out millions of LEP individuals!

Electronic Health Records (EHRs)

• HI-Tech Act enacted in 2009

• Provides $ for Medicaid and Medicare providers to adopt EHRsMust attest to “meaningful use” of certified EHR

technology to be eligible for $

“Meaningful use” requires collection of r/e/l/g

After 2015, Medicare providers must demonstrate meaningful use or lose 1% of reimbursements

13

Electronic Health Records (EHRs)

• EHRs must collect race, ethnicity and language

• Healthcare providers aren’t currently required to use this data or collect info on usage of language services

• Still need advocacy to ensure EHRs are built to analyze data for disparities & track usage of language services

14

Data Collection beyond EHRs

• New requirements apply to health care/public health programs, activities, and surveys collect race, ethnicity, primary language, sex,

disability status CHIP to collect language data of enrollees &

parents/guardians Medicare to collect data

15

Data Collection beyond EHRs

• Need to ensure Exchanges are required to collect and analyze this data share this data with participating plans/insurers require plans/insurers to analyze data and

address disparities require plans/insurers to note when language

services are provided

16

Health Equity and Accountability Act of 2011

• Builds on ACA gains but addresses what was left behind

• Sponsored by Tri-Caucuses

• Introduced Fall 2011 in the House

• Expect Senate introduction this winter/spring

• Includes additional language access provisions

17

Coming Attractions

• Exchanges & mandates fully implemented in 2014

• Medicaid expansion fully implemented in 2014

• CHIP may expire in 2019

18

Opportunities

• Commenting on regulations

• Getting engaged in CA development processes

• Educating about existence of these provisions

• Protecting Medicaid

• Preserving the ACA

19

Thanks for participating!

Mara Youdelman, youdelman@healthlaw.org

www.healthlaw.org

20