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AB-2299 Medi-Cal: managed care plans: informational materials.(2017-2018)

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Date Published: 08/29/2018 09:00 PM
AB2299:v92#DOCUMENT

Enrolled  August 29, 2018
Passed  IN  Senate  August 22, 2018
Passed  IN  Assembly  August 27, 2018
Amended  IN  Senate  August 06, 2018
Amended  IN  Senate  July 02, 2018
Amended  IN  Senate  June 18, 2018
Amended  IN  Assembly  May 21, 2018
Amended  IN  Assembly  April 23, 2018
Amended  IN  Assembly  April 10, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2299


Introduced by Assembly Member Chu

February 13, 2018


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


LEGISLATIVE COUNSEL'S DIGEST


AB 2299, Chu. Medi-Cal: managed care plans: informational materials.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. 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 about the program, including the availability of language assistance services and the availability of the grievance procedure.
This bill would require the department to ensure that all written health education and informing materials, as defined, in English and those translated into threshold languages by managed care plans or their subcontractors are at or below the equivalent of 6th-grade reading level. The bill would require the department to require managed care plans, as defined, or their subcontractors to conduct, by January 1, 2020, a one-time, targeted community review of informing materials in threshold languages for which a 6th-grade reading level cannot be determined, in order for members to ensure the cultural and linguistic appropriateness of materials in community-based settings, as specified. The bill would exempt material translated by either the department or its contractors, excluding managed care plans, from the targeted-community review. The bill would require the managed care plans to adopt additional readability and suitability standards developed by the community review process, and would require the managed care plans to apply the adopted standards to health education and informing materials developed on or after July 1, 2020. The bill would require managed care plans to report the findings of the community review process, and would require the department to publish those findings and develop recommendations for additional readability and suitability standards based on the findings, as described. The bill would include a statement of legislative findings and declarations.
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) A significant number of Medi-Cal managed care plan members 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 literacy levels or low health literacy, which leads to lower quality health care and poorer health care outcomes.
(c) Informing materials provide essential information to members regarding their health care rights, plan benefits, and access to services. Using plain and simple language will increase the readability of materials, improving access for members with varying health literacy levels.
(d) By applying reading level, readability, and suitability requirements to informing materials, the State Department of Health Care Services can empower and help safeguard the health care rights of its most vulnerable members.
(e) The individuals for whom plan documents are designed are best equipped to assess the cultural and linguistic suitability of the materials. Targeted community review is the most effective process to engage these consumers of particular cultural and linguistic groups.

SEC. 2.

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

14029.93.
 (a) The department shall ensure that all written health education and informing materials developed pursuant to managed care plan contracts are at or below the equivalent of sixth-grade reading level in English.
(1) Written health education in English shall meet the readability and suitability checklists established by the department by means of all-county letters, plan letters, including All Plan Letter 11-018, plan or provider bulletins, or similar instructions.
(2) Written informing materials in English shall meet the readability and suitability checklists established through the department’s contracts with managed care plans.
(3) (A) Managed care plans shall adopt any additional readability and suitability standards developed by the community review process described in subdivision (c) and recommended by the department in subdivision (e).
(B) Managed care plans shall apply the adopted standards to health education and informing materials developed by the managed care plans on or after July 1, 2020.
(b) The department shall ensure that all written health education and informing materials translated into threshold languages by managed care plans or their subcontractors are at or below the equivalent of sixth-grade reading level.
(1) For each threshold language for which an equivalent sixth grade reading level cannot be determined, the department shall require managed care plans or their subcontractors to establish a process for Medi-Cal beneficiaries, advocates, and stakeholders to review existing and new informing materials through a one-time community review described in subdivision (c), with sufficient time to provide meaningful feedback. This review shall be completed by January 1, 2020.
(2) Managed care plans shall adopt any additional readability and suitability standards developed by the community review process described in subdivision (c) and recommended by the department pursuant to subdivision (e) by July 1, 2020.
(c) The department shall require managed care plans or their subcontractors to conduct a one-time, targeted community review of informing materials in threshold languages for which a sixth-grade reading level cannot be determined, in order for members to ensure the cultural and linguistic appropriateness of materials in community-based settings. The managed care plans or their subcontractors shall structure the community review process, as follows:
(1) When determining who shall participate in the community review process, the managed care plans or their subcontractors shall do all of the following:
(A) Provide background information on plan members, including the ratio of threshold language speakers, and a summary of the plan’s current community review process.
(B) Include current Medi-Cal beneficiaries and community-based organizations that work directly with Medi-Cal beneficiaries to identify and recruit beneficiaries.
(C) Identify and include native speakers of a specific threshold language to review translated materials in their threshold language.
(2) Outreach methods for participants in the community review process shall include, but not be limited to, email, mail, and telephone calls.
(3) When conducting the community review process, the managed care plans or their subcontractors shall do all of the following:
(A) Incorporate both quantitative and qualitative approaches, including focus groups and surveys with a minimum of four participants.
(B) Allow 45 days for participants to provide feedback.
(C) Have a native speaker of the threshold language assess, conduct, and evaluate the community review process and provide feedback.
(D) Allow community feedback in both written and oral formats.
(4) Managed care plans or their subcontractors shall conduct a targeted community review when new informing materials are created.
(5) Managed care plans or their subcontractors may aggregate community reviews by threshold language, and need not conduct separate reviews for each county served.
(d) (1) Informing materials produced by the managed care plan prior to January 1, 2019, which are field tested by a minimum of four native speakers and meet the additional readability and suitability standards developed pursuant to paragraph (2) of subdivision (b), are exempt from the one-time community review described in subdivision (c). Any material that fails to meet subsequently adopted readability and suitability standards shall be updated accordingly and reviewed pursuant to subdivision (c).
(2) Any material translated by either the department or its contractors, excluding managed care plans, shall be exempt from the community review requirements set forth under subdivision (c).
(3) (A) Any informing material related to a requested service or grievance, including, but not limited to, documents that explain the reason for denial of a requested service, that is produced for an individual beneficiary is exempt from both the community review requirements set forth under subdivision (c) and the field test standards described in paragraph (1) of subdivision (f).
(B) The managed care plans shall ensure that any informing material described under subparagraph (A) include, as may be relevant, language that has been reviewed pursuant to subdivision (c) or tested in accordance with paragraph (1) of subdivision (f).
(e) The managed care plans shall report the findings of the community review process described in subdivision (c). The department shall publish the findings of the community reviews and develop recommendations for additional readability and suitability standards for each threshold language based on the findings. The departmental publication shall also identify any differences between current English readability and suitability standards and the checklists established by the department in accordance with subdivision (a).
(f) The following definitions apply for purposes of this section:
(1) “Field tested” means a review by a minimum of four native speakers that is conducted by either a third-party vendor, managed care plan, or agent. “Field tested” is distinguished from the community review process described in subdivision (c).
(2) (A) “Health education materials” means documents that are designed to assist members to modify personal health behaviors, achieve and maintain healthy lifestyles, and promote positive health outcomes, including updates on current health conditions, self-care, and management of health conditions, as detailed in the department’s All Plan Letter 11-018, or subsequently published letters, bulletins, or similar instructions.
(B) Health education materials include, but are not limited to, topics about preventive care, health promotion, screenings, disease management, healthy living, and health communications.
(3) (A) “Informing materials” means vital documents that provide members with essential information about access to and usage of plan services, as detailed in the department’s All Plan Letter 11-018, or subsequently published letters, bulletins, or similar instructions.
(B) Informing materials include, but are not limited to, all of the following:
(i) Enrollment and disenrollment forms and information.
(ii) Evidence of coverage (EOC) booklets.
(iii) Facility directories.
(iv) Form letters.
(v) Information regarding members’ rights and grievance procedures.
(vi) Insurance plan documents.
(vii) New member welcome packets.
(viii) Notices of action.
(4) “Native speaker” means an individual whose primary language is a threshold language subject to the community review process described in subdivision (c).
(5) “Plans” 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:
(A) Article 2.7 (commencing with Section 14087.3).
(B) Article 2.8 (commencing with Section 14087.5).
(C) Article 2.81 (commencing with Section 14087.96).
(D) Article 2.82 (commencing with Section 14087.98).
(E) Article 2.91 (commencing with Section 14089).
(F) Chapter 8 (commencing with Section 14200).
(G) Chapter 8.9 (commencing with Section 14700).
(H) 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 subdivision, “Special Terms and Conditions” shall have the same meaning as set forth in subdivision (o) of Section 14184.10.
(I) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.
(g) This section does not apply to statements that are specifically required by law to be included in written materials.