Care1st Health Plan CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) 2014 PROGRAM DESCRIPTION

Transcription

1 Care1st Health Plan CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) 2014 PROGRAM DESCRIPTION 1

2 Care1st Policy on Culturally and Linguistically Appropriate Services (CLAS) Care1st Health Plan Cultural &Linguistic Department has adopted policies & procedures that are consistent with the National Standards (i.e. CMS, DHCS, DMHC & LA Care Health Plan) for CLAS. These policies and procedures aim to ensure that Care1st members receive effective and respectful care in a manner compatible with their cultural health beliefs and practices, and preferred language at every medical and non-medical encounter. Care1st Health Plan requires our contracted MSO/PPG/IPAs, Providers, Ancillary Providers, Pharmacies and Hospitals to participate in and comply with the performance standards and policies & procedures. Further, one of the MSO/PPG/IPAs responsibilities is to educate and communicate cultural and linguistics requirements, policies & procedures to their contracted providers on an ongoing basis. These requirements will be found in this program description. Definitions: For Medi-Cal Members Limited English proficient (LEP) Members: Those members, who cannot speak, read, write, or understand the English language at a level that permits them to interact effectively with health care providers and social services agencies. Threshold Languages: Care1st Health Plan has adopted the Department of Health Care Services ( DHCS ) threshold languages identified for each county. These are primary languages spoken by limited English proficient (LEP) population groups meeting a numeric threshold of 3,000 eligible beneficiaries residing in a county. Additionally, languages spoken by a population of eligible LEP beneficiaries residing in a county, who meet the concentration standard of 1,000 in a single zip code or 1,500 in two contiguous zip codes, are also considered threshold languages for a county. Threshold languages identified by DHCS for the following counties: Los Angeles County English Armenian Korean Russian Spanish Farsi Tagalog Vietnamese Chinese (Cantonese and Khmer (Cambodian) Mandarin) San Diego County English Spanish Arabic Vietnamese Tagalog Translation of Member -- Informing and Health Education Materials: Written informing documents provide essential information to members about access and usage of services. It is the responsibility of Care1st Health Plan and MSO/PPG/IPAs to provide culturally and linguistically appropriate informing materials to members in the threshold languages determined by the Department of Health Care Services ( DHCS ) and at a 6 th grade reading level or lower. Member informing materials include, but are not limited to: Access and Availability of Linguistic Services Form letters (Notice of Action letters such as Denials, Deferrals, Modification, Termination and Approval, Emergency Room follow-up, and other member communications) Grievance (Acknowledgement & Resolution letters) and fair hearing process Marketing Materials Member Handbook Member Newsletters Member Surveys Preventive Health Reminders (Appointments and Immunization Reminders, Initial Health Examination Notices and Prenatal Care follow -up) Provider Directory Welcome Packet Materials in Alternative Formats: Upon request, Care1st C&L department will make available member informing materials that can be used by members with disability (e.g. audio, Braille, large print, web-accessible or electronic text files). This includes health education materials, and information on how to access health plan services. 2

3 For Commercial Enrollees The CA Language Assistance Program Law Effective January 1, 2009 CA law (SB 853) and its accompanying regulations require that health plans establish and support a Language Assistance Program (LAP) for commercial members that are Limited English Proficient (LEP). Definitions: Limited English Proficient (LEP): An individual who has an inability or a limited ability to speak, read, write, or understand the English language at a level that permits that individual to interact effectively with health care providers or plan employees. Threshold Languages: Care1st Health Plan has identified the following as threshold languages. Commercial Members English Chinese (Cantonese and Mandarin) Translation of Documents: Vital Documents: Documents that are important to using the health plan and accessing benefits. They may be produced by the plan, or the production or distribution may be delegated to a contracting health care service provider or administrative services provider. They are separated under the following two categories: Standard Vital Document Non-standard Vital Document - General documents that are not specific to - A document containing enrollee-specific a particular enrollee: information: Applications Consent Forms Notice advising LEP enrollees of the availability of free language assistance and other outreach materials that are provided to enrollees Denial letter, Delay letter, Modification letter and Termination letter Appeal Acknowledgement letter, Appeal Uphold letter, Grievance Acknowledgment letter and Resolution letter Claim processing letters or Explanation of Benefice (EOB) if a response is needed from the enrollee For Standard Vital Document translation, Care1st Health Plan will translate the above documents upon request. Please submit a copy of that document to the Plan in a timely manner. For Non-Standard Vital Document translation, Care1st Health Plan will provide the English version with a DMHC approved written notice of the availability of interpretation and translation services, and if a translation is requested, Care1st will provide the translation. Non-Vital Document: A document not covered under the regulation i.e. an authorization approval letter. For health plan specific information please refer to the ICE Health Plan Resource Guide for Provider Offices: Identification of limited English proficient (LEP) Members: Care1st Health Plan and MSO/PPG/IPAs will assess their member population s language preference distributions to determine special needs and develop appropriate plans and services. 3

4 Care1st Health Plan will provide a new member eligibility list to MSO/PPG/IPAs and providers which include the primary language spoken by the member on a monthly basis. MSO/PPG/IPAs and providers may use the eligibility list as a tool to track their LEP and hard-of-hearing or deaf members. Care1st Health Plan, MSO/PPG/IPAs, and providers will ensure that members are routinely given opportunities to declare their need for culturally and linguistically appropriate services (i.e. when making an appointment, during initial health assessment, on arrival, and in the exam room). Providers and clinic staff should record the members primary language in their medical chart. Care1st Health Plan will conduct an assessment on its Commercial membership in order to develop a demographic profile and determine threshold languages of its enrollees. The demographic profile will be reviewed and updated every three years. Identification of Member s Ethnicity and Race: Care1st Health Plan will identify the ethnicity and race of the member, when data is available, to determine special needs and develop appropriate plans and services. MSO/PPG/IPAs and providers may use the eligibility list as a tool to determine special needs in their serving population. Care1st will survey commercial members to determine race and ethnicity. Surveys will be conducted through the mail and over the phone. Care1st will log survey information into an internal database. Care1st staff that interact with members will have access to the aggregate data in order to mail information in the members identified language. For All Lines of Business Access to Free Interpreting Services: It is the responsibility of Care1st Health Plan and MSO/PPG/IPAs to provide 24 hours a day & 7 days a week free interpreting services necessary to afford Limited English Proficient (LEP) and hard-of-hearing or deaf members meaningful access to health care services, free of charge. These free interpreting services should include over-thephone, face-to-face and American Sign Language (ASL). To ensure members have access to the 24 hours a day & 7 days a week over-the-phone interpreting services. All requests for face-to-face and ASL interpreting services must be made with advance notice (amount of days varies of the company). Care1st Health Plan informs MSO/PPG/IPAs and providers about the available protocol, which provides step-by-step instructions on how to access interpreting services through Care1st Health Plan during and after business hours. (Please refer to the Protocol for How to Access Interpreting Services) Care1st Health Plan, MSO/PPG/IPAs and providers must not require or suggest that LEP or hard-of-hearing or deaf members provide their own interpreters or use family members or friends as interpreters. The use of such persons may compromise the reliability of medical information and could result in a breach of confidentiality or reluctance on the part of beneficiaries to reveal personal information critical to their situations. Minors should not interpret for adults, except in life-threatening or emergency situations. If, after being notified of the availability of interpreters, the member elects to have a family member or friend serve as an interpreter, providers may accept the request. However, the use of such an interpreter should not compromise the effectiveness of services nor violate the beneficiary's confidentiality. 4

5 In most cases, if a provider group is not delegated to provide Language Assistance Program (LAP) services, the health plan will offer telephonic interpreting services. Documenting request or refusal of interpreting services: Providers need to ensure to document request or refusal of interpreting services by a LEP or hard-of-hearing or deaf member in their medical record. Provider and staff need to maintain a language capability form (e.g., ICE approved language self-assessment form, certification of language proficiency or interpreter training) on file for bilingual staff providing interpreting services to member. Bilingual staff providing medical interpreting services are encouraged to take a language proficiency test by a qualified agency (e.g. Cyracom, Berlitz, Pacific Interpreters or Pals for Health) to determine if candidate qualified for medical interpreting. Bilingual staff with limited bilingual capabilities or who rate POOR on a language proficiency test should not be providing interpreting service to member. They are required to request over the telephone interpreting services or schedule a face-to-face interpreter for the member. This will help avoid possible liability issues due to improper care. Posting of Interpreter Signage (Poster) at Key Medical and Non-Medical Points of Contact: A translated sign informing members of their right to request free interpreting services should be visibly posted at each provider office (i.e. reception area, waiting room, exam room). Care1st Health Plan and MSO/PPG/IPAs are responsible for on-going distribution of signs to the providers. This will be monitored by Care1st Health Plan. The most current interpreting posters are available; please contact CLAS Department at (323) ext Informing Materials in Threshold Languages & Alternative Format: Make written member informing materials available to LEP members and in the threshold languages and ensuring quality translation and cultural and linguistic appropriateness of materials. Make written member informing materials in alternative, cognitively accessible formats upon request. Enable members to make a standing request to receive all informing material in a specified alternative format and timely manner. Cultural Competency & Disability Awareness and Literacy Training: Cultural competency, disability awareness, and literacy trainings are designed to assist in the development and enhancement of interpersonal and intra-cultural skills to improve communication, access and services, and to more effectively serve our diverse membership including Seniors and People with disabilities (SPD). Care1st Health Plan will include, but not limited to the following topics relevant to the identified cultural groups in the Plan s service area in the appropriate trainings: A/ Cultural Competency Training, including, but not limited to: Beliefs about illness and health; Methods of interacting with providers and the health care structure; Traditional home remedies; Language and literacy needs. B/ Disability Awareness and Literacy, including, but not limited to: Various types of chronic conditions prevalent within the target population; Awareness of personal prejudices; Legal obligations to comply with the American with Disabilities Act (ADA) requirements and Section 504 of the Rehabilitation Act; Definitions and concepts, such as communication access, alternative formats, medical equipment access, physical access, and access to programs; Types of barriers encountered by the target population; Training on person-centered planning and self-determination, the social model of disability, the independent living philosophy, and recovery model; Use of evidence-based practices and specific levels of quality outcomes; 5

6 Use of culturally sensitive practices and access for beneficiaries requiring threshold languages; Working with members with mental health diagnosis, including crisis prevention and treatment; Working with members with mental health diagnosis, including diagnosis and treatment. Providers and staff are strongly encouraged and recommended to attend continuing cultural competency, disability awareness, and literacy trainings that are offered through LA Care Health Plan, Care1st Health Plans, MSO & IPAs, or other approved cultural competency, disability awareness, and literacy trainings that can move towards increasing organizational cultural competency. CLAS Related Grievances: Title VI of the Civil Rights Act prohibits recipients of federal funds from providing services to limited English proficient (LEP) persons that are limited in scope or lower in quality than those provided to others. An individual s participation in a federally funded program or activity may not be limited on the basis of LEP. Care1st Health Plan Medi-Cal, Medicare, Commercial & Dual Demo members have the right to file a grievance if their cultural and/or linguistics needs are not met. Providers and clinic staff are to forward CLAS related grievances presented by a patient at their office directly to Care1st Health Plan and/or LA Care Health Plan. Grievance forms are available in English, Spanish, Arabic, Armenian, Farsi, Chinese, Korean, Khmer, Tagalog, Russian, Vietnamese, and Braille (English & Spanish). For more information please contact Care1st CLAS Department at (323) ext Assessment of member satisfaction with the quality and availability of interpreting services/culturally competent care and evidence of action taken by Plan to correct identified deficiencies. Referrals to Culturally Appropriate Community Resources & Services: It is the responsibility of Care1st Health Plan and MSO/PPG/IPAs to educate the providers on the CLAS Community Resource Directory, and the referral process. Providers should also be reminded to document all referrals in the member s medical chart. This will be monitored during the Medical Records Review audit. Care1st will provide MSO/PPG/IPAs and providers a CLAS Community Resource Directory consisting of culturally and linguistically appropriate education and counseling services on topics such as domestic violence, counseling, cultural adaptation resource, elder care, interpreter resources, etc. during JOCs, site visits, mailings, trainings, etc. PPG/IPAs, Providers, clinical staff, and members can also download the CLAS Community Resource Directory from the Care1st website at A hard copy can also be obtained by contacting the Cultural & Linguistic Department at (323) ext Care1st has a closed loop system in place to monitor those members being referred to CLAS community services & resources. The CLAS referral request form can be fax to the Care1st CLAS Department at (323) Once the member is referred, Care1st will monitor and inform the provider about the member s participation to the program Providers are to maintain all information provided in the member s medical record. o Care1st has incorporated the CLAS Resource Directory into the Member Handbook to ensure all members are aware of the available resources. Care1st Website: The Care1st website offers information in various languages that can be downloaded such as CLAS services, resources, forms, and health education materials. Some of the materials on the Care1st website include Members Rights, Grievance form, Protocol for How to Access Interpreting Services, Community Resource Directory (Los Angeles & San Diego), Free Interpreting Poster, Community Based Organization calendar and Health Education materials in various topics. If needed, some materials are available in large font or by request. MSO/PPG/IPA Monitoring by Care1st: Care1st Cultural & Linguistic Department will collaborate with Health Education, Utilization Management, and Credentialing in the review of the MSO/PPG/IPA ability to comply with C&L Standards prior to contracting and thereafter, annually monitor CLAS related activities, and provide guidance as needed. 6

7 Responsibilities in the Provision of CLAS at the MSO/PPG/IPA Level Organization for CLAS - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Develop C&L Work Plan to demonstrate plan C&L department goals, objective, project timelines, and responsible person; or, Develop C&L Program Description to incorporate all C&L requirements. Designate a person responsible for C&L. Include C&L responsibilities in job description and C&L function in the Organizational Chart. Policies & Procedures - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Documenting the availability of 24 hours a day & 7 days a week interpreting services at no cost to LEP, deaf, hearing and speech impaired members. Include discouraging the use of friends or family members (particularly minors) as interpreters, unless specifically requested by the member after being informed of the availability of free interpreting services. Procedures to provide written member informing materials in threshold languages and alternative formats. Procedures to refer member to culturally and linguistically appropriate community services. Access to Interpreting Services - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Inform providers & staff on the need to identify Limited English Proficient (LEP), hard-of-hearing or deaf members, and recording language preferences in their medical charts. Distribute interpreting signage to contracted providers and inform them to post it at key points of contact to inform LEP members of the right to obtain free interpreting services. Distribute Care1st Protocol of How to Access Interpreting Services to providers if MSO/PPG/IPAs refer members to Health Plan services. Access to Interpreting Services - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. (Cont ) Inform providers & staff on the availability of the free telephonic interpreting services on 24 hours a day & 7 days a week basis. Inform providers & staff on the availability of the free face-to-face interpreting services, and the advance notice is needed. Inform providers & staff on the availability of the American Sign Languages (ASL) interpreting services for hardof-hearing or deaf members, and the advance notice is needed. Inform providers & staff that the California Relay Services is available for hard-of-hearing or deaf members (TTY/TDD users). Inform providers & staff on how to connect an interpreter after business hours. Inform providers & staff about discouraging the use of friends and family members, especially minor as interpreters. Inform providers & staff the need to document request and/or refusal of interpreting services in the member s medical chart. Assessment of Language Capability of Bilingual Staff & Providers - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Distribute ICE approved Self-Assessment tool to providers, and have the providers and clinic staff complete the form on an annual basis to ensure the provider network language capabilities meet member needs. Maintain a current list of qualified bilingual staff including position, department, language and contact information (e.g. ext. number). Maintain a provider roster with languages spoken by providers (this should be monitored every 3 years) and clinic staff (this should be monitored annually) 7

8 Cultural Competency, Disability Awareness, and Literacy trainings Provide and/or promote cultural competency, disability awareness, and literacy trainings for providers and clinic staff on CLAS. Provide evidence of on-going education/training (at minimum annually) for providers on cultural competency and disability awareness. Documentation can include, but is not limited to sign-in sheets, curriculum, and evaluation. Informing Materials in Threshold Languages & Alternative Format - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Make written member informing materials available to LEP members and in the threshold languages and ensuring quality translation and cultural and linguistics appropriateness of materials. Inform providers and clinic staff what materials are available at Care1st and how to obtain them. This includes materials in alternative formats for members with disabilities (e.g. audio, Braille, large print, web-accessible or electronic text files). The alternative format materials need only be available upon member request. Maintain a list of translated materials including title, topic, language and sources. Have the notice of translation (document insert) available. Handling Complaints and Grievances related to C&L Issues - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Ensure members and providers are aware on how to file a grievance related to C&L issues. Have a system in place to address this requirement. Access to Community Resources & Social Services - Have documentation to address this requirement. This will be monitored during the C&L annual audit review. Have the Community Resources Directory in place. Have a process to refer members to culturally and linguistically appropriate services/agencies; inform providers of the availability of, and referral process to, culturally and linguistically appropriate community service programs for members. Need to submit C&L referral reports to Care1st Health Plan according to timeline. 8

9 Responsibilities in the Provision of CLAS at the Provider Level Access to Interpreting Services Have a method to identify Limited English Proficient (LEP), hard-of-hearing or deaf members, and recording language preferences in their medical charts. (This will be monitored during the Facility Site Review Audit). Post Interpreting Poster at all member key points of contact (i.e. reception area, waiting room, exam room, etc.) to inform LEP members on the availability of free interpreting services. Interpreting services are made available in identified threshold languages. (This will be monitored during the Facility Site Review Audit). Ensure clinic staff and LEP members know how to access the free over-the-phone interpreting services on 24 hours a day & 7 days a week basis. Ensure clinic staff and the hard-of-hearing or deaf members know how to access California Relay Services. Ensure clinic staff and LEP members know how to obtain free face-to-face interpreting services. Ensure clinic staff and hard-of-hearing or deaf members how to obtain American Sign Language (ASL) interpreting services. After business hours, your exchange services have staff that speak languages other than English; and they should know how to connect an interpreter if needed. After business hours, your answering machine has an instruction to inform members to call Care1st Health Plan if they need the over-the-phone interpreting services. On-call Physicians/Nurses know how to connect to an interpreter over the telephone. Record requests and refusals of interpreting services in LEP member s medical chart. Assessment of Language Capability of Bilingual Staff & Providers Maintain qualifications of bilingual staff (i.e. ICE approved language capability self-assessment form, certification of language proficiency or interpreter training). (This will be monitored during the Facility Site Review Audit). Cultural Competency, Disability Awareness, and Literacy trainings Attend the Health Plan & Medical Groups cultural competency, disability awareness, and literacy trainings. Informing Materials in Threshold Languages & Alternative Format Distribute member informing materials in other languages. This includes materials in alternative formats for members with disabilities (e.g. audio, Braille, large print, web-accessible or electronic text files). Handling Complaints and Grievances related to C&L Issues Ensure members know how to file a grievance related to C&L issues. Access to Community Resources & Social Services Ensure all staff know how to refer members through Care1st Health Plan for culturally and linguistically appropriate related referrals. Care1st will monitor the MSO/PPG/IPA and provider s ability to comply with CLAS Standards, and provide guidance to rectify areas identified to be deficient. For more information, contact Care1st Cultural & Linguistic Department at (323) at ext