jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Equipment Access NOTES FOR TRAINERS: Instruct your audience that as they watch this 16 minute video, to make notes regarding any communication access, and policies, procedures and process issues that they may not have considered regarding the patient they just discussed. Remind them to consider how Plan policies and procedures must be changed to ensure the patient’s needs are met, as well as the role and actions, including policies and procedures of the provider. 6/5/2018 DHCS DHCS

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jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 NOTES TO TRAINER: Instruct the group that before they report on the results of their group, take a few moments to add any medical equipment access issues and policy issues to the reporter's notes that may not have considered. (suggested time: 5 minutes) What are the communication access issues & policy issues re: Kaisy, Maria, Cho, & Latisha? 6/5/2018 DHCS DHCS

Latisha age 68, wheelchair user jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 6/5/2018 Latisha age 68, wheelchair user A prior FFS patient, is in for 1st MMCO primary care appointment African-American with multiple chronic conditions (obesity, diabetes, hypertension, coronary artery disease, & rheumatoid arthritis) affecting mobility & vision Over many years she has been labeled a “noncompliant” patient because she continually ignores prescribed diets and does not reliably take prescribed medications. She has been lectured repeatedly about these problems. NOTES FOR TRAINER: Ask the group: What about Latisha – What are the equipment access & policy issues that affect her care? Listen for answers that include: Medical Equipment Access -- Making appropriate referrals regarding equipment access – --Getting on an exam table or exam chair, --Lifting assistance --scanners, x-ray equipment Is the equipment height adjustable? Is staff trained to assist with transfers/lifting? Is there an accessible scale? Longer appointments may be needed for assistance with transferring or positioning, dressing   6/5/2018 DHCS DHCS 4

jik@pacbell.net - Harris Family Center for Disability & Health Policy Maria 6/5/2018 Maria, age 60, a prior FFS patient She is blind, as is her husband Mario She is hard of hearing Maria, a new MMCO patient, arrived by bus with Mario for her first primary care appointment She needs a series of tests (including a colonoscopy & endoscopy) over next 6 months involving: Complex pre test preparation Follow up at home   6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy Kaisy 6/5/2018 Age 42, deaf from birth A prior FFS patient, comes alone to his first MMC primary care appointment He points to his stomach at the receptionist window No issues   6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy Cho 6/5/2018 Age 50, she uses a walker A prior FFS patient, coming alone for first primary care appointment Her speech is very difficult to understand due to cerebral palsy She has a mild intellectual disability When making her appointment the receptionist thinks Cho said that she felt a lump in her breast NOTES TO TRAINER: Instructor ask: What are Cho’s equipment access & policy issues? Listen for answers that include: Medical Equipment Access --Making appropriate referrals regarding equipment access --Getting on an exam table or exam chair --Lifting assistance Scanners, x-ray equipment --Is the equipment height adjustable? --Is staff trained to assist with transfers/lifting? --Is there an accessible scale? Longer appointments may be needed for assistance with transferring or positioning, dressing   6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Web Site Resources: Exam Room Selection for Accessible Examination Tables & Chairs Importance of Accessible Examination Tables & Wheelchair Scales Access to Medical Care for Individuals with Mobility Disabilities 6/5/2018 DHCS DHCS

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Making It Happen: Policies Procedures Processes jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Making It Happen: Policies Procedures Processes NOTES TO TRAINER: About 30 minutes The location and responsibilities for policies and procedure within the plan/provider structure varies depending on the plan’s organization, but they must exist somewhere! Examples of PLAN P&P categories include: Use of Interpreter Services and Bilingual Staff Translation of Member Materials Health Education Standards Access Policy and Standards Network Operations Manual may need to be amended or modified. Content categories may include: Oversight of delegated functions Community relations requests Member rights and responsibilities Linguistic services Services for members with disabilities Access for members with disabilities Evidence of Coverage may include relevant topics areas that should be amended such as: If you have a disability Information for members who are hearing impaired Care that Plan covers: DME 6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Planning ahead to: Avoid scrambling to provide quality services Ensure access elements are offered smoothly — without unnecessary disruption wait time & delay, or failure to provide services 6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 NOTES TO TRAINER: Slide Part 1 of 2 Facilitate discussion to summarize need for key policies, procedures and process issues by asking: Based on the discussion, what are 3-5 top policies, procedures & processes your plan needs to attend to, i.e., what policies need to be revised or created? Use the following questions to probe, if needed: What happens when a member or provider calls with an access or accommodation question – who will answer? How will you make appropriate referrals to accessible facilities (primary care providers and referrals to specialists and ancillary service providers)? Do plans/providers have the needed physical and equipment access information to make appropriate referrals to accessible facilities (primary care providers and referrals to specialists and ancillary service providers)? If no, how will the plan address this patient’s needs? Listen for answers that include: Patient requires Sign Language Interpreter Patient requires print materials in alternative formats, i.e., large print, Braille, audio tape, disk. What are 3-5 top policies, procedures & processes your plan needs to attend to? 6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 NOTES TO TRAINER: Part 2 of 2 Does the plan have a process (including timelines) to provide forms, medical information and instructions, and other healthcare-related material for individuals who need materials (health education materials, patient care instructions, etc.) in a usable and understandable format? That is, in formats other than standard print either as a general practice or on request? Methods can include: Establish a policy that enables the Plan to enter into a Sign Language Interpreter contract or that reimburses the provider or providing the interpreter. Establish a policy that enables the Plan to enter into a contract with a local provider who can convert print materials into alternative formats (Braille, large print, disks, audio.) Is it clear who is responsible for what (plan / provider)? How will this happen? What is the time frame? Policies, procedures and processes When making a first appointment: does the provider inquire what assistance or accommodation patients may need (walking, seeing, reading, hearing, filling out forms, interpreter) for and during their appointment? (NOTE: Resources include a provider check sheet for collecting this information.) Does the provider place information into patients’ medical record regarding needed accommodations? Does provider staff refer to and update this information before and during each appointment? What are 3-5 top policies, procedures & processes your plan needs to attend to? 6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Disability Services Director NOTES TO TRAINER: At the PLAN level – Implementation needs point person to identify and establish procedures and processes. A designated position with the responsibility, authority and resources to address and coordinate disability specific access including physical, equipment, communication and program access. Position should be promoted in all public information materials & web sites, including the primary entry points for people who may have questions or concerns regarding accessibility of facilities, equipment and services. 6/5/2018 DHCS DHCS

4 Elements of Recommended Planning jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 4 Elements of Recommended Planning Processes Procedures Policies Training NOTES TO TRAINERS: By developing clear processes, policies, procedures, and training, Plans can help networks to create more welcoming environments. 6/5/2018 DHCS DHCS

Policies & procedures that ensure: i jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Policies & procedures that ensure: i Patients can access & use Web-based information & multimedia products Instructional multimedia materials are purchased or produced that include accessibility features (captioning, descriptive narration, & signed narration) NOTES FOR TRAINER: Stress these two, often overlooked examples of needed and required access that are not provided. 6/5/2018 DHCS DHCS

jik@pacbell.net - Harris Family Center for Disability & Health Policy 6/5/2018 Enter information into a patient’s medical record noting need for access items and accommodations! NOTES FOR TRAINERS: Emphasize the importance of this step for all practices, including small practices regardless of whether they maintain patient records on commuters or not. Planning HIT Modifying fields Patients able to access through portals Other elements of ‘Making it Happen!’ Contract language Realistic time frames Incentives Policy letters 6/5/2018 DHCS DHCS

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