Pre-Delegation Assessment Tool by ezm24188

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									                                                               [Name of Provider Organization] Assessment Tool
                                                                                                     [City], CA




                 Physician Organization
      Pre-Delegation Assessment Tool for
        Language Assistance Programs
This tool is to assess compliance with Title 28, CALIFORNIA CODE OF
REGULATIONS, DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH
CARE CHAPTER 2. HEALTH CARE SERVICE PLANS, ARTICLE 7.
STANDARDS SECTION 1300.67.04: Language Assistance Programs for the
purpose of determining delegation.

[1300.67.04(b)(1)(C) (ii)]: Upon request, the enrollee shall receive a written
translation of the documents described in clause (i). 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. If an enrollee requests a translated document, all
timeframes and deadline requirements related to the document that apply to the
health care service plan and enrollees under the provisions of this chapter and
under any regulations adopted pursuant to this chapter shall begin to run upon the
health care service plan's issuance of the translated document. (iii) A description of
how the plan will provide or arrange for the provision of translation of vital
documents at no charge to enrollees in accordance with the requirements of
Section 1367.04 of the Act and this section. This subsection is not intended to
prohibit or discourage a plan from providing translation of vital documents into a
greater number of languages than the threshold languages.

[1300.67.04(c)(2)(A)&(B)]: A description of the arrangements the plan will make
to provide or arrange for the provision of timely interpretation services at no charge
to LEP enrollees at all points of contact where language assistance is needed. For
purposes of this subsection "timely" means in a manner appropriate for the
situation in which language assistance is needed. Interpretation services are not
timely if delay results in the effective denial of the service, benefit, or right at issue.
A plan's language assistance program shall specify quality assurance standards
for timely delivery of language assistance services for emergency, urgent and
routine health care services, and shall include standards for coordinating
interpretation services with appointment scheduling.




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                                                            [Name of Provider Organization] Assessment Tool
                                                                                                  [City], CA




[1300.67.04(c)(2)(C)]: The plan's processes for informing enrollees of the
availability of language assistance services at no charge to enrollees, and how to
access language assistance services. At a minimum, these processes shall
include the following: (i) . . . , to ensure that LEP enrollees are informed at points
of contact that interpretation services are available at no cost to the LEP enrollee,
and to facilitate individual enrollee access to interpretation services at points of
contact. (ii) Processes for including the notice required by Section
1367.04(b)(1)(B)(v) with all vital documents, . . . . If documents are distributed in
an LEP enrollee's preferred written language the notice need not be included. (iii)
Processes for including statements, in English and in threshold languages, about
the availability of free language assistance services and how to access them, in or
with brochures, newsletters, outreach and marketing materials and other materials
that are routinely disseminated to the plan's enrollees.

(c)(2)(I)(vii): As used in this section, "trained and competent in the skill of
interpreting," "qualified interpretation services" and "qualified interpreter" means
the interpreter meets the plan's proficiency standards established pursuant to
subsection (c)(2)(H).

(c)(2)(H): The plan's policies and standards for ensuring the proficiency of the
individuals providing translation and interpretation services. A plan may develop
and apply appropriate criteria for ensuring the proficiency of translation and
interpretation services or may adopt certification by an association acceptable to
the Department at the time of certification. A plan's language assistance
proficiency standards shall require:        (i) A documented and demonstrated
proficiency in both English and the other language; (ii) A fundamental knowledge in
both languages of health care terminology and concepts relevant to the health care
delivery systems; and (iii) Education and training in interpreting ethics, conduct and
confidentiality. The Department will accept plan standards for interpreter ethics,
conduct and confidentiality that adopt and apply, in full, the standards promulgated
by the California Healthcare Interpreters Association or the National Council on
Interpreting in Healthcare.

                         General Instructions
Any boxes that are checked “NA” or “no” will require explanation in the
comments section and may require supporting documentation.

Any documents in draft form must be checked as “No” and the anticipated
approval date documented in comments at the end of the section.

Please ensure to furnish hard copies of all applicable data in the
“Supporting Documentation” section. If not completed by the health plan
auditor, please complete “Gatherers Information” section.


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                                               [Name of Provider Organization] Assessment Tool
                                                                                     [City], CA




             Provider Group              Management Company
                                                   (if applicable)

        Name:                                Name:

     Address:                             Address:

  City, State, Zip:                   City, State, Zip:

           Phone:                           Phone:

                 Fax:                          Fax:

         Contact:                         Contact:

             Title:                           Title:

  Email Address:                      Email Address:

           RBO#:



        Health Plan Information            Gatherers Information
                                                 (If not Health Plan)


          Name:                               Name :

       Auditor:                                  Title:

       Phone:                               Phone:
         Email                               Email
      Address:                            Address:

   Audit Date:                                 Date:




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                                                            [Name of Provider Organization] Assessment Tool
                                                                                                  [City], CA

                            Pre-Delegation Assessment Tool

   I. Oral Interpretive Services at Points of Contact

           A. Policies and procedures are in place to ensure interpretive services
              at the following points of contact:

                 Yes   No     N/A
                                    Provider Group administrative offices
                                    Contracted/Employed PCP offices
                                    Contracted/Employed SCP offices
                                    Contracted ancillary (P, OT, Speech Therapy,
                                     etc.) providers
                                    Specify
                                    Hospitals
                                    Member Services
                                    Centralized appointment line
                                    Telephone (licensed health professional) advice
                                    line
                                    Other

                 Comments:

           B. Policies and procedures identify that interpretive services may be
              provided in-person, telephonically, electronically or a combination of
              these methods.

                 Yes   No
                              In-person interpretation is provided in the following
                              languages:
                              List:
                              Telephonic interpretation services for all languages
                              Electronic interpretation services for all languages
                              Members are notified of language assistance regarding
                              interpretive services when they bring family or friends
                              to appointments

                 Comments:




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                                                            [Name of Provider Organization] Assessment Tool
                                                                                                  [City], CA

           C. Policies and procedures address the competency of interpretive
              services to ensure adequate provision to all LEP members.

                 Yes   No
                             Provider Group has established or adopted interpretive
                             service standards
                             If part of LEP, Provider Group staff are evaluated
                             against standards
                             If part of LEP, Provider Group staff are certified
                             interpreters
                             If part of LEP, Contracted/Employed physicians/staff
                             that indicate language
                             proficiency are evaluated against standards or are
                             certified
                             % PCPs with secondary language
                             % SCPs with secondary language
                             % Allied Health with secondary language
                             Outside vendors meet established standards
                             Vendor Name
                             Contract Effective Date
                             Contact Person
                             Certification
                             Expiration Date
                             Vendor Name
                             Contract Effective Date
                             Contact Person
                             Certification
                             Expiration Date
                             (Attach a list if more)

                 Comment:

           D. To ensure that all LEP members receive interpretive services in a
              timely manner, policies and procedures define timeliness standards
              for the provision of interpretive services

                 Yes   No
                             In-person interpretation services are provided
                             within        minutes
                             Telephonic/electronic interpretive services are
                             provided within        minutes
                             Vendor contract specifies timeliness standard
                             for threshold and exotic languages
                             (       minutes)

                 Comments:



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                                                                                                 [City], CA




   II. Translation Services

           A. A DMHC approved “Notification of Availability of Translation
              Services” statement must be attached with each non-standardized
              vital document sent to members. The notice must be translated in the
              contracted Health Plan’s threshold language(s). Non-standardized
              vital documents include but are not limited to UM denial and delay
              notices, and claims notices that require action on the part of the
              member.

                 Yes   No
                             Provider Group is able to attach the statement to non-
                             standardized vital documents
                             The statement is DMHC approved (may be the ICE
                             notice)
                             Provider Group can provide samples of non-
                             standardized vital documents for review

                 Comments:

           B. Policy and procedures address translation standards and member
              requests for translation of non-standardized vital documents.


                 Yes   No
                             Translation standards are outlined in policies and
                             procedures
                             Translation vendor has been selected
                             Name of vendor:
                             Contract effective date:
                             Contact person:
                             Certification:
                             Expiration date:
                             (Attach a list if more)
                             Vendor meets translation standards
                             All translation processes include human oversight,
                             review and approval
                             Translation will be provided to member within 21 days
                             Of member request

                 Comments:




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                                                            [Name of Provider Organization] Assessment Tool
                                                                                                  [City], CA




   III. Language Assistance Program Education

           A. Policies and procedures must include training for staff, contracted
              providers, and others who have contact with LEP members regarding
              language assistance services provided by the Provider Group, the
              Health Plan or administrative staff.

                 Yes   No
                             Policy and procedures outlines training for Provider
                             Group staff
                             Policy and procedures outlines training for contracted/
                             employed physicians
                             Policy and procedures outlines training for physician
                             Office/administrative staff

                 Comments:

           B. Does the Provider Group have a method of dispersing information to
              all staff, contracted providers and contracted provider office staff?

           C. Evidence of training programs available to staff and contracted
              providers. Describe the method (s) used to communicate the training
              program and

                 Yes   No
                             Evidence of training provided to Provider Group staff
                             Evidence of training for contracted/employed physicians
                             Evidence of training for physician office staff/
                             administrative staff

                 Comments:




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                                                                  [Name of Provider Organization] Assessment Tool
                                                                                                        [City], CA




                                       Supporting Documentation


                 Policy and procedure for interpretive services

                 Policy and procedure for applicable provider organization staff and
                 persons at points of contact describing education and/or training
                 regarding LAP services

                 Policy, procedure and workflow to address translation requests

                 Interpreter standards for competency and timeliness

                 Member materials advising of interpretive services

                 Member materials advising of translation services

                 Copy of DMHC (ICE statement meets this indicator) approved
                 “Notification of Availability of Translation Services”

                 Samples/templates of non-standardized vital documents including
                 approved DMHC notice or demonstrate ability to include such notice

                 Evidence of current training for applicable provider organization staff
                 and persons at points of contact regarding LAP services

                 Current list of staff that are certified interpreters

                 Vendor contracts including interpreter standards for competency and
                 timeliness standards and any proposed contract amendments
                 designed to meet standards

                 Vendor contracts including translation standards and any proposed
                 contract amendments designed to meet standards




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