The National Health Law
Program
MAKING LANGUAGE SERVICES A
REALITY
2005 CHILD HEALTH SERVICES
RESEARCH MEETING
PART I
Current Payment Methods
for Language Services
What Funding Is Available for
Providing Linguistic Access?
• Federal Sources
• Offices of Refugee Resettlement
• State/County Departments of Health/Social
Services
• Local foundations
• Non-profit organizations
What Funding Is Available –
Federal Sources?
• Medicaid/SCHIP – CMS Letter 8/20/00
• OMH Bilingual/Bicultural Demonstration
Program
• HRSA “Models that Work” Campaign
• HRSA – HIV/AIDS Bureau
CMS Letter to State Officials
• Reimbursement is available for language
assistance including translation and
interpreters to Medicaid/SCHIP enrollees
• States can draw down federal funds at either
their administrative match rate (50%) or
their “covered service” match rate (50-77%
Medicaid, 65-84% SCHIP) depending on
how language services are provided
Statewide Medicaid/SCHIP
Programs
• Only a handful of states have set up
programs to provide direct reimbursement
using federal matching funds to pay for
language services
• Four models –




contract with language service agencies
reimburse providers for hiring interpreters
certify interpreters as Medicaid providers
provide access to language line
Model 1 – Language Service
Agencies
• HI, WA and UT contract with interpreter
organizations; providers schedule
interpreters who bill the state
• WA offers testing and certification –
interpreters must be certified (7 prominent
languages) or qualified (other languages)
• HI & UT – reimbursed as “covered
service”
Model 2 – Provider
Reimbursement
• ME and MN require providers to pay for
interpreters and then reimburse providers
• Providers have discretion on who to hire
• ME – interpreters must sign code of ethics;
cannot use family members/friends
• Considerations – state oversight; quality of
interpreters; provider concerns
Model 3 – Payments to
Interpreters
• NH requires interpreters to become
Medicaid providers
• Interpreters submit bills directly to the state
• Considerations – requirements of becoming
a provider; low reimbursement rates
Model 4 – Language Line
• Kansas –state pays for a telephonic
language line which fee-for-service
providers can access for Medicaid/SCHIP
patients
• Coordinated through the state’s fiscal agent
(EDS); providers receive a code for access
• Estimated budget – $275,000 for first year
(FY O4)
Current State Reimbursement
State
Enrollees
Covered
Providers Covered Who the State Pays
Reimbursement
Rate
Admin or
Service
HI ***
FFS
FFS
Lang. agencies
$36/hr
Service
ID
FFS
FFS
Providers
$7/hr
Service
MA
All
Hospitals
Hospitals
Varies
Admin
ME
FFS
FFS
Providers
$30-$40/hr*
Service
MN
FFS
FFS
Providers
$50/hr**
Admin
MT ***
All Medicaid
All
Interpreters
$6.25/15 minutes
Admin
NH
FFS
FFS
Interpreters
$15/hr
Admin
UT
FFS
FFS
Lang. agencies
$22 (phone)
$39 (in-person)
Service
VA
FFS
FFS
Area Health Ed. Ctr.
& 3 Health Depts.
Still undetermined
Admin
WA
FFS
FFS
Brokers
up to $36/hr
Admin
WA
FFS
Public entities
Public entities
50% expenses
Admin
•$30 for business hours; $40 non-business hours
whichever is less. *** 2002 data
** Or usual and customary fee,
Other State Reimbursement
• Massachusetts Emergency Room
Interpreter Law – payments to hospitals for
costs of language services; based on one
hospital’s expenses compared to all MA
hospitals expenses
• Covers emergency departments and in-
patient psychiatric facilities
Part II
Language Services
Implementation Strategies
Issues to Consider
• How can providers work with advocates and policy makers
to improve language access and funding?
• What model would be most appropriate in your state?
• What data can providers collect to augment advocacy for
improved language access and funding?
• Is legislative or administrative action needed?
• What are actual costs and estimated cost savings?
• How do we improve the workforce – number of and
training for interpreters?
Medicaid and SCHIP
Reimbursement – Considerations
• Discuss what model would be most appropriate
• Identify related issues –
 Training/assessment of interpreters
 Contract amendments between state and providers
• Determine whether legislative and/or
administrative action is needed
• Analyze cost implications – actual costs and
estimated cost savings
• Formulate action plan for advocacy efforts
Medicaid and SCHIP
Reimbursement – Considerations
• Who will be covered?
Enrollees – FFS, managed care, hospitals
 Providers – FFS, managed care, hospitals

• Which model should be used?
• What is the reimbursement rate?
Must be sufficient to attract interpreters
 Travel time, waiting time, administrative time

Medicaid and SCHIP
Reimbursement – Considerations
• Managed Care Plans –


does current capitation rate include language services?
if so, is consideration sufficient?
should managed care plans receive specific
reimbursement on top of capitation rate?
• Hospitals –



should hospitals receive specific reimbursement
separate from administrative expenses?
does current rate sufficiently address language services?
direct reimbursement or inter-local/government
agreement?
Gather Available Data
• Collect information on the need for
language services
State agencies and departments
 Community based organizations providing
health and human services
 Data on primary language spoken in local
schools
 Local institutions (health, financial, etc)

Identify Potential Allies
• Who might support the expansion of
language services in the medical setting?
Diverse Populations
 Health & Human Service Providers
 Civic Leaders
 Education Leaders

Link Language Services to
Quality and Patient Safety
• Build the “Business Case” for Patient
Safety
Attracting new patients
 Avoiding costly lawsuits

• Joint Commission on Accreditation of
Healthcare Organizations – standards,
training for surveyors
Part III
National Language Access
Advocacy Project
Funded by The California Endowment
National Activities
• Coalition -- convened by NHeLP in partnership with
APIAHF, MALDEF, NAPALC, NCLR, NILC
• Participants -- health care provider organizations,
advocates, language companies, interpreters and
interpreter organizations, accrediting organizations
• Goals -- heighten language access awareness among
providers, policymakers and LEP communities;
identify issues, solutions, funding sources and
effective strategies for engaging others
Coalition’s
Statement of Principles
1. Effective communication between health care
providers and patients is essential to facilitating access
to care, reducing health disparities and medical errors,
and assuring a patient’s ability to adhere to treatment
plans.
2. Competent health care language services are
essential elements of an effective public health and
health care delivery system in a pluralistic society.
3. The responsibility to fund language services for
LEP individuals in health care settings is a societal
one that cannot fairly be visited upon any one segment
of the public health or health care community.
4. Federal, state and local governments and health
care insurers should establish and fund mechanisms
through which appropriate language services are
available where and when they are needed.
5. Because it is important for providing all patients
the environment most conducive to positive health
outcomes, linguistic diversity in the health care
workforce should be encouraged, especially for
individuals in direct patient contact positions
6. All members of the health care community should
continue to educate their staff and constituents about
LEP issues and help them identify resources to
improve access to quality care for LEP patients.
7. Access to English as a Second Language instruction is
an additional mechanism for eliminating the
language barriers that impede access to health care
and should be made available on a timely basis to
meet the needs of LEP individuals, including LEP
health care workers.
8. Quality improvement processes should assess the
adequacy of language services provided when
evaluating the care of LEP patients, particularly
with respect to outcome disparities and medical
errors.
9. Mechanisms should be developed to establish the
competency of those providing language services,
including interpreters, translators and bilingual
staff/clinicians.
10. Continued efforts to improve primary language data
collection are essential to enhance both services for,
and research identifying the needs of, the LEP
population.
11.
Language services in health care settings must be
available as a matter of course, and all stakeholders
– including government agencies that fund,
administer or oversee health care programs – must
be accountable for providing or facilitating the
Statement of Principles Endorsers
American Academy of Family Physicians
American Association of Physicians of Indian Origin
American Civil Liberties Union
American College of Physicians
American Counseling Association
American Hospital Association
American Medical Student Association
Asian Pacific Islander America Health Forum
American Psychological Association
Association of Asian Pacific Community Health Organizations
Association of Community Organizations for Reform Now
Association of Language Companies
Association of University Centers on Disabilities
Bazelon Center for Mental Health Law
California Association of Public Hospitals and Health Systems
California Health Care Safety Net Institute
California Healthcare Association
California Healthcare Interpreting Association
Catholic Charities USA
Catholic Health Association
Children’s Defense Fund
Center on and Health
Cuban American Budget and Policy Priorities
Center on Disability National Council
District of Columbia Language Access Coalition
District of Columbia Primary Care Association
Families USA
Family Voices
Greater New York Hospital Association
HIV Medicine Association
Institute for Reproductive Health Access
Joint Commission on the Accreditation of Health Care
La Clinica del Pueblo
Latino Coalition for a Healthy California
Medicare Rights Center
Mexican American Legal Defense and Educational Fund
Statement of Principles Endorsers
(cont.)
Migrant Legal Action Program
National Asian American Pacific Islander Mental
Health Association
National Asian Pacific American Legal Consortium
National Association of Community Health Centers
National Association of Mental Health Planning and
Advisory Councils
National Association of Public Hospitals and Health
Systems
National Association of Social Workers
National Council of La Raza
National Council on Interpreting in Health Care
National Family Planning and Reproductive Health
Association
National Health Law Program
National Immigration Law Center
National Hispanic Medical Association
National Latina Institute for Reproductive Health
National Mental Health Association
National Partnership for Women and Families
National Respite Coalition
National Senior Citizens Law Center
National Women’s Law Center
Northern Virginia Area Health Education Center
Physicians for Human Rights
Presbyterian Church (U.S.A.)
Society of General Internal Medicine - Washington Office
Summit Health Institute for Research and Education
USAction
Welfare Law Center
Resources
• NHeLP Language Access website,
•
•
•
•
http://www.healthlaw.org/langaccess/index.shtml
NHeLP, Promising Practices for Providing Language
Services in Health Care Settings: Examples from the Field,
(May 2002), www.healthlaw.org or www.cmwf.org
NHeLP, Promising Practices for Providing Language
Services in Small Health Care Settings: Examples from the
Field (forthcoming early 2005), www.healthlaw.org or
www.cmwf.org
NHeLP, Ensuring Linguistic Access: Legal Rights and
Responsibilities (2004), www.healthlaw.org
NHeLP & The Access Project, The Language Services
Action Kit (2004), www.healthlaw.org or
www.accessproject.org
Contact Information
Mara Youdelman or Steve Hitov
National Health Law Program
1101 14th Street NW, Suite 405
Washington, DC 20005
Ph: 202-289-7661
Fax: 202-289-7724
youdelman@healthlaw.org
hitov@healthlaw.org
www.healthlaw.org