NAVNEET GREWAL LEP ADVOCACY 201: BEYOND THE BASICS NLADA ANNUAL CONFERENCE NOVEMBER 19-22, 2009 Housing Authorities and Language Access Plans

What We’re Covering Today What is the PHA Planning Process? How can advocates get involved? Comments Public Hearing Follow Up

What are PHA Plans? Annual Plan  Annual Process  Must make civil rights certifications  Must attach Administrative Plan and/or ACOP Administrative Plan  Section 8 ACOP  Public Housing Language Access Plan

Sample Policy (Common)

How to Get Started Obtain relevant documents PHA office  Hard Copy/  PHA Website HUD web site  Approved Plans  Determine if there are partners in the community  Residents  Other advocates

Timeline 6

Key Players Public Housing Residents and Voucher Participants Resident Advisory Board Others in the community interested in the issue PHA Staff PHA Board of Commissioners HUD City/County

Case Study

Initial Comments (Submitted by NHLP and Bay Area Legal Aid)

Initial Comments

Public Hearing Who is on the Board of Commissioners? What is on the agenda? Who will attend? Often limited to 2-3 minutes Required to respond to RAB comments Will often respond to all public comments (see materials)

Follow Up Set up meetings between all interested parties and housing authority - legal services, community organizations, appropriate housing authority staff Engage in drafting LAP Education Often a long process Often incremental Reassessment

Draft Plan

Adopted Plan Training List languages Discourage use of friends/children as interpreters

Adopted Plan Vital Documents

Ongoing Advocacy Continue to monitor plan and efficacy Engage in trainings Use next year’s plan process if necessary Informal complaint to Board of Commissioners Informal complaint to HUD FHEO – Regional Office Informal Hearings/Grievance Procedures Formal Administrative Complaint

Summary PHAs required to engage in annual planning process Most PHAs have not created a language access plan Ensure that all players are engaged in developing plan Advocates can influence the process significantly Requires ongoing interactive process and monitoring

NAVNEET GREWAL STAFF ATTORNEY NATIONAL HOUSING LAW PROJECT (510) EXT. 3102

LEP Advocacy 201: Beyond the Basics NLADA Annual Conference November 19-22, 2009 Copyright © 2009 Empire Justice Center

Advocating for A Cross-agency LEP Workgroup 1.Assess state agency compliance with language access obligations 2.Formally address these issues in a letter and request a follow up meeting 3.Once the LEP workgroup is created, provide ongoing support and training 20

1. Assess State Agency Compliance o Identify existing federal obligations that requires language assistance services o Assess current policies and compare to what is required by state / federal law o Determine if and how the current policies comply with state / federal law 21

2. Formally Address the LEP Issues o Explain why and how the state agency or agencies must take action o Recommend practical changes o Request a cross agency LEP workgroup o Request follow up and explain the consequences if there is no response 22

3.After an LEP Workgroup is Created o Provide an LEP training for the workgroup o Have a designated agency contact person o Check in periodically, provide information o Ensure advocates can review and edit the policy before it is released 23

Contact Information Michael J. Mulé, Esq. Staff Attorney Empire Justice Center One West Main Street, Suite 200 Rochester, NY Phone: (585) TTY (585) Copyright © 2009 Empire Justice Center 24

LEP Advocacy 201: Beyond the Basics NLADA Annual Conference Denver, CO November 20, 2009 Doreena Wong 2639 S. La Cienega Blvd. Los Angeles, CA (310) , ext. 107 (310) (fax) “Securing Health Rights for Those in Need”

NHeLP National non-profit law firm committed to improving healthcare access and quality for low-income individuals Coordinates the National Language Access Advocacy Project, funded by The California Endowment – Includes a national coalition of stakeholders on language access working to improve polices and resources at the federal level To switch from VOIP to a telephone connection, call , access code

Federal Advocacy Strategies re: Legislative Advocacy with Congress – Administrative Advocacy with the Administration – Work in collaboration with coalitions to coordinate efforts – Develop expertise to establish credibility & be in a position to provide technical assistance to policy makers – Decide priority issues

Federal Advocacy Strategies – Develop relationships with policy makers – Educate policy makers – Garnering support for legislation from policy makers Send alerts for calls/letters to policy makers Conference calls to discuss tactics Collect stories from impacted constituents – Persistence Administrative Advocacy

Federal Advocacy National Coalition convened by NHeLP Participants – health care provider organizations, advocates, language companies, interpreters and interpreter organizations, accrediting organizations Goals – heighten language access awareness among providers, policymakers and LEP communities; identify issues, solutions, funding sources and effective strategies for engaging others

Coalition’s Statement of Principles Statement of Principles – the Principles represent a consensus for a framework to ensure that language barriers do not affect health outcomes – the coalition sought to articulate the critical importance of effective communication with LEP populations in providing quality public health programs and health care services – Statement of Principles Explanatory Guide – explains the development of the principles

Coalition’s Accomplishments Statement of Principles endorsed by over 90 orgs. Education of policy makers,Congressional Briefings Meetings with Administration Officials Drafting consensus legislation – funding, research, technical assistance, national clearinghouse

Coalition’s Accomplishments Several Reports & Studies ( available at Language Services Resource Guide for Healthcare Providers includes resources for identifying interpreters, translators, training programs National surveys of hospitals, general internists, community health centers Support of Health Equity and Accountability Act of 2009 & inclusion of language access provisions in federal bills Participation in health care reform debate & National Working Group on Health Disparities & Health Reform

Federal Legislation Medicare Improvement and Patient Protection Act of 2008 (MIPPA) The American Recovery and Reinvestment Act of 2009 (ARRA) Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Health Care Reform Bills – House & Senate

MIPAA July 15, 2008 Translation of model application form in ten languages other than English Sec. to evaluate approaches for data collection on disparities in health care services and performance on the basis of race, ethnicity and gender & report to Congress Inspector General to publish report on compliance with and enforcement of national CLAS standards in Medicare

ARRA February 17, 2009 Health Information Technology provision Health and Human Services Health Information Technology Policy Committee required to make a recommendation about the use of collection of patient demographic data, including, at a minimum, race, ethnicity, primary language, and gender information December – adoption of initial standards, implementation specifications and certification criteria

CHIPRA February 2, 2009 Reauthorized Children’s Health Insurance Program for another 4 1/2 years Enhanced administrative funding for language assistance services (interpretation and translation) to higher of 75% or FMAP plus 5% Children & families in CHIP & Medicaid Does not include adults with disabilities and the elderly

CHIPRA NHeLP, with coalition partners, educated legislative aides re: need to provide language assistance services for LEP beneficiaries in CHIP program Successfully included an increased federal match for language assistance services because of work on health disparities bill August 31, 2009 CMS letter – opportunity to explore ways to obtain increased FMAP

National Working Group on Health Disparities & Health Reform NHeLP participates along with over 200 other organizations, coalitions, and groups To ensure health disparities are addressed in health reform – click on icon for Working Group – Clearinghouse of principles, position papers, issue briefs and other materials of the Working Group To switch from VOIP to a telephone connection, call , access code

Health Reform – The Process House passed its bill but Senate yet to debate – Senate may want to get to 60 votes to cut off debate or could use reconciliation and only need 50 votes Conference Committee – Works out the differences b/t House & Senate – Historical deference to Senate (particularly if bi-partisan vote) To switch from VOIP to a telephone connection, call , access code

Working Group Efforts Developed Statement of Principles on health disparities, including language access provisions, for inclusion in Senate bill and sent to Senator Baucus Drafted Issue Brief on health disparities Sent letter to include the Tri-Caucus health disparities legislation, Health Equity and Accountability Act of 2009, in health reform legislation for your records. To switch from VOIP to a telephone connection, call , access code

Prevention & Wellness – The House Ctr. For Quality Improvement, dissemination of best practices must be done in appropriate formats/languages Health IT data standards for race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, rural, urban, or other geographic setting To switch from VOIP to a telephone connection, call , access code

Workforce House – —Cultural and Linguistic Competency Training for healthcare professionals —Pipeline to nursing grants can include ESL classes To switch from VOIP to a telephone connection, call , access code

Nondiscrimination House – includes broad nondiscrimination provision to ensure public health and healthcare and related services are provided without regard to factors that do not relate to the provision of high quality healthcare Senate – narrower version listing protected categories (race, national origin, women, age & disability) To switch from VOIP to a telephone connection, call , access code

Language Access – The Asks Extend “enhanced” match from CHIP and Medicaid kids to all of Medicaid Initiate reimbursement for language services in Medicare Require culturally and linguistically appropriate services for insurance plans participating in the Exchange To switch from VOIP to a telephone connection, call , access code

Language Access – The House Medicare study/demo on language access Medicaid – extends enhanced match to all of Medicaid CLAS required in plans participating in the Exchange Grants for reducing hospital readmissions – can use $ to pay for language services To switch from VOIP to a telephone connection, call , access code

Language Access – The House Exchange – Requires C&L appropriate communication and services – Requires plans to use “plain language” which includes consideration of LEP – Requires “plain language” and C&L appropriate for outreach/enrollment To switch from VOIP to a telephone connection, call , access code

Data Collection – The Asks Require all HHS programs/activities/surveys to collect r/e/l and by sufficient subpopulations for disaggregation Require collection of r/e/l in Medicare Require Medicaid to use OMB Standards Require CHIP to collect language data To switch from VOIP to a telephone connection, call , access code

Data Collection – House Creates Asst Sec for Health IT Develop standards which should include, as appropriate, for the collection of accurate data on health and health care by race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, rural, urban, or other geographic setting, and any other population or subpopulation determined appropriate by the Secretary To switch from VOIP to a telephone connection, call , access code

Next Steps Education – policy makers & interested stakeholders Advocacy – increased language assistance services & inclusion in health care reform & funding Improve quality of language assistance services, including increasing pool of competent, trained interpreters & ensuring training/education/certification Organize & build effective coalitions with providers, patients, & advocates

NHeLP Resources The California Endowment – “Ensuring Linguistic Access in Health Care Settings: An Overview of Current Legal Rights and Responsibilities” (Sept. 2003) Summary of State Law Requirements Addressing Language Needs in Health Care (March '08) NHeLP and Access Project – Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency” (August 2003 & December 2005 update) Commonwealth Fund – “Providing Language Services in Small Health Care Provider Settings: Examples From the Field” (April 2005) Commonwealth Fund – “Providing Language Services in State and Local Health-Related Benefits Offices : Examples From the Field” (Jan 2007)

NHeLP Resources The National Council on Interpreting in Health Care/NHeLP/TCE – Language Services Resource Guide for Health Care Providers (Oct. 2006) NHeLP/Health Research and Educational Trust – “Hospitals Language Services for Patients with Limited English Proficiency: Results for a National Survey” (October 2006) NHeLP/Center on Budget and Policy Priorities – “Paying for Language Services in Medicare: Preliminary Options and Recommendations” (October 2006) Commonwealth Fund – “Interpretation Services in Health Care Settings: Examples From the Field” (May 2002) Available at: