Interpretation, Perspective


California Senate Bill 853, passed in 2003, mandates language assistance for health plan enrollees. How does this impact the translators and interpreters in California? BY GEORGE RIMAFLOWER

California Senate Bill (SB) 853, passed in 2003, mandates that health plans provide Limited English-Proficient (LEP) enrollees with language assistance services at hospitals, clinics and other healthcare locations that accept plan insurance.
About 100 insurers, including UHC, Health Net, Cigna, Aetna, Kaiser and Blue Shield, offer healthcare coverage in California. In many cases, it is difficult for English speakers to understand medical and legal jargon but it is even more difficult for those with a limited understanding of English. SB 853 was designed to help alleviate language and cultural barriers when LEP enrollees need medical care.

Under the new legislation, the Department of Managed Health Care (DMHC) was charged with formulating language assistance program regulations and ensuring health plan providers were compliant with those regulations. The legislation stipulates that all vital documents must be translated into “threshold languages” and that interpretation services be made available to enrollees at all points of contact. The DMHC will periodically review health plan providers’ language assistance programs to evaluate their compliance and cultural competency.
Health plans are now required to evaluate the language make-up of each of the communities they serve. If a certain percentage or number of residents speaks a language other than English, health plans must provide assistance in that language when enrollees obtain healthcare services. Not surprisingly, SB 853 has provided a substantial boon in healthcare-related work for translation companies.
California healthcare plan providers had until July 1, 2008 to develop a strategy that would provide language assistance in certain threshold languages to LEP enrollees when obtaining healthcare services. Implementation of SB 853, also known as the California Language Assistance Program (CLAP), officially went into effect on January 1, 2009.
The size of the health care service plan dictates the number of threshold languages that must be translated. According to the DMHC, a health care service plan with an enrollment of 1 million or more individuals must translate vital documents into the top two languages spoken by enrollees other than English when 0.75 percent or 15,000 of the enrollee population, whichever number is less, has a preference for written materials in those languages.
A health care service plan with an enrollment of 300,000 or more but less than 1 million must translate vital documents into the single top language other than English as determined by a needs assessment when 1 percent or 6,000 of the enrollee population, whichever number is less, indicates a preference for written materials in that language.
Finally, a health care service plan with an enrollment of less than 300,000 must translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, expresses a preference for written materials in that language.
The DMHC defines vital documents as: applications, consent forms, letters containing important information regarding eligibility and participation criteria, notices pertaining to the denial, reduction, modification or termination of services and benefits, the right to file a grievance or appeal and notices advising LEP persons of the availability of free language assistance and other outreach materials provided to enrollees.
Interpreters are an important part of the mix. When someone who only speaks a designated threshold language comes to a hospital for treatment, he or she must be provided with an interpreter, paid for by the healthcare plan provider, to interpret medical instructions.
If Cantonese is the primary language for a qualifying number of the population, for example, health plan providers near those segments of the population will need to have interpreters available and also provide documentation and instructions in Cantonese.

According to the DMHC, interpreters must: Demonstrate proficiency in both English and the other language; have a fundamental knowledge in both languages of health care terminology and concepts relevant to health care delivery systems; receive education and training in interpreting ethics, conduct and confidentiality.
Failure to comply with SB 853 is a criminal offense. Consequences for violations would be a cease and desist order and the carrier would no longer be able to practice in California. Fines associated with these violations could be significant.
Because of these strict requirements and, in the interest of enhancing communication across language barriers, the demand for translation in healthcare has grown exponentially. The stakes are high whenever dealing with health-related materials and instructions. Translation companies must create not only linguistically correct but also culturally appropriate translated documents that will help promote wellness and create a positive impact on patient outcomes.

Translation companies must be diligent to ensure that the translated materials provided to health care organizations are accurate and in compliance to SB 853 requirements. A linguistically correct and culturally appropriate translation of enrollment materials, educational literature, patient information and informed consents are of critical importance.
To achieve these results, translation companies must go through a series of steps for every project that guarantee a quality translation.

  • Assign the translation to a project manager who is tasked with interfacing with the client, linguists, experts and the graphics department. The Project Manager adheres to deadlines and oversees the project from start to finish.
  • Select a translation team for the project based on the language pair, education level of the audience, cultural background and subject matter.
  • Create glossaries, style guides and a database of matched source-target verbiage.
  • Incorporate at least three separate in-house review steps for the project including the use of a translator, independent editor and in-house proofreaders.
  • Prepare a final translation with client-compatible foreign language graphics.
  • Proofread the project one last time before the project manager sends it to the client.

Checks and double checks are vital to the success of a project but are only as good as the people doing the editing and proofreading. Translators involved in a project should be native-speaking, subject-matter experts, hold advanced degrees in the field in which they translate and hold a certification from the American Translators Association or their foreign equivalent.
While the process is human-intensive, the translation team should be well-versed in computer-aided translation (CAT) tools, translation management systems (TMS) and globalization management tools (GMT).
An estimated seven million Californians have limited English proficiency according to U.S. Census data. If there is compliance with SB 853, fewer medical mistakes should occur because of communication issues. Translation companies are playing an integral role in helping millions of Californians understand their medical options.
The need for comprehensive medical translation requirements won’t stop at California’s borders. SB 853 is considered a model for other states with large LEP populations. California is a pioneer; look for other states to follow. GR