Ch 6: Cultural, Linguistics, & Disability Access Requirements & Services

This Chapter Includes:

1. An Overview

2. Summary of VHP’s Language Assistance Plan 3. VHP’s Threshold Languages 4. Identifying Limited English Proficiency Members 5. Demographic Profile 6. Providing Interpretation Services 7. Tips for Working with Interpreters 8. Vital Documents

9. Standard Vital Documents

10.Non-Standard Vital Documents

11. Request for Translation 12.Training and Education 13.Monitoring LAP Compliance

14.Inclusion and Culturally Responsive Health Care

Alert

Alert draws attention to critical information that has changed this year.

Contact

Contact information on who to contact for assistance.

Book Table of Contents

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Overview

VHP is committed to providing equal access to quality health care services in a manner responsive to diverse cultural health beliefs and practices, preferred languages, disability access requirements, health literacy, and other needs. VHP provides these services in accordance with the U.S. Office of Minority Health Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards), and all relevant federal, state, and local requirements. VHP accomplishes this commitment in partnership with providers through the following: • Identifying the cultural, communication and disability access needs of members; • Providing cultural, linguistic, and disability access services in a timely manner at no cost to members; and • Educating members so they fully understand the health care services they receive, can participate in their own care, and make informed decisions.

Summary of VHP’s Language Assistance Plan

VHP is committed to identifying and addressing disparities. VHP’s Language Assistance Program (LAP) specifies the roles and responsibilities of VHP and its contracted providers in supporting the reduction and elimination of barriers based on English language proficiency. It is the policy of VHP to enhance and implement strategic plans that improve access and eliminate disparities in the quality of care and access for individuals with Limited English Proficiency (LEP) or non-English speaking individuals and to comply with Senate Bill 853, LAP regulations.

VHP’s Threshold Languages

1. English 2. Spanish 3. Vietnamese

Identifying Limited English Proficiency Members

While caring for VHP members, providers may identify a patient with limited English proficiency. Providers must offer language assistance resources to identified LEP members.

Providers may identify LEP members when they: • Self-identify as LEP by requesting language assistance; • Bring a family member or a friend to interpret; • Have trouble communicating in English or the provider has a difficult time understanding what is communicated; • Respond with simple “yes” or “no” answers or give inappropriate or inconsistent answers to questions; or • Are quiet or do not respond to questions.

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Demographic Profile

VHP will disclose member demographic profile data (including identification of VHP’s threshold languages) to contracting providers (including physicians’ offices, hospitals, laboratories, radiology centers, physical therapy offices, and pharmacies services) upon request.

Providing Interpretation Services

VHP provides the following interpretation resources to contracted providers to assist members: • Providers should contact VHP Language Services by dialing 1.844.670.6820 or 1.850.633.4047 to gain access to interpretation resources. For TTY, contact the California Relay by dialing 711 and provide the following phone number: 1.800.735.2929. • Upon reaching Language Services, a caller should be prepared to identify themselves as a VHP network provider, inform Language Services they are calling on behalf of a VHP member, and identify the language requiring interpretation. • For in-person interpretations, a request should be submitted to Language Services 72 hours in advance of when the in-person interpretation is needed. To schedule an in-person interpretation, call 1.844.670.6820. • The requestor will need to provide Language Services with the name of the provider, provider’s address, the member’s name and VHP ID number, the language needed, and the appointment date, time, and location. • Providers must arrange for, or cooperate with the following VHP provisions: • Interpretation services, in multiple languages (including American Sign Language) are offered at all key points of contact for members accessing routine, urgent, and emergency health care services; • The delivery of interpretation services includes, but is not limited to trained and competent face-to-face interpreters, signers, or bilingual providers and provider staff, telephone or telecommunications relay language services, or any electronic options VHP and the provider choose to utilize, in a manner that is appropriate for the situation in which language assistance is needed; • Offer fully translated, written materials in the designated threshold languages required by VHP; • Offer oral interpretation for a non-English language upon request; and • Make available auxiliary aids and services, and modifications of policies, practices, and procedures for members with disabilities within a reasonable time-frame appropriate for the situation.

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Providers must inform and facilitate access to these no-cost services to VHP members. In addition, providers must document the offer or provision of the services in the member’s medical record, including any instance in which the member declines the services. Providers must also provide any information necessary to assess compliance; require bilingual providers and/or office staff to complete and sign capability disclosure forms; and provide monthly updates on any changes in disability access and/or the language capabilities of providers or staff for the VHP Provider Directory. See Chapter 2 “Resources for Providers” and Chapter 9, “Credentialing and Recredentialing.”

If a member insists upon using a friend, family member, or minor to translate for them during a provider visit, the provider is required to document in the member’s medical record the refusal of qualitied interpreter services and the preference of the member to use a family member, friend or minor as an interpreter. It is important to also document in the member’s medical record the name and contact information of any interpreter whose services were used for a health care visit.

In certain situations, such as in an emergency, a minor may be the only available, knowledgeable interpreter. If this situation occurs, verify the following conditions before the use of a minor as an interpreter: • The minor can demonstrate an ability to understand and interpret complex medical information that is relevant to the current situation. • The member is fully informed in their preferred language that a qualified interpreter is available to them and can be provided to interpret at no charge.

Document in the member’s medical record that these conditions were assessed and verified.

Tips for Working with Interpreters

• Speak at an even pace in relatively short segments or sentences. • Pause often to allow the interpreter to translate. • Ask one question at a time. • Acknowledge the interpreter as a professional.

For hearing impaired members, contact California Relay Services by dialing 711 or 1.800.735.2929. VHP will assist hearing impaired members to access language services.

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Vital Documents

Vital documents are generally those documents that describe benefits, exclusions, limitations, and terminations of the member’s services or benefits. VHP identifies vital documents based on regulatory requirements and translates these documents into VHP’s threshold languages. Vital documents are classified into two categories – standard and non-standard.

Standard Vital Documents

1. Applications and consent forms; 2. Notices of the right to file a grievance or appeal; and 3. Notice of language assistance at no cost.

Non-Standard Vital Documents

1. Letters containing important information regarding eligibility and participation criteria; and 2. Notices pertaining to the denial, reduction, modification, or termination of services and benefits.

Request for Translation

Providers should forward the member’s request for translation of standard and non-standard documents to VHP’s Member Service Department using the following email: Memberservices@vhp.sccgov.org within one day if it is urgent or within two days if it is not urgent.

Note: If appropriate based on the language proficiency of a VHP provider, the provider can also translate the vital document(s) to the member.

VHP will make the determination if a document meets the criteria of a non-standard vital document, in which case VHP will have the document translated, and will send the translated document to the requesting provider. Members requiring additional help to read any document should be instructed to call the VHP Member Services Department at 1.888.421.8444 for additional assistance.

Providers are required to submit to VHP all relevant documentation, including provider language capability disclosure forms and attestations, when providers utilize themselves or staff as translators. The VHP Language Capability Attestation (Disclosure) Form is available on the VHP website at https://www.valleyhealthplan.org/sites/p/fr/Forms/Documents/LanguageAttestation-Form.pdf, and a copy is included in the Appendix.

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Back to Chapter 6 Table of Contents

Please email, fax, or mail the completed form to:

Valley Health Plan Attention: Language Assistance Program 2480 N. First Street, Suite #160 San Jose, CA 95131

Email: memberservices@vhp.sccgov.org Fax: 1.408.885.4425

Training and Education

Providers are expected to ensure that all employed or contracted providers and their staff receive appropriate education and training regarding VHP’s LAP through a formal process. Regulations require that any provider who utilizes bilingual office staff as translators must ensure that the translator demonstrates proficiency at the minimum standards set forth below: • A demonstrated and properly documented proficiency in both English and the other language. • A fundamental knowledge in both languages of health care terminology and concepts relevant to health care delivery systems. • Education and training in interpreting ethics, conduct, and confidentiality.

Monitoring LAP Compliance

VHP’s LAP annual compliance audit includes: 1. Monitoring VHP’s internal organization, vendors, and contracted providers for compliance with regulatory standards for the LAP, including the availability, quality, and utilization of language assistance services; 2. Tracking grievances and complaints related to its LAP; 3. Tracking language attestations and/or language capability disclosure forms; and 4. Documenting actions taken to correct problems.

Inclusion and Culturally Responsive Health Care

VHP considers inclusion an important part of the delivery of care. Therefore, VHP expects all of its network providers to treat members equally regardless of race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference, health status, income status, program membership or physical or behavioral disabilities except where medically required.

VHP acknowledges the impact of culture, diversity, and language preference on providing culturally responsive health care. VHP encourages providers to recognize and address a LEP member’s needs alongside VHP’s efforts to assist LEP members. It is the goal of VHP to recognize and address concerns when a communication breakdown occurs, whether due to an existing language barrier, or differences in cultural expectations such as health beliefs and practices that may affect member engagement or adherence to treatment plans. It is the policy of VHP to continue to enhance and implement policies and initiatives that improve access and eliminate disparities for individuals with limited English proficiency and non-English speaking individuals and to comply with Senate Bill (SB) 835 LAP regulations.

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