Insurers Updating Contracts to Comply with Language Access Regs
[Posted 11/10/08]

CMA has updated ON-CALL document #0813, “Language Interpreters,” to address various new health plan contract amendments related to the Language Assistance Program (LAP) regulations that will take effect next year. Because the law leaves it up to each insurer to establish its own LAP standards and procedures, physicians are understandably concerned about what these regulations mean to their practices. (ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.)

The regulations, recently adopted by the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI), require health insurance companies to provide free interpretation and translation services in “threshold languages” to enrollees with limited English proficiency (LEP). The DMHC regulations take effect on January 1, 2009, and the DOI regulations April 1.

The regulations place the financial responsibility for compliance on the insurers, except when delegated financial responsibility has been negotiated separately. Previously proposed regulations would have placed the burden on physicians to provide these services.

Physicians’ obligations will vary by insurer, but in general physicians will be required to: inform patients of the availability of translation and interpretation assistance at the point of service; document when and if LEP patients refuse language assistance; and complete provider language capability disclosure forms so that the health plans can assess the LAP needs of their enrollees.

As each insurer’s LAP standards may vary, it is critical that contracted physicians are provided with adequate information about those standards. Some plans, such as Blue Cross, have already forwarded the details of their programs to physicians through contract amendments and updated program manuals. Other plans, such as United Healthcare, have merely required that physicians comply with their LAP without disclosing the underlying details. CMA believes this is insufficient and urges physicians faced with the latter scenario to contact the plan so that they understand their obligations. CMA has already discussed this issue with United, and the insurer has agreed to provide physicians with additional detail about its language assistance program.

CMA is closely monitoring the situation and encourages physicians to report any burdensome requirements to CMA.

Contact: CMA’s Reimbursement Helpline 888/401-5911 or drice@cmanet.org.