Bridging the Language Gap: Creating a Sustainable Workforce

1. Bridging the Language Gap:Creating a Sustainable Workforce

2. Workshop Presenters • Mary J Pohl Health Policy Consultant Minnesota Department of Human Services • Sidney E. Van Dyke Director, Interpreter Services Health Partners/Regions Hospital • Veronica Newington Associate Director of Programs in Interpreting/Translation University of Minnesota

3. VeronicaNewington MaryPohl SydneyVan Dyke

4. Workshop Learning Objectives • Describe a public policy resulting in Medicaid reimbursement for interpreter services • Identify the functional provision of interpreter services within an integrated healthcare network • Describe the work of the Minnesota Interpreting Stakeholder Group, a collaborative • Identify ways to improve interpreter training and services

5. Spoken Language Interpreter Services Minnesota’s Journey

7. Demographics

17. Minnesota Health Care Programs • Medical Assistance (MA – Minnesota’s Medicaid program) • General Assistance Medical Care (GAMC – low-income adults with no dependents) • Minnesota Care (publicly subsidized coverage assistance)

19. Minnesota Law • Yang v. O’Keefe: Language Access Settlement Agreement 11 December 2000 Judge James Rosenbaum federal district court of Minnesota approved a settlement agreement between welfare applicants and recipients who do not speak English and organizations serving immigrant communities in Minnesota and MnDHS for practices violating Title VI of the Civil Rights Act of 1964

20. Minnesota Law • Summary Terms: Yang v. O’Keefe • MnDHS and counties required to provide applicants with free translation assistance • State health and welfare forms will be made available in seven languages (Spanish, Somalli, Russian, Hmong, Laotian, Vietnamese & Cambodian) • MnDHS Help Desk lines for Minnesota Care will be available in these seven languages

21. Minnesota Law • Summary Terms: Yang v. O’Keefe cont. • MnDHS forms will be translated additional alnguages when new eligible populations reach 750 in Minnesota • MnDHS and counties will mail forms to welfare recipients in their preferred language • MnDHS will modify its statewide data collection system to include a mandatory language field to track the languages spoken by welfare and MA recipients

22. Minnesota Law • Summary Terms: Yang v. O’Keefe cont. • Minnesota counties must develop language access plans under guidance from MnDHS • Court to retain supervisory jurisdiction for 18 months

23. Minnesota Law • 256B.0625 COVERED SERVICES Subd. 18a. Access to medical services (d) Regardless of the number of employees that an enrolled health care provider may have, medical assistance covers sign and oral language interpreter services when provided by an enrolled health care provider during the course of providing a direct, person-to-person covered health care service to an enrolled recipient with limited English proficiency or who has a hearing loss and uses interpreting services

24. MA Fee-for-service Policy • Providers are responsible for arranging and paying the interpreter • Three people must be present for the service to be covered • Provider’s office staff members competent in spoken language interpretation may interpret the medical service • Providers are encouraged not to use family members and are not reimbursed • Coverage of service provided to the parent/guardian when the patient is a minor

25. MA Fee-for-service Policy • Providers are encouraged to use the same principles when hiring, contracting or arranging for interpreting services • Bill only for direct face-to-face/video/phone service time • Use HCPCS code T1013 (1 unit= 15 minutes) • MHCP payment rate is the lower of $12.50, or the usual and customary charge, for each 15-minute unit • Bill DHS directly for dual eligible recipients

26. MHCP Language Determination

27. FFS Interpreter Services

28. Interpreter Service Study Target Population: 97,194 MinnesotaCare Enrollees FFS and Managed Care 23 of 36 possible months of enrollment 1/1/04 – 12/31/06

29. Interpreter Service Study: Design • Eliminated enrollees with ASL or no language code and without Hispanic ethnicity • Remainder represents enrollees potentially needing interpreter services based on the eligibility information indicating a language other than English • Identified enrollees within the remainder group having a claim with an office visit code Study population: n=5331

30. Interpreter Service Study Eligible study population = 5331 • 73.4% had no claim for interpreter services • 26.6% had a claim for interpreter services

31. Interpreter Service Study Eligible study population = 5331 • 29% of study eligible adults had a claim for interpreter services • 24% of study eligible children had a claim for interpreter services

32. Interpreter Service Study Eligible study population = 5331 Language code and interpreter service claim • > 50% Russian, Somali, Oromo, Cantonese and Korean • ~ 50% Spanish, Hmong, Vietnamese, Amharic and Mandarin • < 50% Khmer, Laotian, Arabic, Serbo-Croatian, Tigrinya and French

33. Interpreter Service Study Metro area counties claimed interpreter services with greater frequency than rural counties • Hennepin (Mpls) 49.6% of study population had claims for interpreter services • Lyon, Clay, and Olmstead < 10% of study population had claims for interpreter services

34. Interpreter Service Study Outstanding rural counties • Kanabec (Mora) 44% of study population had claims for interpreter services • Steele (Owatonna) 59% of study population < 18yrs had claims for interpreter services

35. Interpreter Service Study Study population recipients with claims for interpreter services had an increased frequency of: • Office visits • Emergency room visits • Inpatient hospital stays • Prescriptions claimed When compared to study population recipients with no claims for interpreter services

36. Interpreter Service Study: Results Using multivariate logistic regression analysis: • Females were 1.402 more likely to have interpreter claims than males (95% CI [1.236 – 1.590]) • Adults were 0.621 less likely to have interpreter claims than females (95% CI [0.496 – 0.777]) • Children 1-5 yrs were 3.847 more likely to have interpreter claims than older children (95% CI [2.802 – 5.283])

37. Interpreter Service Study: Limits • Reflects only claimed services • Does not account for language concordant providers • Received services are not associated with any standard quality metric

38. Interpreter Service Legislation2008 Requires the Minnesota Department of Health (MDH) • Create a statewide roster of spoken language health care interpreters by January 2009 • Develop a plan for a spoken language registry of health care interpreters by January 2010 • Work towards National Certification

39. Presenter contact information Mary J. Pohl Health Services & Medical Management Division Minnesota Department of Human Services P.O. Box 64984 St. Paul MN 55169-0984 mary.pohl @state.mn.us 651 431 3431

40. Language data Language data from Minnesota Department of Education http://children.state.mn.us/MDE/Data/Data_Downloads/Student/Languages/index.html. Data counts home primary language forK-12 students enrolled on October 1, 2006 in each district.