1. Medicare: Updates on Language Access and Data Collection Mara Youdelman, youdelman@healthlaw.orgyoudelman@healthlaw.org NHMA Conference – March 26, 2010 “Securing Health Rights for Those in Need”

2. 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

3. Medicare & LEP Limited English proficient (LEP) individuals include about 3.1 million individuals over 65 Of LEP over 65 who speak English “not well” or “not at all”:  Over 46% of all Spanish speakers  50% of all Asian and Pacific Islander language speakers 2007 American Community Survey, Table B16004, Age by Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over, available at http://www.factfinder.gov. http://www.factfinder.gov

4. Medicare & LEP According to GAO, approximately 1 million calls to 1-800-MEDICARE (7/2007-6/2008) were assisted in a language other than English. A 2006 study found that LEP Medicare beneficiaries had less access to a usual source of health care and to preventative cancer screenings than non-LEP beneficiaries.

5. Medicare & LEP A “secret shopper” survey by the California Medicare Part D Language Access Coalition conducted in 2008 revealed that Medicare Part D plan call centers are not regularly able to serve LEP beneficiaries.

6. Health Reform – Language Access Health Reform Principles included –  Initiate reimbursement for language services in Medicare  Increase Medicaid match for language services for adults in Medicaid (would assist dual- eligibles)  Translation of Medicare forms To switch from VOIP to a telephone connection, call 213-286-1201, access code 435-253-182

7. Language Access – The House Medicare study/demo on language access Medicaid – extends enhanced match to all of Medicaid Grants for reducing hospital readmissions – can use $ to pay for language services

8. Language Access – The Senate Nothing re: Medicare Nothing re: Medicaid Some references in workforce, prevention, and navigators for Exchange

9. CMS LEP Plan Released 11/2009 Weaker than OCR LEP Guidance for oral communication and translation thresholds  CMS should translate all Medicare beneficiary- related forms into at least top 15 languages  CMS should to take leadership on assisting providers to effectively provide language services (clearinghouse, translated materials, etc.)

10. Health Reform – Data Collection Sec. 4302 – applies to all health care/public health programs, activities, and surveys  Collect race, ethnicity, primary language  Collect sufficient data to generate statistically reliable estimates for subgroups  Medicaid to use OMB standards  Medicare will have to start collecting data Builds on HITECH Act which will require collecting r/e/l data in EHRs

11. IOM Recommendations Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement  Released 2009  How to collect race/ethnicity/language  Offers standardization to allow apples-to-apples comparisons across health programs/plans/surveys Should be adopted by CMS for Medicare

12. Related Data Collection re: Language Access Risk Management Issues  Lack of effective language services can hinder communication and raise risk of harm/malpractice Use of language services  Usage of interpreters  Provision of translated materials Competency of interpreters/translators  OCR LEP Guidance – need to ensure competency  Efforts to create national standards – Certification Commission for Healthcare Interpreters

13. Conclusions Significant numbers of LEP are in Medicare CMS needs to do more in its federally conducted activities and to assist providers in meeting the needs of LEP patients Future legislation should include improvements in language access and addressing disparities