The State of California recently implemented regulations intended to improve access to care for patients with limited English proficiency (LEP). The regulations, adopted by the Department of Managed Health Care and the Department of Insurance, require insurers to provide free interpretation and translation services in “threshold languages” to LEP patients. Previously proposed regulations would have placed the burden on physicians to provide these services.

It is important to note, however, that the regulations do allow health plans to delegate the responsibility for providing language access services to their contracted physicians. Although such delegation must be negotiated separately, physicians are urged to carefully review any new or renewing contracts or addendums for provisions related to language access.

The regulations also require health plans to assess the language needs of their members and provide language assistance in “threshold languages.” Threshold languages will vary by plan based on the needs of plan members.

CMA is pleased that the final regulations do not prohibit the use of a minor family member as an interpreter, as was proposed in previous versions of the regulations. The regulations do, however, require that patients be informed of the availability of qualified interpreters at no charge. If the patient instead chooses to use a family member or friend as an interpreter, the patient’s choice must be documented in his or her medical record.

Health plans regulated by DMHC must assess the language needs of their enrollees by March 2008 and implement language assistance programs by January 1, 2009. Insurers regulated by DOI must develop and implement their language assistance programs by January 1, 2008.

Unfortunately, the regulations do not require that insurers notify their members of the availability of translation and interpretation services. Instead, patients must be informed at the point of service.

These new regulations do not change physicians’ obligations under federal law. Physicians who receive “federal financial assistance” are still required to take “reasonable steps” to ensure “meaningful access” to LEP patients.

For more information, see CMA ON-CALL document # 0813, “Language Interpreters.” ON-CALL documents are free to members. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.