Language Assistance Program
Provider Training
Created by
ICE Education and
Training Workgroup
12/2008
Background

The CA Language Assistance Program Law
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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 enrollees that are limited English proficient
(LEP).
 Who
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is eligible?
Enrollees under the jurisdiction of the CA of
Department Managed Health Care (DMHC) and/or
California Department of Insurance (CDI) are
eligible for the CA Language Program.
Key Definitions
Limited English Proficient (LEP)
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An enrollee 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.
Key Definitions, cont.
Vital Documents
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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.
Examples of vital documents are: Applications,
Consent Forms, Letters, Denial notices, free
language assistance notices and explanation of
benefits.
Key Definitions, cont.
Standard Vital Document
–
General documents that are not specific to a
particular enrollee.
Non-standard Vital Document
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A document containing enrollee-specific information,
such as a service authorization or claim denial.
Key Definitions, cont.
How to identify a LEP Patient
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Patient is quiet or does not respond to questions
Patient simply says yes or no, or gives
inappropriate or inconsistent answers to your
questions
Patient may have trouble communicating in English
or you may have a very difficult time understanding
what they are trying to communicate
Patient self identifies as LEP by requesting
language assistance.
How to Access Interpreters
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
In most cases, if a provider group is not delegated to
provide Language Assistance Program (LAP)
services, the health plan will offer telephonic
interpreter services.

For health plan specific information please refer to
the ICE Health Plan Resource Guide for Provider
Offices:
http://www.iceforhealth.com/library/documents/Healthpl
an_CA_LAP_Contact_Sheet_Draft.xls.

The guide also lists health plan contacts should you
have any questions.
Documenting Refusal of Interpreter
Documenting refusal of interpreter services in
the medical record not only protects you and
your practice, it also ensures consistency when
your medical records are monitored through
site reviews/audits by contracted health plans
to ensure adequacy of the plan’s Language
Assistance Program.
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Documenting Refusal of Interpreter,
cont.
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
It is preferable to use professionally trained interpreters.

If the patient was offered an interpreter and refused the
service, it is important to note that refusal in the medical
record for that visit.

Although using a family member or friend to interpret
should be discouraged, it is extremely important to
document this in the medical record if the patient insists,
especially if the family member or friend is a minor.
Documenting Refusal of Interpreter,
cont.

Smart Practice Tip: Consider offering a telephonic interpreter in addition
to the family member/friend to ensure accuracy of interpretation.

For all Limited English Proficient (LEP) patients, it is a best practice to
document the patient’s preferred language in paper and/or electronic
medical records (EMR) in the manner that best fits your practice flow.*

For EMRs, contact your IT department to determine the best method of
advising all health team members of a preferred spoken language.
* Source: Industry Collaboration Effort (ICE) Tips for Communicating
Across Language Barriers; www.iceforhealth.org
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Documenting Refusal of Interpreter,
cont.

For a paper record, one way to do this is to
post colored stickers on patient’s chart to flag
when an interpreter is needed. (For example:
Orange = Spanish, Yellow = Vietnamese,
Green = Russian)*
* Source: Industry Collaboration Effort (ICE) Tips for Communicating
Across
Language Barriers; www.iceforhealth.org
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Requesting Translations for
Non-Standard Vital Documents

Objective:
Ensure Enrollees receive requested translations of
non-standard vital documents in a timely manner,
meeting the needs of the enrollee & regulatory
standards.

Requirement:
“The health care service plan shall have up to, but
not to exceed, 21 days to comply with the enrollee's
request for a written translation.”
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Requesting Translations for
Non-Standard Vital Documents, cont.
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
Vital documents issued in English by Plans or Providers
with delegated claims/UM responsibility, will include a
Notice of Translation informing Enrollee of the
availability of free language assistance that will be
provided by the health plan.

If the Enrollee’s preferred language is one of the
threshold languages, they may also receive a written
translation of the vital document.
Requesting Translations for
Non-Standard Vital Documents, cont.
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
If the Enrollee requires help, the Notice instructs them to call the
Plan’s number on their ID card or a toll-free number provided on
the Notice.

Translation requests will normally come through the Health Plan,
but may be received by Providers.

To ensure that plans are able to properly contact the provider,
please make sure your medical group contact information is listed
on the ICE grid. Insert link here…

If translation request is for a Provider-produced letter, the Provider
will need to submit a copy of that letter to the Plan in a timely
manner.
LAP Notice of Translation

Customized by each health plan to include their
name, contact number and availability in the
plan’s threshold languages.

ICE-approved message:
“IMPORTANT: Can you read this letter? If not, we
can have somebody help you read it. You may also
be able to get this letter written in your language. For
free help, please call right away at {plan’s phone #}.”
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Letter Templates for Delegated
Groups
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
The texts of each Plan’s Notice of Translation
are available under Option 1 in the ICE UM
Templates and Tools for LAP Regulations:
http://www.iceforhealth.com/library.asp?sf=&sci
d=1769#scid1769

Alternatively, the group may use the revised
letter templates under Option 2 that already
have the notice inserted.
Claims Denial Notices

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Template inserts have been created for each
health plan to be attached to Claims Denial
Notices and are available under Option 1 in the
ICE Claims Approved
Documents: http://www.iceforhealth.org/library
.asp?sf=&cid=268#cid268
Alternatively, groups may chose to utilize the
template letters for each health plan under
Option 2.
Translation Timeliness
Element
Request for translation of a
non-standard vital
document comes from the
enrollee to the provider
organization.
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Minimum Policy Requirements
Urgent:
1. Forward the translation request and copy of
document to the contracted health plan
within one business day.
2. Log the date request received from the
enrollee, and the date request and
document were forwarded to the health
plan.
Non-Urgent:
1. Forward the translation request and copy of
document to the contracted health plan
within two business days.
2. Log the date request received from the
enrollee, and the date request and
document were forwarded to the health
plan.
Translation Timeliness, cont.
Element
Request for a non-standard
vital document comes from
the health plan to the
provider organization
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Minimum Policy Requirements
Urgent:
1. Forward a copy of document to the
contracted health plan within one business
day.
2. Log the date request received from the
enrollee, and the date request and
document were forwarded to the health
plan.
Non-Urgent:
1. Forward a copy of document to the
contracted health plan within two business
days.
2. Log the date request received from the
enrollee, and the date request and
document were forwarded to the health
plan.
Translation Timeliness (continued)
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Element
Minimum Policy Requirements
Request for a planproduced vital document
comes from the member to
the provider organization
All Plan-produced vital documents:
1. Forward enrollee’s request within one business
day.
2. Log the date request received from the
enrollee, and the date request and
document were forwarded to the health
plan.
Translation Requests – remember...

When forwarding a copy of the document
needing translation, use a secure method to
protect the Enrollee’s Protected Health
Information (PHI):
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FAX to a secured Health Plan location
If by eMail, make sure you’re using secure
(encrypted) eMail.
Independent Medical Review
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
Informational notices about how to contact a plan,
file a complaint, obtain assistance from the DMHC
and seek an independent medical review (IMR)
are available in non-English languages on the
DMHC site at www.hmohelp.ca.gov.

IMR forms available in English, Spanish, Arabic,
Armenian, Chinese, Farsi, Hmong, Khmer/
Cambodian, Korean, Lao, Russian, Tagalog and
Vietnamese.
Need Answers?
For answers to
Frequently Asked Questions
go to the ICE website at
http://www.iceforhealth.org/library.asp?sf=&scid=
1618#scid1618
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Additional Information
For additional information, please check out the
Industry Collaboration Effort (ICE) website:
www.iceforhealth.org
or contact your contracted health plan
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