LANGUAGE BARRIERS: CMA Questions Translator Requirement Costs

      The California Medical Association believes that a recent federal mandate clarifying that doctors in federally funded health care programs are required to provide translation services to non-English speaking patients will "create an enormous financial burden" for many doctors "already struggling" with low reimbursement rates, the Sacramento Bee reports. "We think this is a wonderful, much-needed requirement, but unless the federal and state governments decide to provide the funds for translation services, it will become a nightmare," California Medical Association CEO Jack Lewin said. Officials from HHS' Office for Civil Rights, however, stated that the mandate is "nothing new" and that the policy, which "has been in effect for decades," is only a written guidance to clarify "what has always been required of doctors who participate in federally funded health care programs" such as Medi-Cal and Healthy Families. Larry Velez, equal-opportunity specialist with the Office for Civil Rights, said, "If you get federal funds and you serve a significant population of people (who) don't speak English, you should know that you're required to provide language assistance. Ignorance is no excuse." Stating they were "unaware" of the requirement, physicians have labeled the latest directive "a poorly thought- out reinterpretation of existing law" that will "discourage" doctors from serving a diverse, low-income patient base. "For me [the directive] would mean hiring about 60 bilingual staff. It would put us out of business," Dr. Patricia Samuelson, director of the Sacramento Urban Indian Health Project, said. Lewin agreed that the cost of providing official translators would prove to be a hurdle to many physicians. "This will be just one more huge barrier that forces doctors and some community hospitals to stop seeing publicly funded patients," he said. The Bee reports that some telephone translation services may cost up to twice as much as the patient's visit. Samuelson added that without state or federal funds, it will be "impossible" for many doctors to meet the requirement. HHS announced they "have no intention" of closing the practices of physicians who fail to comply with the requirement. Velez said, "If we receive a complaint, we will investigate and try to work with doctors to find ways for them to comply. Doctors shouldn't be unduly burdened financially. We suggest many different ways of meeting the requirements, from volunteer services to telephone translation services. We don't foresee doctors pulling out of the program."

What's Next?
      Both the CMA and the Office for Civil Rights agree that state- funded translation services may be the solution to the financial problem. The CMA said it would work with the California Hospital Association and consumer groups to bring the issue to the attention of "every member of California's Legislature and congressional delegation." The CMA also has proposed three cost- absorbing solutions, including: HHS funding for the mandate; an increase in physician payments from Medi-Cal and Healthy Families; or a state-funded mechanism to provide interpretation and written translation services (Chavez, Sacramento Bee, 10/9).