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AB-318 Medi-Cal materials: readability.(2019-2020)

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Date Published: 08/12/2019 02:00 PM
AB318:v94#DOCUMENT

Amended  IN  Senate  August 12, 2019
Amended  IN  Senate  June 24, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  March 26, 2019
Amended  IN  Assembly  March 12, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 318


Introduced by Assembly Member Chu

January 30, 2019


An act to add Sections 14029.93 and 14029.94 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 318, as amended, Chu. Medi-Cal materials: readability.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department to notify Medi-Cal beneficiaries, prospective beneficiaries, and members of the public of the availability of language assistance services free of charge and in a timely manner, when those services are necessary to provide meaningful access to individuals with limited English proficiency (LEP). Existing law requires the department to require all managed care plans contracting with the department to provide Medi-Cal services to provide language assistance services to LEP Medi-Cal beneficiaries who are mandatorily enrolled in managed care.
This bill would, commencing January 1, 2020, require the field testing of all Medi-Cal beneficiary materials, and informing materials, as defined, that are translated into threshold languages and released by the department and managed care plans, respectively, except as specified. The bill would define “field testing” as a review of translations for accuracy, cultural appropriateness, and readability. The bill would also define a “managed care plan” for these purposes.
The bill would also require the department to establish a readability workgroup to identify at least 10 documents that are released to Medi-Cal beneficiaries, including certain documents, and to designate a readability expert to revise those documents, as specified. The bill would require the readability expert and workgroup to provide the department with specific recommendations for revising the selected documents to improve the readability of the documents. The bill would require the department to rerelease the documents with revisions based on those recommendations, and would require the translation and field testing of those documents. The bill would require the implementation of these provisions no later than January 1, 2021.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Low health literacy and low reading literacy are barriers to meaningful access and equal opportunity to fully participate in one’s health care services.
(b) One-third of Medi-Cal beneficiaries speak a language other than English as their primary language. In comparison to their English-speaking counterparts, limited-English-proficient (LEP) individuals are more likely to have low reading literacy or low health literacy, which leads to lower quality health care and poorer health outcomes.
(c) Using plain and simple language will increase the readability of materials, improving access for Medi-Cal beneficiaries with varying reading or health literacy levels.
(d) By improving the readability of key Medi-Cal documents and ensuring that translated materials are field tested, the State Department of Health Care Services can empower consumers and help safeguard the health care rights of Medi-Cal beneficiaries.

SEC. 2.

 Section 14029.93 is added to the Welfare and Institutions Code, to read:

14029.93.
 (a) Commencing January 1, 2020, all Medi-Cal beneficiary materials translated into threshold languages and released by the department, and informing materials as defined in subdivision (e) that are translated into threshold languages and released by managed care plans contracting with the department, shall be field tested as part of the translation process, except as described in subdivisions (c) and (d).
(b) (1) For purposes of this section, “field testing” means a review of translations for accuracy, cultural appropriateness, and readability.
(2) Field testing shall be conducted by a focus group, or another form of review, involving native speakers of the applicable language or community-based organizations with an understanding of the linguistic needs of the targeted population.
(3) Field testing may be administered internally by the department or the managed care plan, or by a third-party contractor, including, but not limited to, an entity already contracted for translation.
(c) Information contained in a material on an individualized, nonstandard basis for a Medi-Cal beneficiary, including, but not limited to, personal identifying information or specific information regarding a Medi-Cal beneficiary’s medical condition, shall not be field tested.
(d) Information released to Medi-Cal beneficiaries during a state of emergency or a local emergency, as defined in Section 8558 of the Government Code, that cannot be written before the state of emergency or local emergency, including information required pursuant to Section 1368.7 of the Health and Safety Code or Section 8594.16 of the Government Code, is exempt from the field testing requirement described in this section.
(e) For purposes of this section, “informing materials” means documents that provide Medi-Cal managed care members with essential information about access to, and usage of, plan services, including only the following:
(1) Plan termination notices.
(2) New member welcome packets.
(3) Member handbooks.
(4) Forms and information regarding grievance or complaint procedures and information regarding external review of plan decisions.
(5) Notices of Forms and information regarding appeals and adverse benefit determinations.
(f) For purposes of this section, “managed care plan” refers to any individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(1) Article 2.7 (commencing with Section 14087.3).
(2) Article 2.8 (commencing with Section 14087.5).
(3) Article 2.81 (commencing with Section 14087.96).
(4) Article 2.82 (commencing with Section 14087.98).
(5) Article 2.91 (commencing with Section 14089).
(6) Chapter 8 (commencing with Section 14200).
(7) Chapter 8.9 (commencing with Section 14700).
(8) A county Drug Medi-Cal organized delivery system authorized under the California Medi-Cal 2020 Demonstration, Number 11-W-00193/9, as approved by the federal Centers for Medicare and Medicaid Services and described in the Special Terms and Conditions. For purposes of this paragraph, “Special Terms and Conditions” has the same meaning as set forth in subdivision (o) of Section 14184.10.

SEC. 3.

 Section 14029.94 is added to the Welfare and Institutions Code, to read:

14029.94.
 (a) The department shall establish a readability workgroup to identify at least 10 documents released by the department, or by the State Department of Social Services as described in subparagraph (B) of paragraph (4), to Medi-Cal beneficiaries, and shall designate a readability expert to revise those documents. In identifying those documents, the workgroup shall consider the number of Medi-Cal beneficiaries who use the document and whether the document is needed to determine eligibility for benefits, to describe the availability of services, or to describe a Medi-Cal beneficiary’s rights.
(1) The workgroup shall consist of interested stakeholders, including, but not limited to, consumer advocates and managed care plans as defined in Section 14029.93. 14029.93, and the State Department of Social Services State Hearings Division.
(2) The readability expert shall have demonstrated expertise in improving the readability and visual layout of consumer documents intended for populations with low reading or health literacy.
(3) The readability expert shall consult with the department, the workgroup, and other stakeholders to ensure that essential messages are preserved through the translation process.
(4) The list of documents shall include, as part of the minimum 10 documents, the most recently updated versions of all of the following documents:
(A) California Medi-Cal Dental Services Beneficiary Handbook, as released by the department.
(B) Notice of hearing rights, known as NA Back 9 Form, as released by the State Department of Social Services and cited in All County Welfare Directors Letter No. 17-31. Medi-Cal Managed Care Model Member Handbook, as released by the department.
(C) Rights and Responsibilities Form, known as MC 219 Form, as released by the department and cited in Medi-Cal Eligibility Division Information Letter No. I 16-05.
(D) Medi-Cal Request for Information Form, known as MC 355 Form, as released by the department and cited in All County Welfare Directors Letter No. 18-25.
(E) Medi-Cal Annual Redetermination Form, known as MC 210 RV Form, as released by the department and cited in All County Welfare Directors Letter No. 11-23.
(b) After revising the documents, the readability expert shall present to the workgroup and department employees preparing consumer materials on best practices in readability and the principles used to revise the documents, and shall demonstrate the improvements in readability.
(c) The readability expert and workgroup shall provide the department with specific recommendations for revising the selected documents to improve the readability of the documents.
(d) The department shall rerelease the selected documents with revisions based on the recommendations from the readability expert and workgroup.
(e) After the department completes the revisions to the documents, the documents shall be translated into all threshold languages and field tested pursuant to Section 14029.93.
(f) This section shall be implemented no later than January 1, 2021.