1. Federal Updates on Language Access Mara Youdelman, youdelman@healthlaw.orgyoudelman@healthlaw.org Managing Attorney (DC Office) Chair, CCHI CHIA Conference March 9, 2012 “Securing Health Rights for Those in Need” 1

2. 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.orgwww.healthlaw.org 2

3. Today’s Presentation Topics Health Insurance is changing! Nondiscrimination Language Access Data Collection Opportunities 3

4. Health Insurance is Changing! 2009 – CHIPRA & Health IT laws enacted  CHIPRA gave states more $ for language services in Medicaid/CHIP 2010 – major health reform enacted 2014 – it all comes together (we think)! 4

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Summary of Benefits & Coverage Specifically requires consideration of C&L Adopts same standard from appeals/notices 11

12. The Impact – 10% v. 5%/500 10%5%500 # Counties2555651,284 # States233750 states plus DC, PR 12 A 10% threshold leaves out millions of LEP individuals!

13. Electronic Health Records (EHRs) HI-Tech Act enacted in 2009 Provides $ for Medicaid and Medicare providers to adopt EHRs  Must 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

14. 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

15. 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

16. 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

17. 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

18. Coming Attractions Exchanges & mandates fully implemented in 2014 Medicaid expansion fully implemented in 2014 CHIP may expire in 2019 18

19. Opportunities Commenting on regulations Getting engaged in CA development processes Educating about existence of these provisions Protecting Medicaid Preserving the ACA 19

20. Thanks for participating! Mara Youdelman, youdelman@healthlaw.orgyoudelman@healthlaw.org www.healthlaw.org 20