Federal Updates on Language Access Mara Youdelman, [email protected]@healthlaw.org...
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Transcript of Federal Updates on Language Access Mara Youdelman, [email protected]@healthlaw.org...
Federal Updates on Language Access
Mara Youdelman, [email protected] 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
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Today’s Presentation Topics
• Health Insurance is changing!• Nondiscrimination• Language Access• Data Collection• Opportunities
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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)!
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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
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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
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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
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Summary of Benefits & Coverage
• Specifically requires consideration of C&L
• Adopts same standard from appeals/notices
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The Impact – 10% v. 5%/500
10% 5% 500# Counties 255 565 1,284# States 23 37 50 states plus
DC, PR
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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
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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
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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
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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
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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
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Coming Attractions
• Exchanges & mandates fully implemented in 2014
• Medicaid expansion fully implemented in 2014
• CHIP may expire in 2019
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Opportunities
• Commenting on regulations
• Getting engaged in CA development processes
• Educating about existence of these provisions
• Protecting Medicaid
• Preserving the ACA
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