1. Why does HCA provide Interpreter Services?  Title VI of the Civil Rights Act of 1964 prohibits recipients of federal funding from discrimination on the basis of race, color, or national origin.  DSHS Administrative Policy 7.21 requires DSHS employees, organizational units, programs and services to ensure that Limited English Proficient (LEP) clients are given equal access to DSHS services and programs. [Note: HCA is currently developing the same policy]  Washington State is one of about a dozen states that has a program to assist health care providers in ensuring equal access to services for patients of Limited English Proficiency by reimbursing some of the cost of language access services.

2. Overview of the Former Broker System for Interpreter Services  Brokers scheduled and coordinated interpreter appointments  There were 6 brokers in 13 regions  Brokers contracted with interpreter language agencies  Language agencies then contracted with individual interpreters  Interpreters are DSHS certified or authorized

3.  At the direction of the Washington State Legislature, the Health Care Authority (HCA) was directed to establish a new coordinating entity for receiving and scheduling statewide Interpreter Service requests for medical appointments and DSHS social services.  CTS Language Link out of Vancouver was selected, and began accepting interpreter service requests on September 10, 2012 for appointments scheduled September 24 or later.  First of its kind in the nation  CTS provides three modalities of interpreting at the request of the medical provider through an on-line scheduling system:  Telephonic,  Video Remote Interpretation (VRI), and  In-person.  CTS contracts directly with interpreters

4. When a medical provider calls CTS LanguageLink (CTS) to schedule an interpreter appointment… CTS will need:  48-hour advance notice of requested appointment  4-hours advance notice for an urgent appointment

5. Who decides if a face-to-face interpreter, telephonic or video connection is needed?  Providers are in the driver’s seat for those decisions, which may be influenced by the type of appointment, an individual’s health status, or even past experience of the doctor with the patient.  The option to use telephonic and video remote interpreting is new, and will facilitate increased client access to needed services at reduced costs. What if it’s an emergency and an interpreter is needed right now?  Medical providers, including hospitals, have backup systems they use in such cases. The state’s interpreter system is supplemented by other resources and is intended to support providers and their communication with Medicaid clients.

6. HCA will pay for interpreter services if:  The client is Medicaid eligible;  The Interpreter is authorized to provide services under the HCA contract with CTS;  The interpreter is DSHS certified or qualified; and  The medical service is covered by the client's Medicaid medical benefits. HCA will NOT pay for interpreter services if:  The interpreter is requested by someone other than the doctor or the doctor's staff;  The interpreter is a member of the client’s family;  The interpreter is not contracted with or approved by CTS; or  The medical service is not covered by the client’s Medicaid medical benefits package.

7.  Inpatient hospital services (e.g. labor and delivery);  Nursing facility services (covered by Aging and Adult Services);  Community mental health centers, mental health clinics or mental health institution services (covered by Regional Support Networks or by DSHS programs);  Alcohol or other drug-related treatment centers/programs;  Emergency medical appointments (one hour notice or less);  Services provided by any other facility, agency, or provider that is required by federal or state law, regulation, or rules to provide those services (e.g. public health agencies, public hospitals and local health jurisdictions);

8. YTD Encounters that have billed YTD Total hours of Interpretation for YTDTotal HCA 4332851,735.93 $ 1,778,233.71 DSHS 4,276 12,919.97 $ 422,140.76 Total 47,604 64,655.90 $ 2,200,374.47 YTDService Area 1Service Area 2 Client 18,581 3,533 Med Providers888357 DSHS Providers18376 Interpreter Services Provided September - December 2012 Figures Provided by Contractor as of 1/23/2013

9. Appointments by Language for December 2012 Language count only Service Area 1 Row Labels Count of Language Amharic72 Bosnian (Serbo Croatian)38 Bulgarian1 Burmese37 Cambodian (Khmer)97 Cantonese555 Chinese8 Croatian1 Farsi149 French20 Hindi2 Korean358 Kurdish2 Laotian31 Mandarin245 Oromo11 Portuguese5 Punjabi81 Romanian20 Russian2617 Somali485 Spanish6919 Swahili5 Thai8 Tigrinya40 Toisanese5 Turkish3 Ukrainian132 Urdu1 Vietnamese990 Grand Total13373 Appointments by Language for December 2012 Service Area 2 Row Labels Count of Language Amharic19 Bosnian (Serbo Croatian)12 Bulgarian1 Burmese19 Cambodian (Khmer)54 Cantonese179 Chinese4 Farsi68 French20 Hindi1 Korean150 Laotian23 Mandarin125 Oromo6 Portuguese2 Punjabi37 Romanian5 Russian801 Somali165 Spanish2421 Swahili4 Thai5 Tigrinya19 Turkish3 Ukrainian43 Urdu1 Vietnamese423 Grand Total4785

10. The Medicaid Administrative Match (MAM) program reimburses governmental agencies a portion of the expenses incurred for performing administrative activities that support the goals of the Medicaid State Plan.  All LHJ’s participate in the MAM program and can be reimbursed for providing interpreter services for LEP Medicaid Clients Reimbursable Medicaid Administrative Match activities include:  Medicaid outreach and education  Identifying children and families who may be eligible  Helping people with the application process  Providing Interpreter Services For further information regarding the MAM program, please contact Alan Himsl at Alan. Himsl@hca.wa.gov