Re: Re: Translation Services for Non-english Speaking Pati...

[Guest guest]

__Tr_,___For

Pay as you go translation service :

https://www.languageline.com/webpi/webpi.php

For ASL, it's trickier. An internist on Sermo recently suggested http://www.sorensonvrs.com/

, a company that sends a videophone to the patient and then provides

ASL translation . I've not needed ASL yet so I haven't researched

this or other options.

Happy snow day,

[Guest guest]

__Tr_,___For

Pay as you go translation service :

https://www.languageline.com/webpi/webpi.php

For ASL, it's trickier. An internist on Sermo recently suggested http://www.sorensonvrs.com/

, a company that sends a videophone to the patient and then provides

ASL translation . I've not needed ASL yet so I haven't researched

this or other options.

Happy snow day,

[Guest guest]

__Tr_,___For

Pay as you go translation service :

https://www.languageline.com/webpi/webpi.php

For ASL, it's trickier. An internist on Sermo recently suggested http://www.sorensonvrs.com/

, a company that sends a videophone to the patient and then provides

ASL translation . I've not needed ASL yet so I haven't researched

this or other options.

Happy snow day,

[Guest guest]

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation. It never got paid. Medicaid may say they pay for interpreters but we never found it to be true.

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones.

To: Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp > Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.> > Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement? > Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share â€" as a service or > administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) >

FFS < 15 employees > language agencies6 > $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service > Medicaid (MA) â€" 57.55% SCHIP â€" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA â€" 70.36% SCHIP â€" 79.25% > KS > Managed care > not applicable (state pays for language line) > EDS (fiscal agent) > Spanish â€" $1.10/minute; other languages â€" $2.04/minute > Admin > 50% > ME > FFS > FFS > providers > reasonable costs reimbursed > Service > MA â€" 63.27% SCHIP â€" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary

fee > Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS > interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic) > Service > MA â€" 70.14% SCHIP â€" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin > 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses > Admin

> 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07) > Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_ > (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_ > (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care > > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this > constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3) > > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > "Improving Access to Services for Persons with Limited English Proficiency," > Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients > from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage > or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or >

provided in a different manner, from those provided to others; > • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly > to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34 > Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections > extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35

> The federal government has long recognized that Title VI requires language > access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is > a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language > access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English > Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and

federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that > receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_ > (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees.

For more information, see the National Health Law > Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the > Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for > providing language services in small health care provider

settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision > of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency > * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for > Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive

Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by > Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples > from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice,

> which can be ordered through _www.lep.gov_ (http://www.lep.gov/) > For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic > Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/) > > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html) > > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters > Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39. > > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am>

=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under > Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must > comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�? > Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality,

accuracy and completeness. Good medical interpreters are not only > fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only > Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and > certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message > clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither

party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices > lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and > resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly > dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same > gender as the patient. Some patients

feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order > 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without > injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters > Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background

> information to the interpreter. Remind the interpreter that everything you > and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient > that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with > the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or

your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks > you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice > of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep > your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use > diagrams and pictures to facilitate

comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points > during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions > about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that > provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a > service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add > on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters: > Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively > inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of > seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a

patient who is six months pregnant�). > Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need > conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always > leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the > cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_ > (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for > patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near > you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained > telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom > International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and > MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its > limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in > the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a > summarized interpretation to the other party. This decreases the accuracy of > the interpretation and

may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a > bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state > health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t > accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters > above. > A few words

about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services) > or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service > provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for > Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the

language > You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure > and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she > has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought! > > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School

of Medicine in Atlanta. She > currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical > interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff > members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_ > (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of > cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization. > Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.> > >

> > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/) > Synapse - the use from anywhere EMR.>

[Guest guest]

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation. It never got paid. Medicaid may say they pay for interpreters but we never found it to be true.

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones.

To: Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp > Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.> > Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement? > Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share â€" as a service or > administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) >

FFS < 15 employees > language agencies6 > $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service > Medicaid (MA) â€" 57.55% SCHIP â€" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA â€" 70.36% SCHIP â€" 79.25% > KS > Managed care > not applicable (state pays for language line) > EDS (fiscal agent) > Spanish â€" $1.10/minute; other languages â€" $2.04/minute > Admin > 50% > ME > FFS > FFS > providers > reasonable costs reimbursed > Service > MA â€" 63.27% SCHIP â€" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary

fee > Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS > interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic) > Service > MA â€" 70.14% SCHIP â€" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin > 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses > Admin

> 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07) > Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_ > (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_ > (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care > > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this > constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3) > > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > "Improving Access to Services for Persons with Limited English Proficiency," > Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients > from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage > or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or >

provided in a different manner, from those provided to others; > • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly > to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34 > Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections > extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35

> The federal government has long recognized that Title VI requires language > access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is > a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language > access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English > Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and

federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that > receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_ > (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees.

For more information, see the National Health Law > Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the > Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for > providing language services in small health care provider

settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision > of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency > * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for > Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive

Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by > Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples > from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice,

> which can be ordered through _www.lep.gov_ (http://www.lep.gov/) > For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic > Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/) > > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html) > > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters > Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39. > > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am>

=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under > Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must > comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�? > Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality,

accuracy and completeness. Good medical interpreters are not only > fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only > Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and > certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message > clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither

party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices > lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and > resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly > dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same > gender as the patient. Some patients

feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order > 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without > injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters > Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background

> information to the interpreter. Remind the interpreter that everything you > and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient > that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with > the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or

your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks > you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice > of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep > your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use > diagrams and pictures to facilitate

comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points > during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions > about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that > provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a > service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add > on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters: > Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively > inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of > seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a

patient who is six months pregnant�). > Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need > conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always > leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the > cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_ > (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for > patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near > you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained > telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom > International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and > MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its > limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in > the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a > summarized interpretation to the other party. This decreases the accuracy of > the interpretation and

may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a > bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state > health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t > accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters > above. > A few words

about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services) > or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service > provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for > Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the

language > You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure > and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she > has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought! > > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School

of Medicine in Atlanta. She > currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical > interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff > members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_ > (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of > cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization. > Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.> > >

> > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/) > Synapse - the use from anywhere EMR.>

[Guest guest]

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation. It never got paid. Medicaid may say they pay for interpreters but we never found it to be true.

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones.

To: Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp > Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.> > Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement? > Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share â€" as a service or > administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) >

FFS < 15 employees > language agencies6 > $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service > Medicaid (MA) â€" 57.55% SCHIP â€" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA â€" 70.36% SCHIP â€" 79.25% > KS > Managed care > not applicable (state pays for language line) > EDS (fiscal agent) > Spanish â€" $1.10/minute; other languages â€" $2.04/minute > Admin > 50% > ME > FFS > FFS > providers > reasonable costs reimbursed > Service > MA â€" 63.27% SCHIP â€" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary

fee > Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS > interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic) > Service > MA â€" 70.14% SCHIP â€" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin > 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses > Admin

> 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07) > Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_ > (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_ > (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care > > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this > constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3) > > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > "Improving Access to Services for Persons with Limited English Proficiency," > Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients > from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage > or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or >

provided in a different manner, from those provided to others; > • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly > to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34 > Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections > extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35

> The federal government has long recognized that Title VI requires language > access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is > a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language > access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English > Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and

federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that > receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_ > (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees.

For more information, see the National Health Law > Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the > Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for > providing language services in small health care provider

settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision > of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency > * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for > Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive

Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by > Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples > from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice,

> which can be ordered through _www.lep.gov_ (http://www.lep.gov/) > For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic > Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/) > > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html) > > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters > Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39. > > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am>

=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under > Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must > comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�? > Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality,

accuracy and completeness. Good medical interpreters are not only > fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only > Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and > certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message > clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither

party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices > lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and > resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly > dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same > gender as the patient. Some patients

feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order > 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without > injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters > Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background

> information to the interpreter. Remind the interpreter that everything you > and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient > that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with > the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or

your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks > you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice > of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep > your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use > diagrams and pictures to facilitate

comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points > during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions > about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that > provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a > service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add > on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters: > Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively > inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of > seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a

patient who is six months pregnant�). > Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need > conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always > leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the > cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_ > (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for > patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near > you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained > telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom > International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and > MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its > limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in > the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a > summarized interpretation to the other party. This decreases the accuracy of > the interpretation and

may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a > bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state > health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t > accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters > above. > A few words

about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services) > or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service > provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for > Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the

language > You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure > and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she > has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought! > > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School

of Medicine in Atlanta. She > currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical > interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff > members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_ > (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of > cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization. > Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.> > >

> > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/) > Synapse - the use from anywhere EMR.>

[Guest guest]

If Tim MAlia  is listening I think he has cared for many deaf patietns  and can chime in

Unfortunaltey I think   might you not run into discriminatin for refusing ot care for folks who  have these probelms>

That happened a while back to a doc  who felt  he could not care adequaltey for an HIV  patietn and he got sued.

 

It screws docs  to pAY for  a translaotor ( of course it screws docs to put in a covered service IUD that costs 400  but reimburses 150  I mean really what is teh difference??) but relying on a friend or family mmebr is really not the best( as shown about theinterjecting of opionion in this example )

 Very tough porbelm BEst answered by patietns  self selecting docs who  can speak their langage but not always possible

It isn;t just medicaid isit It is a professinal obligation  across teh board isn;t it?

 

 

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation.  It never got paid.  Medicaid may say they pay for interpreters but we never found it to be true.

 

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones. 

To:

Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

 

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp

> Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.>

> Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_

> (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.

> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement?

> Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share †" as a service or

> administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) > FFS < 15 employees > language agencies6

> $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service

> Medicaid (MA) †" 57.55% SCHIP †" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA †" 70.36% SCHIP †" 79.25% > KS > Managed care

> not applicable (state pays for language line) > EDS (fiscal agent) > Spanish †" $1.10/minute; other languages †" $2.04/minute > Admin > 50% > ME > FFS > FFS

> providers > reasonable costs reimbursed > Service > MA †" 63.27% SCHIP †" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary fee

> Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS

> interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic)

> Service > MA †" 70.14% SCHIP †" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin

> 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses

> Admin > 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07)

> Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_

> (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_

> (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care

> > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this

> constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3)

> > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > " Improving Access to Services for Persons with Limited English Proficiency, "

> Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca

> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p

> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients

> from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage

> or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or > provided in a different manner, from those provided to others;

> • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly

> to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34

> Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections

> extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35 > The federal government has long recognized that Title VI requires language

> access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is

> a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language

> access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English

> Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that

> receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_

> (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?

> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees. For more information, see the National Health Law

> Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf)

> Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the

> Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for

> providing language services in small health care provider settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision

> of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency

> * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for

> Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by

> Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-

> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples

> from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice, > which can be ordered through _www.lep.gov_ (http://www.lep.gov/)

> For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic

> Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/)

> > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html)

> > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters

> Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39.

> > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am

> =!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under

> Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must

> comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_

> (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en

> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI

> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�?

> Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality, accuracy and completeness. Good medical interpreters are not only

> fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only

> Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and

> certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message

> clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices

> lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and

> resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly

> dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same

> gender as the patient. Some patients feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order

> 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without

> injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters

> Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background > information to the interpreter. Remind the interpreter that everything you

> and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient

> that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with

> the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?

> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks

> you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice

> of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep

> your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use

> diagrams and pictures to facilitate comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points

> during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions

> about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that

> provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b

> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a

> service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add

> on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters:

> Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively

> inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of

> seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a patient who is six months pregnant�).

> Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need

> conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always

> leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the

> cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_

> (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for

> patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near

> you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained

> telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom

> International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and

> MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).

> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its

> limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in

> the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a

> summarized interpretation to the other party. This decreases the accuracy of > the interpretation and may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a

> bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state

> health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t

> accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters

> above. > A few words about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services)

> or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service

> provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for

> Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the language

> You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure

> and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she

> has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought!

> > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School of Medicine in Atlanta. She

> currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical

> interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.

> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff

> members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_

> (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of

> cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization.

> Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.

> > > > > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/)

> Synapse - the use from anywhere EMR.>

--      MD          ph    fax

impcenter.org

[Guest guest]

sorry I didnl;t mean speaking a foreign language  was a problemI meant if you refuse to care for people you  might?be accused of discrimination

If Tim MAlia  is listening I think he has cared for many deaf patietns  and can chime in

Unfortunaltey I think   might you not run into discriminatin for refusing ot care for folks who  have these probelms>

That happened a while back to a doc  who felt  he could not care adequaltey for an HIV  patietn and he got sued.

 

It screws docs  to pAY for  a translaotor ( of course it screws docs to put in a covered service IUD that costs 400  but reimburses 150  I mean really what is teh difference??) but relying on a friend or family mmebr is really not the best( as shown about theinterjecting of opionion in this example )

 Very tough porbelm BEst answered by patietns  self selecting docs who  can speak their langage but not always possible

It isn;t just medicaid isit It is a professinal obligation  across teh board isn;t it?

 

 

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation.  It never got paid.  Medicaid may say they pay for interpreters but we never found it to be true.

 

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones. 

To:

Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

 

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp

> Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.>

> Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_

> (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.

> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement?

> Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share †" as a service or

> administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) > FFS < 15 employees > language agencies6

> $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service

> Medicaid (MA) †" 57.55% SCHIP †" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA †" 70.36% SCHIP †" 79.25% > KS > Managed care

> not applicable (state pays for language line) > EDS (fiscal agent) > Spanish †" $1.10/minute; other languages †" $2.04/minute > Admin > 50% > ME > FFS > FFS

> providers > reasonable costs reimbursed > Service > MA †" 63.27% SCHIP †" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary fee

> Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS

> interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic)

> Service > MA †" 70.14% SCHIP †" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin

> 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses

> Admin > 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07)

> Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_

> (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_

> (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care

> > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this

> constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3)

> > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > " Improving Access to Services for Persons with Limited English Proficiency, "

> Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca

> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p

> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients

> from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage

> or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or > provided in a different manner, from those provided to others;

> • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly

> to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34

> Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections

> extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35 > The federal government has long recognized that Title VI requires language

> access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is

> a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language

> access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English

> Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that

> receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_

> (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?

> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees. For more information, see the National Health Law

> Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf)

> Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the

> Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for

> providing language services in small health care provider settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision

> of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency

> * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for

> Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by

> Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-

> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples

> from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice, > which can be ordered through _www.lep.gov_ (http://www.lep.gov/)

> For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic

> Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/)

> > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html)

> > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters

> Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39.

> > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am

> =!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under

> Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must

> comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_

> (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en

> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI

> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�?

> Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality, accuracy and completeness. Good medical interpreters are not only

> fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only

> Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and

> certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message

> clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices

> lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and

> resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly

> dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same

> gender as the patient. Some patients feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order

> 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without

> injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters

> Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background > information to the interpreter. Remind the interpreter that everything you

> and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient

> that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with

> the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?

> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks

> you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice

> of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep

> your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use

> diagrams and pictures to facilitate comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points

> during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions

> about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that

> provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b

> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a

> service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add

> on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters:

> Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively

> inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of

> seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a patient who is six months pregnant�).

> Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need

> conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always

> leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the

> cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_

> (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for

> patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near

> you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained

> telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom

> International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and

> MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).

> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its

> limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in

> the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a

> summarized interpretation to the other party. This decreases the accuracy of > the interpretation and may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a

> bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state

> health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t

> accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters

> above. > A few words about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services)

> or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service

> provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for

> Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the language

> You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure

> and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she

> has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought!

> > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School of Medicine in Atlanta. She

> currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical

> interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.

> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff

> members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_

> (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of

> cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization.

> Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.

> > > > > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/)

> Synapse - the use from anywhere EMR.>

--      MD    

     ph    fax

impcenter.org

--      MD          ph    fax impcenter.org

[Guest guest]

sorry I didnl;t mean speaking a foreign language  was a problemI meant if you refuse to care for people you  might?be accused of discrimination

If Tim MAlia  is listening I think he has cared for many deaf patietns  and can chime in

Unfortunaltey I think   might you not run into discriminatin for refusing ot care for folks who  have these probelms>

That happened a while back to a doc  who felt  he could not care adequaltey for an HIV  patietn and he got sued.

 

It screws docs  to pAY for  a translaotor ( of course it screws docs to put in a covered service IUD that costs 400  but reimburses 150  I mean really what is teh difference??) but relying on a friend or family mmebr is really not the best( as shown about theinterjecting of opionion in this example )

 Very tough porbelm BEst answered by patietns  self selecting docs who  can speak their langage but not always possible

It isn;t just medicaid isit It is a professinal obligation  across teh board isn;t it?

 

 

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation.  It never got paid.  Medicaid may say they pay for interpreters but we never found it to be true.

 

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones. 

To:

Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

 

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp

> Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.>

> Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_

> (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.

> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement?

> Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share †" as a service or

> administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) > FFS < 15 employees > language agencies6

> $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service

> Medicaid (MA) †" 57.55% SCHIP †" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA †" 70.36% SCHIP †" 79.25% > KS > Managed care

> not applicable (state pays for language line) > EDS (fiscal agent) > Spanish †" $1.10/minute; other languages †" $2.04/minute > Admin > 50% > ME > FFS > FFS

> providers > reasonable costs reimbursed > Service > MA †" 63.27% SCHIP †" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary fee

> Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS

> interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic)

> Service > MA †" 70.14% SCHIP †" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin

> 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses

> Admin > 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07)

> Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_

> (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_

> (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care

> > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this

> constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3)

> > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > " Improving Access to Services for Persons with Limited English Proficiency, "

> Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca

> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p

> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients

> from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage

> or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or > provided in a different manner, from those provided to others;

> • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly

> to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34

> Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections

> extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35 > The federal government has long recognized that Title VI requires language

> access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is

> a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language

> access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English

> Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that

> receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_

> (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?

> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees. For more information, see the National Health Law

> Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf)

> Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the

> Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for

> providing language services in small health care provider settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision

> of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency

> * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for

> Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by

> Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-

> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples

> from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice, > which can be ordered through _www.lep.gov_ (http://www.lep.gov/)

> For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic

> Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/)

> > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html)

> > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters

> Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39.

> > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am

> =!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under

> Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must

> comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_

> (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en

> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI

> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�?

> Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality, accuracy and completeness. Good medical interpreters are not only

> fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only

> Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and

> certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message

> clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices

> lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and

> resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly

> dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same

> gender as the patient. Some patients feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order

> 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without

> injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters

> Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background > information to the interpreter. Remind the interpreter that everything you

> and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient

> that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with

> the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?

> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks

> you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice

> of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep

> your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use

> diagrams and pictures to facilitate comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points

> during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions

> about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that

> provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b

> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a

> service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add

> on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters:

> Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively

> inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of

> seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a patient who is six months pregnant�).

> Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need

> conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always

> leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the

> cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_

> (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for

> patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near

> you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained

> telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom

> International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and

> MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).

> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its

> limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in

> the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a

> summarized interpretation to the other party. This decreases the accuracy of > the interpretation and may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a

> bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state

> health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t

> accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters

> above. > A few words about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services)

> or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service

> provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for

> Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the language

> You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure

> and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she

> has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought!

> > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School of Medicine in Atlanta. She

> currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical

> interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.

> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff

> members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_

> (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of

> cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization.

> Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.

> > > > > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/)

> Synapse - the use from anywhere EMR.>

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     ph    fax

impcenter.org

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[Guest guest]

sorry I didnl;t mean speaking a foreign language  was a problemI meant if you refuse to care for people you  might?be accused of discrimination

If Tim MAlia  is listening I think he has cared for many deaf patietns  and can chime in

Unfortunaltey I think   might you not run into discriminatin for refusing ot care for folks who  have these probelms>

That happened a while back to a doc  who felt  he could not care adequaltey for an HIV  patietn and he got sued.

 

It screws docs  to pAY for  a translaotor ( of course it screws docs to put in a covered service IUD that costs 400  but reimburses 150  I mean really what is teh difference??) but relying on a friend or family mmebr is really not the best( as shown about theinterjecting of opionion in this example )

 Very tough porbelm BEst answered by patietns  self selecting docs who  can speak their langage but not always possible

It isn;t just medicaid isit It is a professinal obligation  across teh board isn;t it?

 

 

When I worked at the Health Center they tried billing Medicaid for Sign Language Interpreter when I was on vacation.  It never got paid.  Medicaid may say they pay for interpreters but we never found it to be true.

 

Additonally there is a minimum two hour fee to hire interpreters for ASL to come to your office. I don't know about the services that use video phones. 

To:

Sent: Wed, February 2, 2011 6:31:30 AMSubject: Re: Translation Services for Non-english Speaking Pati...

 

this goes for sign language too, just so you know.grace> > > > Subject was brought up again - Don't even get me started on the > requirement to pay for an interpreter -- which can cost more than the visit (esp

> Medicaid) even pays.> > Probably good to remind new docs what the requirements are -- the onus is > on the provider to provide the interpreter - otherwise you are > descriminating.>

> Regarding Medicaid paying for Interpretation services (this probably > changed with the Great Recession and state budgets drying up, but...) check out > this document...> > _http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf_

> (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf) > > Some states will pay for interpreters - see if your state does.

> > Deanna, I believe you are in Colorado, so you are just SOOL.> , you are OOL, too - being from California.> > > State > For which Medicaid and SCHIP enrollees? > Which Medicaid and SCHIP providers can submit for reimbursement?

> Who does the State reimburse? > How much does the state pay for language services provided to > Medicaid/SCHIP enrollees? > How does the state claim its federal share †" as a service or

> administrative expense3? > What percentage of the state’s costs does the federal government pay (FY > 2006)4? > DC > Fee-for-service5 (FFS) > FFS < 15 employees > language agencies6

> $135-$190/hour (in-person) $1.60/min (telephonic) > Admin > 50% > HI > Fee-for-service (FFS) > FFS > language agencies > $36/hour (in 15 min. increments) > Service

> Medicaid (MA) †" 57.55% SCHIP †" 70.29% > ID > FFS > FFS > providers > $12.16/hour > Service > MA †" 70.36% SCHIP †" 79.25% > KS > Managed care

> not applicable (state pays for language line) > EDS (fiscal agent) > Spanish †" $1.10/minute; other languages †" $2.04/minute > Admin > 50% > ME > FFS > FFS

> providers > reasonable costs reimbursed > Service > MA †" 63.27% SCHIP †" 74.29% > MN > FFS > FFS > providers > lesser of $12.50/15 min or usual and customary fee

> Admin > 50% > MT > all Medicaid > all7 > interpreters > lesser of $6.25/15 minutes or usual and customary fee > Admin > 50% > NH > FFS > FFS

> interpreters (who are Medicaid providers) > $15/hour $2.25/15 min after first hour > Admin > 50% > UT > FFS > FFS > language agencies > $28-35/hour (in-person) $1.10/minute (telephonic)

> Service > MA †" 70.14% SCHIP †" 79.10% > VA > FFS > FFS > Area Health Education Center & 3 public health departments > reasonable costs reimbursed > Admin

> 50% > VT > All > All > language agency > $15/15 min. increments > Admin > 50% > WA > All > public entities > public entities > 50% allowable expenses

> Admin > 50% > WA > All > non-public entities > brokers; language agencies > brokers receive administrative fee language agencies receive $33/hour ($34 > as of 7/1/07)

> Admin > 50% > WY > FFS > FFS > interpreters > $11.25/15 min > Admin > 50% > > > =====================================> > See - _http://www.justice.gov/crt/about/cor/13166.php_

> (http://www.justice.gov/crt/about/cor/13166.php) > > ========================================> > _http://content.healthaffairs.org/content/24/2/435.full_

> (http://content.healthaffairs.org/content/24/2/435.full) > > > Pay Now Or Pay Later: Providing Interpreter Services In Health Care

> > Title VI of the Civil Rights Act obligates medical caregivers to provide > interpretation and translation services so that LEP patients can have access > to health care services equal to that of English speakers; this

> constitutes a protection against discrimination based on national origin._3_ > (http://content.healthaffairs.org/content/24/2/435.full#R3)

> > 1. J. Perkins, Ensuring Linguistic Access in Health Care Settings: An > Overview of Current Legal Rights and Responsibilities, August 2003, > _www.kff.org/uninsured/upload/22093_1.pdf_

> (http://www.kff.org/uninsured/upload/22093_1.pdf) (6 January 2005); and Presidential Executive Order 13166, > " Improving Access to Services for Persons with Limited English Proficiency, "

> Federal Register 65, no. 159 (2000): 50121 > _http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Ca

> re-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.pdf> _ > (http://www.kff.org/uninsured/upload/Ensuring-Linguistic-Access-in-Health-Care-Settings-An-Overview-of-Current-Legal-Rights-and-Responsibilities-PDF.p

> df) > > > The United States Supreme Court has treated discrimination based on > language as national origin discrimination.32 Regulations issued by the U.S. > Department of Health and Human Services in 1964 prohibit federal fund recipients

> from: > • Using criteria or methods of administration which have the effect of > subjecting individuals to discrimination because of their race, color or > national origin; > • Restricting an individual in any way in the enjoyment of any advantage

> or privilege enjoyed by others receiving any service, financial aid, or > other benefit under the program; > • Providing services or benefits to an individual that are different, or > provided in a different manner, from those provided to others;

> • Treating an individual different from others in determining whether he > satisfies an admission, enrollment, eligibility, or other requirement for a > service.33 > The obligations under Title VI and implementing regulations apply broadly

> to any “program or activity� that receives federal funding, either > directly or indirectly (through a contract or subcontract, for example), and > without regard to the amount of funds received.34

> Covered entities include hospitals, nursing homes, managed care > organizations, state Medicaid agencies, home health agencies, health service > providers, and social service organizations. Notably, the Title VI protections

> extend to all of the operations of the organization or individual, not just > that portion that received the federal funds.35 > The federal government has long recognized that Title VI requires language

> access. > In fact, the first Title VI regulations, directed at vocational education > programs, provided that federal fund recipients “may not restrict an > applicant’s admission to vocational education programs because the applicant, is

> a member of a national origin minority with limited English language skills.> �36 In the decades following, the federal government has repeatedly > recognized the need for federal fund recipients to offer meaningful language

> access.37> > > Executive Order 13166 > On August 11, 2000, President Clinton issued Executive Order (EO) 13166, > entitled Improving Access to Services for Persons with Limited English

> Proficiency.58 The reach of EO 13166 is extensive, affecting all “federally > conducted and federally assisted programs and activities.� This includes the > Department of Health and Human Services and programs and activities that

> receive federal assistance such as Medicare, Medicaid and State Children’s > Health Insurance Program (SCHIP) funding.> ====================================> _http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc_

> (http://www.ncihc.org/mc/page.do?sitePageId=101286 & orgId=ncihc) > > > Who pays for interpreter services?

> Patients themselves are under no obligation to pay for these services. > Thirteen states currently provide reimbursement for language services provided > to Medicaid enrollees. For more information, see the National Health Law

> Program’s publication, _Medicaid/SCHIP Reimbursement Models for Language > Services: 2007 Update._ > (http://www.healthlaw.org/images/stories/issues/Medicaid-SCHIP.2007.pdf)

> Some health care providers pay for interpreter services themselves. For > more information, see the NHeLP’s publication, _Providing Language > Interpretation Services in Small Health Care Provider Settings: Examples from the

> Field_ (http://www.cmwf.org/publications/publications_show.htm?doc_id=270667) > (April 2005). This report focuses specifically on promising practices for

> providing language services in small health care provider settings, > including solo and small group practices and community clinics. > Is there a law that requires provision of interpreters?> Yes. The following are key laws and policy guidance concerning provision

> of services to people with limited English proficiency (LEP): > * Title VI of the Civil Rights Act of 1964 > * HHS Policy Guidance on the Prohibition Against National Origin > Discrimination as it Affects Persons With Limited English Proficiency

> * DOJ Guidance to Federal Financial Assistance Recipients Regarding > Title VI Prohibition Against National Origin Discrimination Affecting > Limited English Proficient Persons > * _Culturally and Linguistically Appropriate Services Standards for

> Health Care_ (http://www.hablamosjuntos.org/signage/PDF/omh.pdf) > * Executive Order 13166 > * Strategic Plan to Improve Access to HHS Programs and Activities by

> Limited English Proficiency Persons > For an explanation of these federal laws and policies, see NHeLP’s > publication, _Language Services Action Kit_ > (http://www.healthlaw.org/index.php?option=com_content & view=article & id=119:language-services-action-kit-interpreter-

> services-in-health-care-settings-for-people-with-limited-english-proficiency> -revd-feb-04- & catid=40 & Itemid=187) (2004). > For an explanation of federal laws concerning language access and examples

> from the field in video format, see the LEP Video, Breaking Down the > Language Barrier: Translating Limited English Proficiency Policy into Practice, > which can be ordered through _www.lep.gov_ (http://www.lep.gov/)

> For a more comprehensive explanation of language access responsibilities > under federal and state law, as well as in the private sector, and > recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic

> Access in Health Care Settings: Legal Rights & Responsibilities (2nd > edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To > order, go to _www.healthlaw.org_ (http://www.healthlaw.org/)

> > ======================================> > _http://www.aafp.org/fpm/2004/0600/p37.html_ > (http://www.aafp.org/fpm/2004/0600/p37.html)

> > > _Jun, 2004 Table of Contents_ (http://mail.google.com/fpm/2004/0600/) > Getting the Most From Language Interpreters

> Communicating with patients who have limited English proficiency requires > more than simply “finding someone who speaks their language.� > Herndon, MD, and Joyce > Fam Pract Manag. 2004 Jun;11(6):37-39.

> > More than 31 million foreign-born people live in the United States._1_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am

> =!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37> -b1) Eighteen percent report speaking a language other than English at > home, and almost half say they speak English “less than very well.� Under

> Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients > with limited English proficiency (LEP) have the right to a trained > interpreter. Any practice receiving federal funding aside from Medicare part B must

> comply. Failure to use interpreters for LEP patients has led to higher > hospital admission rates, increased use of testing, poorer patient > comprehension of diagnosis and treatment, and misdiagnosis and improper treatment._2_

> (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en

> . & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm2004060> 0p37-b2) -_4_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2bqel1j3ntDvD0zwrD4A0LtuaOamI

> & fri#fpm20040600p37-b4) This article provides some general guidelines to > help maximize communication with LEP patients when using interpreters of all > skill levels. > What is a “trained language interpreter�?

> Trained language interpreters have formal education in interpreting and > abide by a professional code of ethics that includes confidentiality, > impartiality, accuracy and completeness. Good medical interpreters are not only

> fluent; they are also familiar with medical terminology and have experience > in health care. Although there are several accredited training programs for > medical interpreters, there is no national certification. In fact, only

> Washington offers state testing and certification. Fortunately, most companies > that offer interpretation services have developed procedures to “qualify� > their interpreters and can provide verification of their training and

> certification. > Well-trained interpreters convert the meaning of all messages from one > language to another without unnecessary additions, deletions or changes in > meaning and without injecting their own opinions. They act as message

> clarifiers when there is a possible misunderstanding and are always careful to > ensure that neither party is left out of the discussion. Interpreters can also > act as cultural clarifiers when traditional health beliefs or practices

> lack equivalent terms. Well-trained interpreters will communicate both > verbally and nonverbally, in such a way that their presence is barely noticed by > either party. Trained interpreters are costly but can save time and

> resources in the long run by decreasing the number of callbacks, misdiagnoses and > unnecessary tests, and increasing patient comprehension, compliance and > satisfaction. > Although the success of an encounter with an LEP patient is strongly

> dependent on an interpreter’s training, family physicians can do several > important things to facilitate the process. For example, if you have a choice or > feel that a patient would prefer it, ask for an interpreter of the same

> gender as the patient. Some patients feel more comfortable having someone of > the same sex interpret for them, particularly when discussing personal > issues. > > KEY POINTS > * According to the Civil Rights Act of 1964 and Executive Order

> 13166, patients with limited English proficiency have the right to a trained > interpreter. > * Well-trained interpreters abide by a code of ethics and interpret > without unnecessary additions, deletions or changes in meaning, and without

> injecting their own opinions. > * Friends or family members may unconsciously screen what they hear > and provide only a summarized interpretation to the other party.> > Guidelines for using trained on-site interpreters

> Other points to keep in mind when working with an on-site interpreter > include the following: > Confidentiality. Prior to the office visit, give any necessary background > information to the interpreter. Remind the interpreter that everything you

> and the patient say needs to be interpreted and that all information must > be kept confidential. When you enter the exam room, introduce yourself and > the interpreter to the patient. Have the interpreter explain to the patient

> that all information will be kept confidential. > Addressing the patient. If you can, position the interpreter so that he or > she is sitting beside the patient, facing you. Maintain eye contact with

> the patient (if culturally appropriate) and be careful to address the > patient, not the interpreter. For example, look at the patient and ask, “Have you > had any fever?� instead of asking the interpreter, “Has she had any fever?

> � Before entering the exam room, ask the interpreter to speak in first > person when speaking for either you or your patient (e.g.,“I think you have an > ear infection�). Statements in the third person (i.e., “The doctor thinks

> you have an ear infection.�) can create a barrier between you and your > patient. When both sides talk directly to each other, the interpreter has the > opportunity to melt into the background and unobtrusively become the voice

> of each party. > Time constraints. Because English is relatively direct compared with other > languages, interpretation might take longer than you expect. Consequently, > you should allow for extra time. When interacting with LEP patients, keep

> your sentences brief and pause often to allow time for interpreting. Avoid > highly technical medical jargon and idiomatic expressions that may be > difficult for the interpreter to convey and the patient to comprehend. Use

> diagrams and pictures to facilitate comprehension. Listen without interrupting > and make it a point to confirm that the patient understands by asking him or > her to repeat important instructions back to you. Pause at several points

> during the conversation to ask whether the patient has any questions. Many > cultures see questioning physicians as a sign of disrespect and may be > hesitant to respond initially. Finally, if you have any concerns or questions

> about the interpretation, don’t hesitate to ask the interpreter. > Guidelines for using trained phone interpreters > If you don’t have an on-site interpreter available, using a phone > interpreter service is another option. (For a partial list of companies that

> provide these services, see _the resources box_ > (http://mail.google.com/mail/?ui=2 & view=js & name=main,tlist & ver=CKbPYpt__Vc.en. & am=!diUD_x4pKA37BT5ibrQ2BFDZNB2b

> qel1j3ntDvD0zwrD4A0LtuaOamI & fri#fpm20040600p37-bt2) ). Costs for phone > interpretation services vary between $2 and $3 per minute, but you may be able > to negotiate a lower price based on volume. Setting up an account with a

> service is the most cost-effective method for frequent users. If you rarely > need interpreter services, some companies will allow you to access their > services without an account, but will generally charge more per minute and add

> on a service fee of several dollars for each call. > A distinct advantage of phone interpretation is that companies generally > offer a wide variety of languages from which to choose. The main > disadvantage to phone interpretation is that the interpreter does not have the ability

> to read the nonverbal clues accompanying the interactions. Though the same > general principles for using on-site interpreters apply, the following > points are unique to working with phone interpreters:

> Confidentiality. Interviews using phone interpreters should be conducted > in a private room with a speakerphone. For three-way conversations, consider > investing in splitters and extra handsets. These are relatively

> inexpensive and help to maintain privacy. Begin every phone interview by reminding > the patient and the interpreter that all information must be kept > confidential. > Setting the stage. The phone interpreter does not have the advantage of

> seeing you or your patient face-to-face. After introducing yourself, give a > brief statement summarizing the clinical situation (e.g., “This is a doctor’> s office and I’m with a patient who is six months pregnant�).

> Time constraints. Because of the cost of using a phone interpreter, it is > important to use your time wisely. Before calling, prepare yourself by > compiling a list of questions you want to ask and the information you need

> conveyed. Often, two separate phone calls will be necessary during the patient > visit: one to take the patient’s pertinent history and another on > completion of the physical exam to discuss findings, diagnosis and treatment. Always

> leave time at the end of the phone call for questions or to have the > patient repeat important instructions back to you. > > RESOURCES > There are many resources available to help you better understand the

> cultural backgrounds of the patients in your community. Two good Web-based > resources include DiversityRx (_http://www.diversityrx.org_

> (http://www.diversityrx.org/) ) and the Cross Cultural Health Care Program > (_http://www.xculture.org_ (http://www.xculture.org/) ). Further information about caring for

> patients with limited English proficiency is available at > _http://www.lep.gov_ (http://www.lep.gov/) . For help locating an interpreter association near

> you, contact the National Council on Interpreting in Healthcare at > _http://www.ncihc.org_ (http://www.ncihc.org/) . Companies that provide trained

> telephone language interpreters for health care workers include Language Line > (_http://www.languageline.com_ (http://www.languageline.com/) ), CyraCom

> International (_www.cyracom.net_ (http://www.cyracom.net/) ), Telelanguage > (_http://www.telelanguage.com_ (http://www.telelanguage.com/) ) and

> MultiLingual Solutions (_http://www.mlsolutions.com_ (http://www.mlsolutions.com/) ).

> Using untrained interpreters > It is not uncommon for LEP patients to have family members or friends > interpret for them. Although the guidelines state that LEP patients can select > an interpreter of their choice, using friends and family members has its

> limitations. For example, most untrained interpreters don’t have enough > medical knowledge to be able to understand or explain medical terminology. > Patient confidentiality may also be an issue. With friends or family members in

> the room, patients may be unwilling to volunteer sensitive information. It > may also be difficult for friends or family members to interpret what is > being said. Often, they will unconsciously screen what they hear and give a

> summarized interpretation to the other party. This decreases the accuracy of > the interpretation and may also serve to weaken the doctor-patient > relationship. If you don’t have access to an interpreter, it may be best to use a

> bilingual staff member rather than a patient’s friend or family member. > However, some states have laws about who can perform medical interpretation. > Before you ask a bilingual staff member for help, check with your state

> health officials. > Most patients are willing to use a nonfamily member as an interpreter once > they are assured that patient confidentiality will be maintained. However, > if a patient insists on a family member and you feel communication isn’t

> accurate or adequate, you have the right to call in your own interpreter as > well. When using someone other than a trained interpreter, have the person > doing the interpreting review the guidelines for on-site interpreters

> above. > A few words about documentation and billing > When documenting an encounter with an LEP patient, it is important to > include the language spoken and the interpreter’s name (for on-site services)

> or the company used (for telephone services). If a patient insists on using > a family member or friend, document that this was by choice (i.e., “per > patient request�). Although you cannot bill a patient for the actual service

> provided by the interpreter, you may be able to bill a prolonged service > code (99354-99357) in addition to the appropriate E/M code. (For more coding > information, see _“Time Is of the Essence: Coding on the Basis of Time for

> Physician Services,� FPM, June 2003, page 27_ > (http://www.aafp.org/fpm/20030600/27time.html) .) > When you speak the language

> You may decide you have enough proficiency in a foreign language that an > interpreter isn’t necessary. Unless you are fluent in the language, it is a > good idea to use an interpreter (especially following the exam) to ensure

> and document patient understanding. To do so, simply call a phone language > service or ask an on-site interpreter to join you in the exam room at the > end of the patient visit. Ask the interpreter to ask the patient if he or she

> has any additional questions. Also ask that the patient repeat back to you > any instructions you may have given. You may be surprised to discover that > you and the patient were not communicating as well as you thought!

> > ____________________________________> > > Dr. Herndon is assistant professor in the Department of Family and > Preventive Medicine at Emory University School of Medicine in Atlanta. She

> currently works at a community clinic where less than 30 percent of her patients > speak English proficiently. Joyce is coordinator for language > interpretive services at Grady Health System in Atlanta and is a certified medical

> interpreter for Spanish and English. She coordinates a team of 19 staff > interpreters who service Grady Memorial Hospital, Hugh Spalding Children’s > Hospital and the Grady Health System Neighborhood Clinics.

> > Conflicts of interest: none reported.> Send comments to _fpmedit@..._ (mailto:fpmedit@...) .> > Editor’s note: Additional information on the use of bilingual staff

> members for interpretation services will be addressed in an upcoming issue of > FPM. > 1. U.S. Immigration Statistics by State. U.S. Census Bureau Web site. > Available at _http://www.gcir.org/about_immigration/usmap.htm_

> (http://www.gcir.org/about_immigration/usmap.htm) . Accessed April 5, 2004. > 2. G, Rabke-Verani J, Pine W, Sabharwal A. The importance of

> cultural and linguistic issues in the emergency care of children. Pediatr > Emerg Care. 2002;18:271-284. > 3. Hampers LC, McNulty JE. Professional interpreters and bilingual > physicians in a pediatric emergency department: effect on resource utilization.

> Arch Pediatr Adoles Med. 2002;156:1108-1113. > 4. Meunch J, Verdieck A, -Vasquez A, Newell M. Crossing > diagnostic borders: herpes encephalitis complicated by cultural and language > barriers. J Am Board Fam Pract. 2001;14:46-50.

> > > > > > > > > > > -- > Graham Chiu> _http://www.compkarori.co.nz:8090/_ (http://www.compkarori.co.nz:8090/)

> Synapse - the use from anywhere EMR.>

--      MD    

     ph    fax

impcenter.org

--      MD          ph    fax impcenter.org