Amended  IN  Assembly  April 10, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2299

Introduced by Assembly Member Chu

February 13, 2018

An act to add Section 14029.93 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2299, as amended, Chu. Medi-Cal: managed care plans: informational materials.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program Program provisions. Existing law requires the department to notify Medi-Cal beneficiaries, prospective beneficiaries, and members of the public about the program, including the availability of language assistance services and the availability of the grievance procedure.
This bill would require the department to ensure that all written health education and informing materials, as defined, developed and in English and those translated into threshold languages by managed care plans are at or below the equivalent of 6th grade reading level in English. level. The bill would require the department to require managed care plans or other contractors to conduct a one-time, targeted community review of health education and informing materials in English and each threshold language, in order for members to ensure the cultural and linguistic appropriateness of materials in community-based settings. The bill would require the managed care plans to report the findings of the community review process, and would require the department to publish those findings and develop recommendations for additional readability and suitability standards based on the findings. The bill would include a statement of legislative findings and declarations.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Low health literacy and low reading literacy are barriers to meaningful access and equal opportunity to fully participate in one’s healthcare health care services.
(b) A significant number of Medi-Cal managed care plan members speak a language other than English as their primary language. In comparison with to their English-speaking counterparts, limited-English-proficient (LEP) individuals are more likely to have low literacy levels or low health literacy, which leads to lower quality health care and poorer healthcare health care outcomes.
(c) Informing materials provide essential information to members regarding their health care rights, plan benefits, and access to services. Using plain and simple language will increase the readability of materials, improving access for members with varying health literacy levels.
(d) By applying reading level, readability, and suitability requirements to informing materials, the State Department of Health Care Services can empower and help safeguard the health care rights of its most vulnerable members.
(e) The individuals for whom plan documents are designed are best equipped to assess the cultural and linguistic suitability of the materials. Targeted community review is the most effective process to engage these consumers of particular cultural and linguistic groups.

SEC. 2.

 Section 14029.93 is added to the Welfare and Institutions Code, to read:

14029.93.
 (a) The department shall ensure that all written health education and informing materials developed by managed care plans are at or below the equivalent of sixth grade reading level in English.
(1) Written health education in English shall meet the readability and suitability checklists established by Medi-Cal Managed Care Division’s (MMCD) All Plan Letter 11-018.
(2) Written informing materials in English shall meet the readability and suitability checklists established through the department’s contracts with managed care plans.
(3) Managed care plans shall adopt any additional readability and suitability standards developed by the community review process described in subdivision (c) and recommended by the department in subdivision (d).
(b) The department shall ensure that all written health education and informing materials translated into threshold languages by managed care plans are at or below the equivalent of sixth grade reading level.
(1) For all each threshold language for which an equivalent sixth grade reading level cannot be determined, the department shall require managed care plans to establish a process for advocates Medi-Cal beneficiaries, advocates, and stakeholders to review materials existing and new materials through a one-time community review described in subdivision (c), with sufficient time to provide meaningful feedback.
(2) Plans shall adopt any additional readability and suitability standards developed by the community review process described in subdivision (c) and recommended by the department pursuant to subdivision (d).
(c) The department shall require managed care plans or other contractors to conduct a one-time, targeted community review of health education and informing materials in English and each threshold language, in order for members to ensure the cultural and linguistic appropriateness of materials in community-based settings. The managed care plans or other contractors shall structure the community review process, as follows:
(1) When determining who shall participate in the community review process, the managed care plans or other contractors shall do all of the following:

(A)Include or conduct background research on members’ literacy and numeracy skills, the review process for English literacy, and threshold languages.

(B)Partner with community-based organizations, such as adult literacy groups and consumer advocate groups who work directly with members, in order to help recruit members with varying levels of literacy.

(2)When conducting the community review process, the managed care plans or other contractors shall incorporate both quantitative and qualitative approaches, including focus groups and survey collection.

(A) Provide background information on plan members, including the ratio of threshold language speakers, and a summary of the plan’s current community review process.
(B) Include current Medi-Cal beneficiaries and community-based organizations that work directly with Medi-Cal beneficiaries to identify and recruit beneficiaries with varying levels of literacy.
(C) Identify and include native speakers of a specific threshold language to review translated materials in their threshold language. The use of software shall not be used in lieu of a native speaker to evaluate consumer-facing materials.
(2) Outreach methods for participants in the community review process shall include, but not be limited to, e-mail, mail, and telephone calls.
(3) When conducting the community review process, the managed care plans or other contractors shall do all of the following:
(A) Incorporate both quantitative and qualitative approaches, including focus groups and surveys with a minimum of four participants.
(B) Allow 60 days for participants to provide feedback.
(C) Have a native speaker of the threshold language assess, conduct, and evaluate the community review process and provide feedback.
(D) Allow community feedback in both written and oral formats.

(3)

(4) Managed care plans or other contractors shall conduct a targeted community review when new informing materials are created.
(d) The managed care plans shall report the findings of the community review process described in subdivision (c). The department shall publish the findings of the community reviews and develop recommendations for additional readability and suitability standards based on the findings.
(e) The following definitions apply for purposes of this section:
(1) (A) “Health education materials” means documents that are designed to assist members to modify personal health behaviors, achieve and maintain healthy lifestyles, and promote positive health outcomes, including updates on current health conditions, self-care, and management of health conditions, as detailed in MMCD All Plan Letter 11-018.
(B) Health education materials include, but are not limited to, topics about preventive care, health promotion, screenings, disease management, healthy living, and health communications.
(2) (A) “Informing materials” means vital documents that provide members with essential information about access to and usage of plan services, as detailed in MMCD All Plan Letter 11-018.
(B) Informing materials include, but are not limited to, all of the following:
(i) Enrollment and disenrollment forms and information.
(ii) Evidence of coverage (EOC) booklets.
(iii) Facility directories.
(iv) Form letters.
(v) Information regarding members’ rights and grievance procedures.
(vi) Insurance plan documents.
(vii) New member welcome packets.
(viii) Notices of action.
(3) “Plans” refers to managed care plans.
(f) This section does not apply to statements that are specifically required by law to be included in written materials.