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		<ns0:Id>20250AB__084396ENR</ns0:Id>
		<ns0:VersionNum>96</ns0:VersionNum>
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			<ns0:Action>
				<ns0:ActionText>INTRODUCED</ns0:ActionText>
				<ns0:ActionDate>2025-02-19</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-07-07</ns0:ActionDate>
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				<ns0:ActionDate>2025-09-05</ns0:ActionDate>
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				<ns0:ActionText>ENROLLED</ns0:ActionText>
				<ns0:ActionDate>2025-09-12</ns0:ActionDate>
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		<ns0:LegislativeInfo>
			<ns0:SessionYear>2025</ns0:SessionYear>
			<ns0:SessionNum>0</ns0:SessionNum>
			<ns0:MeasureType>AB</ns0:MeasureType>
			<ns0:MeasureNum>843</ns0:MeasureNum>
			<ns0:MeasureState>ENR</ns0:MeasureState>
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		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Garcia</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Garcia</ns0:Name>
			</ns0:Legislator>
		</ns0:Authors>
		<ns0:Title> An act to amend Sections 1367.04, 1367.041, 1367.042, and 1367.07 of, and to add Section 1367.071 to, the Health and Safety Code, and to amend Sections 10133.8, 10133.9, 10133.10, and 10133.11 of, and to add Section 10133.91 to, the Insurance Code, relating to health care coverage. </ns0:Title>
		<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>Health care coverage: language access.</ns0:Subject>
		</ns0:GeneralSubject>
		<ns0:DigestText>
			<html:p>
				(1)
				<html:span class="EnSpace"/>
				Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance, which is under the control of the Insurance Commissioner. Existing law requires the Department of Managed Health Care and the commissioner to develop and adopt regulations establishing standards and requirements to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services and covered benefits. Existing law requires the Department of Managed Health Care and commissioner, in developing the regulations, to require health care service plans and health insurers to assess the linguistic needs of
			 the enrollee and insured population, and to provide for translation and interpretation for medical services, as indicated.
			</html:p>
			<html:p>This bill would require a health care service plan or health insurer to take reasonable steps to provide meaningful access to each individual with limited English proficiency, including companions with limited English proficiency, eligible to receive services or likely to be directly affected by its programs and activities. The bill would require a health care service plan or health insurer to offer a qualified interpreter or to utilize a qualified translator when interpretation or translation services are required, as specified. The bill would prohibit a health care service plan or health insurer from requiring an individual with limited English proficiency to provide or pay for the costs of their own interpreter. The bill would require a health care service plan or health insurer to comply with specified requirements when providing remote
			 interpreting services. The bill would make a health care service plan or health insurer that violates these provisions liable for administrative penalties, as specified.</html:p>
			<html:p>
				(2)
				<html:span class="EnSpace"/>
				Existing law requires certain vital documents containing enrollee- or insured-specific information to include a written notice of the availability of interpretation services in certain threshold languages. Existing law requires a health care service plan or health insurer, upon request, to provide a written translation of those documents within a specified timeframe. For those documents that also relate to expedited plan review of a grievance for a case involving an imminent and serious threat to the health of the patient, existing law authorizes a health care service plan or health insurer to satisfy the requirement by providing notice of the availability of oral interpretation services.
			</html:p>
			<html:p>This bill would authorize a health care
			 service plan or health insurer to satisfy the notice requirement by taking reasonable steps to inform the enrollee or insured of any required actions, including by providing a sight translation of a document.</html:p>
			<html:p>
				(3)
				<html:span class="EnSpace"/>
				Existing law requires a health care service plan or health insurer that advertises or markets products in a non-English language, as specified, to provide specified documents in the same non-English language.
			</html:p>
			<html:p>This bill would add to the list of documents required to be provided in the advertised or marketed non-English language, (A) notices related to any termination of coverage and change in covered services, (B) complaint forms to file a grievance or appeal, and (C) communications related to costs and payment of covered services, as specified.</html:p>
			<html:p>
				(4)
				<html:span class="EnSpace"/>
				Existing law requires a health care service plan or health insurer to notify
			 enrollees or insureds, as applicable, and members of the public of nondiscrimination policies, grievance or complaint procedures, as applicable, and the availability of language assistance services and appropriate auxiliary aids and services, as specified.
			</html:p>
			<html:p>This bill would require a health care service plan or health insurer to also provide the information to persons seeking coverage. The bill would require a health care service plan or health insurer to notify enrollees or insureds, persons seeking coverage, and members of the public that the plan or insurer provides language assistance services and appropriate auxiliary aids and services, as specified.</html:p>
			<html:p> Existing law requires this information to be provided upon initial enrollment, upon renewal, and annually in or with materials that are routinely disseminated.</html:p>
			<html:p>This bill would require a health care service plan or health insurer to
			 also provide the above-described information in clear and prominent physical locations, as specified, and upon request. The bill would require a health care service plan or health insurer to provide information regarding the provision of language assistance services, as described above, in a notice when specified forms or communications are provided, as specified.</html:p>
			<html:p>
				(5)
				<html:span class="EnSpace"/>
				Existing law requires a health care service plan or health insurer to report to the applicable department on internal policies and procedures relating to cultural appropriateness in specified contexts.
			</html:p>
			<html:p>This bill would require a health care service plan or health insurer to additionally report to the applicable department on internal
			 policies and procedures relating to language access, as specified.</html:p>
			<html:p>
				(6)
				<html:span class="EnSpace"/>
				Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.
			</html:p>
			<html:p>The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.</html:p>
			<html:p>This bill would provide that no reimbursement is required by this act for a specified reason.</html:p>
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			<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
			<ns0:Appropriation>NO</ns0:Appropriation>
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	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_E0695CA4-15FB-4FF7-AB85-A71169DB869F">
			<ns0:Num>SECTION 1.</ns0:Num>
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				Section 1367.04 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_8AC46CBF-4D68-4876-B993-0B4C1EDEA950">
					<ns0:Num>1367.04.</ns0:Num>
					<ns0:LawSectionVersion id="id_26AA47BC-DCCB-4C10-A232-EB2327E96385">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. The regulations shall include the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Requirements
						for the translation of vital documents that include the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment separately indicates in
						the needs assessment as required by this subdivision a preference for written materials in that language.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Specification of vital documents produced by the health care service plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Applications.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Consent forms.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Letters containing important information regarding eligibility and participation criteria.
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal.
							</html:p>
							<html:p>
								(v)
								<html:span class="EnSpace"/>
								Notices advising individuals with limited English proficiency, as defined in Section 1367.071, of the availability of free language assistance and other outreach materials that are provided to enrollees.
							</html:p>
							<html:p>
								(vi)
								<html:span class="EnSpace"/>
								Translated documents shall not include a health care service plan’s explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								(i)
								<html:span class="EnSpace"/>
								For those documents described in subparagraph (B) that are not standardized but contain enrollee-specific
						information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan subject to the requirements in Section 1367.042 shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Upon request, the enrollee shall receive a written translation of the documents described in clause (i). The health
						care service plan shall have up to, but not to exceed, 21 days to comply with the enrollee’s request for a written translation. If an enrollee requests a translated document, all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plan’s issuance of the translated document.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by taking reasonable steps to inform the enrollee of any required actions, including by providing a sight translation of a document, or providing notice of the availability and
						access to oral interpretation services or auxiliary aids and services.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								A requirement that health care service plans advise
						individuals with limited English proficiency of the availability of interpreter services.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit
						health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Requirements for individual access to interpretation services that include the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								A requirement that an interpreter meets, at a minimum, all of the following qualifications:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Demonstrated proficiency in both English and the target language.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Knowledge in both English and the target language of health care
						terminology and concepts relevant to health care delivery systems.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								A requirement that the individual with limited English proficiency shall not be required to provide their own interpreter or rely on a staff member who does not meet the qualifications described in subparagraph (A) to communicate directly with the limited-English-proficient enrollee.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								A requirement that the individual with limited English proficiency shall not be required to rely on an adult or minor child accompanying the enrollee to interpret or facilitate communication except under either of the following circumstances:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								In an emergency, as described in Section 1317.1, if a qualified interpreter is not immediately available for the enrollee with limited English proficiency.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								If the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								In developing the regulations, standards, and requirements, the department shall
						consider the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Standards adopted by other states pertaining to language assistance requirements for health care service plans.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Center for Data Insights and Innovation and the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former Section 852 of the Business
						and Professions Code.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								The cost of compliance and the availability of translation and interpretation services and professionals.
							</html:p>
							<html:p>
								(9)
								<html:span class="EnSpace"/>
								Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written interpretation
						services.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								The department shall seek public input from a wide range of interested parties through advisory bodies established by the director.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess
						compliance.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								The department shall report biennially to the Legislature and advisory bodies established by the director regarding plan compliance with the standards, including results of compliance audits made in conjunction with other audits and reviews. The reported information shall also be included in the publication required under subparagraph (B) of paragraph (1) of subdivision (b) of Section 136000. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The department may also delay or otherwise phase in implementation of standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								Except for contracts with the State Department of Health Care Services Medi-Cal program, the standards developed under this section shall be considered the minimum required for compliance.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The regulations shall provide that a health plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, either by contract or state law, if the standards provide as much access to cultural and linguistic services as the standards established by this section for an equal or higher number of enrollees and therefore meet or exceed the standards of the regulations established pursuant to this section, and the department determines that the health care service plan is in compliance with the standards required by the Medi-Cal program. To meet this requirement, the department shall not be required
						to perform individual audits. The department shall, to the extent feasible, rely on audits, reports, or other oversight and enforcement methods used by the State Department of Health Care Services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The determination pursuant to paragraph (2) shall only apply to the enrollees covered by the Medi-Cal program standards. A health care service plan subject to paragraph (2) shall comply with the standards established by this section with regard to enrollees not covered by the Medi-Cal program.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								This section does not prohibit a government purchaser from including in their contracts additional translation or interpretation requirements, to meet linguistic or cultural needs, beyond those set forth pursuant to this section.
							</html:p>
							<html:p>
								(j)
								<html:span class="EnSpace"/>
								For purposes of this section, “sight translation” means the oral or signed rendering of written text into spoken or signed language by an interpreter without changes based on the visual review of the original text or document. 
							</html:p>
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		<ns0:BillSection id="id_C26CE4B0-971F-4B7D-B75E-026CCB9B7EA5">
			<ns0:Num>SEC. 2.</ns0:Num>
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				Section 1367.041 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_34215C1C-EF60-407C-B447-0CB8047C9E06">
					<ns0:Num>1367.041.</ns0:Num>
					<ns0:LawSectionVersion id="id_BF02EBB0-153A-4E42-BFEF-E5FB8A07B68A">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								A health care service plan that advertises or markets products in the individual or small group health care service plan markets, or allows any other person or business to market or advertise on its behalf in the individual or small group health care service plan markets, in a non-English language that does not meet the requirements set forth in Sections 1367.04 and 1367.07, shall provide the following documents in the same non-English language:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Welcome letters or notices of initial coverage, if provided.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Applications for enrollment and any information pertinent to eligibility or participation, including
						communications related to costs and payment of covered services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notices advising limited-English-proficient persons of the availability of no-cost translation and interpretation services.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Complaint forms and notices pertaining to the right and instructions on how an enrollee may file a grievance or appeal.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Notices related to any termination of coverage and change in covered services.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								The uniform summary of benefits and coverage required pursuant to subparagraph (A) of paragraph (3) of subdivision (c) of Section 1363.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								A health care service plan shall use a trained and qualified translator
						for all written translations of marketing and advertising materials relating to health care service plan products, and for all of the documents specified in subdivision (a).
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								This section shall not apply to a specialized health care service plan that does not offer an essential health benefit as defined in Section 1367.005.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_B74BFDF3-5DBD-45CA-BEEC-857637C82DCD">
			<ns0:Num>SEC. 3.</ns0:Num>
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				Section 1367.042 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_483CACC3-2C6B-4D11-97F9-C0740B5F4036">
					<ns0:Num>1367.042.</ns0:Num>
					<ns0:LawSectionVersion id="id_BC01770D-8EEB-42CA-AFEA-8E70834A4F26">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								A health care service plan shall notify enrollees, persons seeking coverage, and members of the public of its policy of nondiscrimination, including all of the following information:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								The health care service plan provides language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 1367.04, including how to access these services. This information shall be provided in the top 15 languages spoken by limited-English-proficient individuals in California as determined by the State Department of Health Care Services.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The health care service plan provides appropriate auxiliary aids and services, including qualified
						interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner, when those aids and services are necessary to ensure an equal opportunity to participate for individuals with disabilities.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The health care service plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								The availability of the grievance procedure described in Section 1368, how to file a grievance, including the name of the plan representative and the telephone number, address, and email address of the plan representative who may be contacted about the grievance, and how to submit the grievance to the department for review
						after completing the grievance process or participating in the process for at least 30 days.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								How to file a discrimination complaint with the United States Department of Health and Human Services Office for Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The information required to be provided pursuant to this section shall be provided to an enrollee with individual coverage upon initial enrollment and annually thereafter upon renewal, and to enrollees and subscribers with group coverage upon initial enrollment and annually thereafter upon renewal. A health care service plan may include this information with other materials sent to the enrollee. The information shall also be provided in the following
						manner:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								In a conspicuously visible location in the evidence of coverage.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the plan’s enrollees.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								At a conspicuous place on the internet website published and maintained by the health care service plan, in a manner that allows enrollees, prospective enrollees, and members of the public to easily locate the information.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Upon request.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								In clear and prominent physical locations, in font no smaller than 20-point sans serif font, where it is reasonable to expect individuals
						seeking services from a health care service plan to be able to read or read and hear the notice.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								A health care service plan shall incorporate a notice that contains a statement indicating the health care service plan provides language assistance services, as described in paragraph (1) of subdivision (a), into all of the following written communications or forms, whether delivered by postal mail, electronically, or by other means, when a health care service plan provides these written communications or forms:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								A notice of privacy practices, as required by Section 164.520 of Title 45 of the Code of Federal Regulations.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Application forms.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notice of termination, eligibility, benefits, or services, including an explanation of benefits, and notices of appeal and grievance rights.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Communications related to an individual’s rights, eligibility, benefits, or services that request a response from an enrollee or applicant for health care coverage.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Communications related to a public health emergency. Communications related to a public health emergency that are delivered by text message, including short message service (SMS) or multimedia messaging service (MMS), may incorporate the notice of language assistance services, as described in paragraph (1) of subdivision (a), by referencing a uniform resource locator (URL) linked to the information.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Communications related to the cost and payment of care with respect to an individual including medical billing and collections
						materials, and good faith estimates required by Section 2799B-6 of the federal Public Health Service Act.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Complaint forms.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								Member and enrollee handbooks.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A specialized health care plan that is not a covered entity, as defined in Section 92.4 of Title 45 of the Code of Federal Regulations, subject to Section 1557 of the federal Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18116) may request an exemption from the requirements under this section.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The department shall not grant an exemption under this subdivision to a specialized health care service plan that arranges for mental health benefits, except for employee assistance program plans.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The department shall provide information on its internet website about any exemptions granted under
						this subdivision.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								This section does not apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								This section does not require an individual with limited English proficiency to accept language assistance services. 
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_4F676F5F-D8A7-44E9-9977-95D6964DF573">
			<ns0:Num>SEC. 4.</ns0:Num>
			<ns0:ActionLine action="IS_AMENDED" ns3:href="urn:caml:codes:HSC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'2.2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'5.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'1367.07.'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
				Section 1367.07 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_B94BEBB2-66DA-4E47-B11F-060B534FA30E">
					<ns0:Num>1367.07.</ns0:Num>
					<ns0:LawSectionVersion id="id_B6802BE5-CD0B-4B76-927C-BEA93382502A">
						<ns0:Content>
							<html:p>Within one year after a health care service plan’s assessment pursuant to subdivision (b) of Section 1367.04, the health care service plan shall report to the department, in a format specified by the department, regarding internal policies and procedures related to language access and cultural appropriateness in each of the following contexts:</html:p>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Collection of data regarding the enrollee population pursuant to the health care service plan’s assessment conducted in accordance with subdivision (b) of Section 1367.04.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								Employee training and resources on the policies and procedures for serving individuals with limited English proficiency, including
						all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								How an employee identifies whether an individual has limited English proficiency.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								How an employee obtains the services of qualified interpreters and translators the health care service plan uses to communicate with an individual with limited English proficiency.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								How to identify and work with any qualified bilingual or multilingual staff members.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								How to obtain access to any electronic and written translated materials the health care service plan has available, the language they are translated into, and their date of issuance.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								The appointment of a language
						access coordinator to coordinate the health care service plan’s responsibilities under this section, unless the plan has fewer than 15 employees.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Education of health care service plan staff who have contact with enrollees on the diverse needs of the enrollee population.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								Recruitment and retention efforts that encourage workforce diversity.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								Evaluation of the health care service plan’s programs and services with respect to the plan’s enrollee population, using processes such as an analysis of complaints and satisfaction survey results.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								The periodic provision of information regarding the ethnic diversity of the health care service plan’s enrollee
						population and any related strategies to plan providers. Health care service plans may use existing means of communication.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								The periodic provision of educational information to plan enrollees on the health care service plan’s services and programs. Plans may use existing means of communication.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								For purposes of this section, “qualified bilingual or multilingual staff” means a member of the health care service plan’s workforce who is designated by the plan to provide in-language oral language assistance as part of the person’s current assigned job responsibilities and who has demonstrated to the plan that they are both of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Proficient in speaking and understanding both spoken English and at
						least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Able to effectively, accurately, and impartially communicate directly with individuals with limited English proficiency in their primary languages.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_B38699E7-E93A-4460-AE2D-769352711869">
			<ns0:Num>SEC. 5.</ns0:Num>
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				Section 1367.071 is added to the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				, 
				<ns0:Positioning>immediately following Section 1367.07</ns0:Positioning>
				, to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_0C90334F-9C0F-4E9F-A55C-138F7F31B15C">
					<ns0:Num>1367.071.</ns0:Num>
					<ns0:LawSectionVersion id="id_DD0589DC-1C35-4A4E-8739-AB932A58A344">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Health care service plans shall take reasonable steps to provide meaningful access to each individual with limited English proficiency, including companions with limited English proficiency, eligible to receive services or likely to be directly affected by its programs and activities.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								Health care service plans shall provide accurate and timely language assistance services, free of charge to individuals with limited English proficiency. When providing language access services, health care service plans shall protect the privacy and independent decisionmaking ability of individuals with limited English proficiency.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								When interpretation services are required pursuant to this section or Section 1367.04, 1367.041, 1367.042, or 1367.07, or any regulations adopted thereunder, a health care service plan shall offer a qualified interpreter in its health programs and activities.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								When translation services are required pursuant to this section or Section 1367.04, 1367.041, 1367.042, or 1367.07, or any regulations adopted thereunder, a health care service plan shall utilize a qualified translator in its health programs and activities. Machine translation may be used to supplement services by translators for translation of general information that is not critical to the rights, benefits, or meaningful access to an individual with limited English proficiency, or when a qualified translator is unavailable. If a health care service plan uses machine
						translation when the underlying text is critical to the rights, benefits, or meaningful access to an individual with limited English proficiency, when accuracy is essential or when the source documents or other materials contain complex, nonliteral, or technical language, the translation shall be reviewed by a qualified translator.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								A health care service plan shall not do any of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Require individuals with limited English proficiency to provide or pay for the costs of their own interpreter.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Rely on an adult, not qualified as an interpreter, to interpret or facilitate communications with an individual with limited English proficiency except under either of the following circumstances:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								As a temporary measure, while finding a qualified interpreter in an emergency involving an immediate threat to the safety or welfare of an individual or the public welfare where there is no qualified interpreter for the individual with limited English proficiency immediately available and the qualified interpreter that arrives confirms or supplements the initial communication with an adult interpreter.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Where the individual with limited English proficiency specifically requests, in private with a qualified interpreter present and without an accompanying adult present, that the accompanying adult interpret or facilitate communications, provided that all of the following conditions are met:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								The request is
						confirmed in private with a qualified interpreter and without the accompanying adult present.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								The accompanying adult agrees to provide the assistance.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								The individual’s request and agreement by the accompanying adult is documented.
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								The reliance on that adult for the assistance is appropriate under the circumstances.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Rely on a minor child to interpret or facilitate communication, except as a temporary measure while finding a qualified interpreter in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the enrollee with limited English proficiency
						immediately available and the qualified interpreter that arrives confirms or supplements the initial communications with the minor child.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Rely on staff other than qualified interpreters, qualified translators, or qualified bilingual or multilingual staff to communicate with individuals with limited English proficiency.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								A health care service plan that provides a qualified interpreter for an individual with limited English proficiency through video remote interpreting services shall ensure the modality allows for meaningful access and shall provide all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers
						high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A sharply delineated image that is large enough to display the interpreter’s face and the participating person’s face regardless of that person’s body position.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								A clear, audible transmission of voices.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Adequate training to users of the technology and other involved persons so that they can quickly and efficiently set up and operate the video remote interpreting.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								A health care service plan that provides a qualified interpreter for an individual with limited English proficiency through audio remote interpreting services shall
						ensure the modality allows for meaningful access and shall provide all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Real-time audio over a dedicated high-speed, wide-bandwidth connection or wireless connection that delivers high-quality audio without lags or irregular pauses in communication.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A clear, audible transmission of voices.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Adequate training to users of the technology and other involved persons so that they may quickly and efficiently set up and operate the remote interpreting services.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								The director may take enforcement action, including, but not limited to, imposing penalties for noncompliance with the requirements of this section or
						regulations promulgated thereunder.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								If the director determines that a health care service plan, or an entity contracted with the health care service plan, has violated this section, the director may, after appropriate notice and opportunity for hearing in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), by order, assess an administrative penalty not to exceed five thousand dollars ($5,000) for each violation, or if a violation was willful, an administrative penalty not to exceed ten thousand dollars ($10,000) for each violation.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								For the purposes of this section, the following definitions apply:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								“Companion” means a family member, friend, or associate of an individual seeking access to services from a health care service plan, who, along with such individual, is an appropriate person with whom a plan should communicate.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								“Individual with limited English proficiency” means an enrollee or prospective enrollee whose primary language for communication is not English and who has limited ability to read, write, speak, or understand English. An individual may be competent in English for certain types of communication, including speaking or understanding, but still have limited English proficiency for purposes of this section.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								“Machine translation” means automated translation, without the assistance of, or review by, a qualified translator, that is text-based
						and provides instant translations between various languages, sometimes with an option for audio input or output. Machine translation technology is not a qualified translator or qualified interpreter.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								(A)
								<html:span class="EnSpace"/>
								“Qualified interpreter” means a human interpreter who meets all of the following requirements:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Interprets via a remote interpreting service or an
						onsite appearance.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Has demonstrated proficiency in speaking and understanding both English and at least one other spoken language.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Is able to interpret effectively, accurately, and impartially, to and from a language and English, using any necessary specialized vocabulary or terms without changes, omissions, or additions, and while preserving the tone, sentiment, and emotional level of the original oral statement.
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								“Qualified interpreter” includes a qualified interpreter for relay interpretation.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								“Qualified interpreter for relay interpretation” means a human interpreter who meets all of the following requirements:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Interprets via a remote interpreting service or an onsite appearance.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Demonstrates proficiency in two non-English spoken languages.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Is able to interpret effectively, accurately, and impartially, to and from two non-English languages using any necessary specialized vocabulary or terms without changes, omissions, or additions, and while preserving the tone, sentiment, and emotional level of the original oral statement.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter
						ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								“Qualified translator” means a human translator who meets all of the following requirements:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Has demonstrated proficiency in writing and understanding both written English and at least one other written non-English language.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Is able to translate effectively, accurately, and impartially to and from a language and English using any necessary specialized vocabulary or terms without changes, omissions, or additions and while preserving the tone, sentiment, and emotional level of the original written statement.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client
						confidentiality.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								“Relay interpretation” means interpreting from one language to another through an intermediate language, including interpretation used for monolingual speakers of languages of limited diffusion. In relay interpreting, the first interpreter listens to the speaker and renders the message into the intermediate language. The second interpreter receives the message in the intermediate language and interprets into a third language for the speaker who speaks neither the first nor second language.
							</html:p>
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			<ns0:Num>SEC. 6.</ns0:Num>
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				Section 10133.8 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
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					<ns0:Num>10133.8.</ns0:Num>
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						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide insureds with appropriate access to translated materials and language assistance in obtaining covered benefits.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The regulations described in subdivision (a) shall include the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								A requirement to conduct an assessment of the needs of the insured group, pursuant to this subdivision.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Requirements for surveying the language preferences and assessment
						of linguistic needs of insureds within one year of the effective date of the regulations that permit health insurers to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, newsletters, or other mailings. Health insurers shall update the linguistic needs assessment, demographic profile, and language translation requirements every three years. However, the regulations may provide that the surveys and assessments by insurers of supplemental insurance products may be conducted less frequently than every three years if the commissioner determines that the results are unlikely to affect the translation requirements.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Requirements for the translation of vital documents that include the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								A requirement that all
						vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								A health insurer with an insured population of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment pursuant to paragraph (2) and any additional languages when 0.75 percent or 15,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) a preference for written materials in that language.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								A health insurer with an insured population of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment pursuant to paragraph (2) and any
						additional languages when 1 percent or 6,000 of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) a preference for written materials in that language.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								A health insurer with an insured population of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the insured population, whichever number is less, indicates in the needs assessment pursuant to paragraph (2) a preference for written materials in that language.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Specification of vital documents produced by the health insurer that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office
						for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Applications.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Consent forms.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Letters containing important information regarding eligibility or participation criteria.
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a complaint or appeal.
							</html:p>
							<html:p>
								(v)
								<html:span class="EnSpace"/>
								Notices advising individuals with limited English proficiency, as defined in Section 10133.91 of the availability of free language assistance and other outreach materials that are provided
						to insureds.
							</html:p>
							<html:p>
								(vi)
								<html:span class="EnSpace"/>
								Translated documents shall not include a health insurer’s explanation of benefits or similar claim processing information that are sent to insureds unless the document requires a response by the insured.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								For those documents described in subparagraph (B) that are not standardized but contain insured specific information, health insurers shall not be required to translate the documents into the threshold languages identified by the needs assessment pursuant to paragraph (2) but rather shall include with the document a written notice of the availability of interpretation services in the threshold languages identified by the needs assessment pursuant to paragraph (2). A health insurer subject to the requirements in Section 10133.11 shall also include with the
						documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Upon request, the insured shall receive a written translation of those documents. The health insurer shall have up to, but not to exceed, 21 days to comply with the insured’s request for a written translation. If an enrollee requests a translated document, all timeframes and deadline requirements related to the documents that apply to the health insurer and insureds under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health insurer’s issuance of the translated document.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								For appeals that require expedited review and response in accordance with the statutes and regulations of this chapter, the health insurer may satisfy this requirement by taking reasonable steps to inform the insured of any required actions, including by providing a sight translation of a document, or providing notice of the availability and access to oral interpretation services or auxiliary aids and services.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								A requirement that health insurers advise individuals with limited English proficiency of the availability of interpreter services.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Standards to ensure the quality and accuracy of the written translation and that a translated document meets the same standards
						required for the English version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Requirements for individual access to interpretation services that include the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								A requirement that an interpreter meets, at a minimum, all of the following qualifications:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Demonstrated proficiency in both English and the target language.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Knowledge in both
						English and the target language of health care terminology and concepts relevant to health care delivery systems.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								A requirement that the individual with limited English proficiency shall not be required to provide their own interpreter or rely on a staff member who does not meet the qualifications described in subparagraph (A) to communicate directly with the limited-English-proficient insured.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								A requirement that the individual with limited English proficiency shall not be required to rely on an adult or minor child accompanying the insured to interpret or facilitate communication except under either
						of the following circumstances:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								In an emergency, as described in Section 1317.1 of the Health and Safety Code, if a qualified interpreter is not immediately available for the insured with limited English proficiency.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								If the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Standards to ensure the quality and timeliness of oral interpretation services provided by health insurers.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								In developing the regulations, standards,
						and requirements described in this section, the commissioner shall consider the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Publications and standards issued by federal agencies, including the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance 65 (65 Federal Register 52762 (August 30, 2000)).
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Other cultural and linguistic requirements under state programs, including the Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide
						Medi-Cal managed care services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Standards adopted by other states pertaining to language assistance requirements for health insurers.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding interpretation services.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report card to the public on the comparative performance of plans and reports on cultural and linguistic services issued by the Center for Data Insights and Innovation and the report to the Legislature from the Task Force on Culturally and Linguistically
						Competent Physicians and Dentists required pursuant to former Section 852 of the Business and Professions Code.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Examples of best practices relating to language assistance services by health care providers and health insurers that contract for alternative rates of payment with providers, including existing practices.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Information gathered from complaints to the commissioner and consumer assistance help lines regarding language assistance services.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								The cost of compliance and the availability of translation and interpretation services and professionals.
							</html:p>
							<html:p>
								(9)
								<html:span class="EnSpace"/>
								Flexibility to accommodate variations in networks and method of service delivery. The
						commissioner shall allow for health insurer flexibility in determining compliance with the standards for oral and written interpretation services.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								In designing the regulations, the commissioner shall consider all other relevant guidelines in an effort to accomplish maximum accessibility within a cost-efficient system of indemnification. The commissioner shall seek public input from a wide range of interested parties.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								Services, verbal communications, and written materials provided by or developed by the health insurers that contract for alternative rates of payment with providers, shall comply with the standards developed under this section.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								Beginning on January 1, 2008, the department shall report
						biennially to the Legislature regarding health insurer compliance with the standards established by this section, including results of compliance audits made in conjunction with other audits and reviews. The department shall also utilize the reported information to make recommendations for changes that further enhance standards pursuant to this section. The commissioner shall work to ensure that the biennial reports required by this section, and the data collected for the reports, do not require duplicative or conflicting data collection with other reports that may be required by government-sponsored programs. The commissioner may also delay or otherwise phase in implementation of the standards and requirements in recognition of costs and availability of translation and interpretation services and professionals.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								This
						section does not prohibit government purchasers from including in their contracts additional translation or interpretation requirements, to meet the linguistic and cultural needs, beyond those set forth pursuant to this section.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								For purposes of this section, “sight translation” means the oral or signed rendering of written text into spoken or signed language by an interpreter without changes based on the visual review of the original text or document. 
							</html:p>
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			<ns0:Num>SEC. 7.</ns0:Num>
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				Section 10133.9 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
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					<ns0:Num>10133.9.</ns0:Num>
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							<html:p>Within a year after the health insurer’s assessment pursuant to paragraph (2) of subdivision (b) of Section 10133.8, health insurers shall report to the department on internal policies and procedures related to language access and cultural appropriateness, in a format specified by the department, in the following ways:</html:p>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Collection of data regarding the insured population based on the needs assessment as required by paragraph (2) of subdivision (b) of Section 10133.8.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								Employee training and resources on the policies and procedures for serving individuals with limited English proficiency, including all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								How an employee identifies whether an individual has limited English proficiency.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								How an employee obtains the services of qualified interpreters and translators the health insurer uses to communicate with an individual with limited English proficiency.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								How to identify and work with any qualified bilingual or multilingual staff members.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								How to obtain access to any electronic and written translated materials the health insurer has available, the language they are translated into, and their date of issuance.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								The appointment of a language access coordinator to coordinate the
						health insurer’s responsibilities under this section, unless the insurer has fewer than 15 employees.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Education of health insurer staff who have contact with insureds on the diverse needs of the insured population.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								Recruitment and retention efforts that encourage workforce diversity.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								Evaluation of the health insurer’s programs and services with respect to the insurer’s insured populations, using processes such as an analysis of complaints and satisfaction survey results.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								The periodic provision of information regarding the ethnic diversity of the health insurer’s insured population and any related strategies to an insurer’s providers. Health insurers
						may use existing means of communication.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								The periodic provision of educational information to insureds on the health insurer’s services and programs. Health insurers may use existing means of communication.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								For purposes of this section, “qualified bilingual or multilingual staff” means a member of the insurer’s workforce who is designated by the insurer to provide in-language oral language assistance as part of the person’s current assigned job responsibilities and who has demonstrated to the insurer that they are both of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Able to effectively, accurately, and impartially communicate directly with individuals with limited English proficiency in their primary languages.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_7A30505D-09B8-4C46-8AAC-BEDDF9883DB6">
			<ns0:Num>SEC. 8.</ns0:Num>
			<ns0:ActionLine action="IS_ADDED" ns3:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2F%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'10133.91'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
				Section 10133.91 is added to the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				, 
				<ns0:Positioning>immediately following Section 10133.9</ns0:Positioning>
				, to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_B6B8B72D-2CFF-489F-A9EA-9AEB05047B2C">
					<ns0:Num>10133.91.</ns0:Num>
					<ns0:LawSectionVersion id="id_292BFC6C-1E3D-4B2E-8726-23CA87501276">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Health insurers shall take reasonable steps to provide meaningful access to each individual with limited English proficiency, including companions with limited English proficiency, eligible to receive services or likely to be directly affected by its programs and activities. 
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								Health insurers shall provide accurate and timely language assistance services, free of charge to individuals with limited English proficiency. When providing language access services, health insurers shall protect the privacy and independent decisionmaking ability of individuals with limited English proficiency. 
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								When interpretation services are required pursuant to this section or Section 10133.8, 10133.9, 10133.10, or 10133.11, or any regulations adopted thereunder, a health insurer shall offer a qualified interpreter in its health programs and activities. 
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								When translation services are required pursuant to this section or Section 10133.8, 10133.9, 10133.10, or 10133.11, or any regulations adopted thereunder, a health insurer shall utilize a qualified translator in its health programs and activities. Machine translation may be used to supplement services by translators for translation of general information that is not critical to the rights, benefits, or meaningful access to an individual with limited English proficiency, or when a qualified translator is unavailable. If a health insurer uses machine translation when the underlying text
						is critical to the rights, benefits, or meaningful access to an individual with limited English proficiency, when accuracy is essential or when the source documents or other materials contain complex, nonliteral, or technical language, the translation shall be reviewed by a qualified translator. 
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								A health insurer shall not do any of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Require individuals with limited English proficiency to provide or pay for the costs of their own interpreter. 
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Rely on an adult, not qualified as an interpreter, to interpret or facilitate communications with an individual with limited English proficiency except under either of the following circumstances: 
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								As a temporary measure, while finding a qualified interpreter in an emergency involving an immediate threat to the safety or welfare of an individual or the public welfare where there is no qualified interpreter for the individual with limited English proficiency immediately available and the qualified interpreter that arrives confirms or supplements the initial communication with an adult interpreter. 
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Where the individual with limited English proficiency specifically requests, in private with a qualified interpreter present and without an accompanying adult present, that the accompanying adult interpret or facilitate communications, provided that all of the following conditions are met:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								The request is confirmed in private with a qualified interpreter and
						without the accompanying adult present.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								The accompanying adult agrees to provide the assistance.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								The individual’s request and agreement by the accompanying adult is documented. 
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								The reliance on that adult for the assistance is appropriate under the circumstances. 
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Rely on a minor child to interpret or facilitate communication, except as a temporary measure while finding a qualified interpreter in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the insured with limited English proficiency immediately available and the qualified interpreter that
						arrives confirms or supplements the initial communications with the minor child.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Rely on staff other than qualified interpreters, qualified translators, or qualified bilingual or multilingual staff to communicate with individuals with limited English proficiency. 
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								A health insurer that provides a qualified interpreter for an
						individual with limited English proficiency through video remote interpreting services shall ensure the modality allows for meaningful access and shall provide all of the following: 
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. 
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A sharply delineated image that is large enough to display the interpreter’s face and the participating person’s face regardless of that person’s body position.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								A clear, audible transmission of voices. 
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Adequate training to users of the technology and other involved persons so that they can quickly and efficiently set up and operate the video remote interpreting.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								A health insurer that provides a qualified interpreter for an individual with limited English proficiency through audio remote interpreting services shall ensure the modality allows for meaningful access and shall provide all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Real-time audio over a dedicated high-speed, wide-bandwidth connection or wireless connection that delivers high-quality audio without lags, or irregular pauses in communication.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A clear, audible transmission of voices.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Adequate training to users of the technology and other involved persons so that they may quickly and efficiently set up and operate the remote interpreting services.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								The commissioner may take enforcement action, including, but not limited to, imposing penalties for noncompliance with the requirements of this section or regulations promulgated thereunder. 
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								If the commissioner determines that a health insurer, or an entity contracted with the health insurer, has violated this section, the commissioner may, after appropriate notice and opportunity for hearing in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), by order, assess an
						administrative penalty not to exceed five thousand dollars ($5,000) for each violation, or if a violation was willful, an administrative penalty not to exceed ten thousand dollars ($10,000) for each violation. 
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								For the purposes of this section, the following definitions apply:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								“Companion” means a family member, friend, or associate of an individual seeking access to services from a health insurer, who, along with such individual, is an appropriate person with whom an insurer should communicate.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								“Individual with limited English proficiency” means an insured or prospective insured whose primary language for communication is not English and who has limited ability to read, write, speak, or
						understand English. An individual may be competent in English for certain types of communication, including speaking or understanding, but still have limited English proficiency for purposes of this section.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								“Machine translation” means automated translation, without the assistance of, or review by, a qualified translator, that is text-based and provides instant translations between various languages, sometimes with an option for audio input or output. Machine translation technology is not a qualified translator or qualified interpreter.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								(A)
								<html:span class="EnSpace"/>
								“Qualified interpreter” means a human interpreter who meets all of the following requirements:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								Interprets via a remote interpreting service or an
						onsite appearance. 
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Has demonstrated proficiency in speaking and understanding both English and at least one other spoken language.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								Is able to interpret effectively, accurately, and impartially, to and from a language and English, using any necessary specialized vocabulary or terms without changes, omissions, or additions, and while preserving the tone, sentiment, and emotional level of the original oral statement.
							</html:p>
							<html:p>
								(iv)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								“Qualified interpreter” includes a qualified interpreter for relay interpretation.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								“Qualified interpreter for relay interpretation” means a human interpreter who meets all of the following requirements:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Interprets via a remote interpreting service or an onsite appearance.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Demonstrates proficiency in two non-English spoken languages.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Is able to interpret effectively, accurately, and impartially, to and from two non-English languages using any necessary specialized vocabulary or terms without changes, omissions, or additions, and while preserving the tone, sentiment, and emotional level of the original oral statement. 
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client
						confidentiality.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								“Qualified translator” means a human translator who meets all of the following requirements:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Has demonstrated proficiency in writing and understanding both written English and at least one other written non-English language.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Is able to translate effectively, accurately, and impartially to and from a language and English using any necessary specialized vocabulary or terms without changes, omissions, or additions and while preserving the tone, sentiment, and emotional level of the original written statement. 
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Adheres to generally accepted interpreter ethics principles, including client confidentiality.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								“Relay interpretation” means interpreting from one language to another through an intermediate language, including interpretation used for monolingual speakers of languages of limited diffusion. In relay interpreting, the first interpreter listens to the speaker and renders the message into the intermediate language. The second interpreter receives the message in the intermediate language and interprets into a third language for the speaker who speaks neither the first nor second language.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_79C7EFD3-FC35-412A-923C-44844647C60E">
			<ns0:Num>SEC. 9.</ns0:Num>
			<ns0:ActionLine action="IS_AMENDED" ns3:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'PART'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'10133.10.'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
				Section 10133.10 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_B9027563-200D-412B-98CC-3EA8E6B16663">
					<ns0:Num>10133.10.</ns0:Num>
					<ns0:LawSectionVersion id="id_88ACC4EB-5318-4C99-BA60-3B67604C0479">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								A health insurer that markets, advertises, or produces educational materials for a health insurance policy, as defined in Section 106, in the individual or small group health insurance markets, or allows any other person or business to market or advertise on its behalf in the individual or small group health insurance markets, in a non-English language that does not meet the requirements set forth in Sections 10133.8 and 10133.9, shall provide the following documents in the same non-English language:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Welcome letters or notices of initial coverage, if applicable.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Applications for health insurance and any information pertinent
						to eligibility or participation, including communications related to costs and payment of covered services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notices advising limited-English-proficient persons of the availability of no-cost translation and interpretation services.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Complaint forms and notices pertaining to the right and instructions on how an insured may file a grievance or appeal.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Notices related to any termination of coverage and change in covered services. 
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								The uniform summary of benefits and coverage required pursuant to paragraph (2) of subdivision (a) of Section 10603.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								A health insurer shall use trained and qualified
						translators for the translation of all marketing and advertising materials relating to health insurance products and for all of the documents specified in subdivision (a).
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								This section shall not apply to a specialized health insurance policy that does not offer an essential health benefit as defined in Section 10112.27.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_5394379C-CC98-4805-8F70-2F2AFB837845">
			<ns0:Num>SEC. 10.</ns0:Num>
			<ns0:ActionLine action="IS_AMENDED" ns3:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'PART'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'10133.11.'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
				Section 10133.11 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_136729C4-634B-497B-B2EC-8F4480ADA592">
					<ns0:Num>10133.11.</ns0:Num>
					<ns0:LawSectionVersion id="id_3D824F8D-F7B6-4310-87D6-14575503C842">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								A health insurer shall notify insureds, persons seeking coverage, and members of the public of its policy of nondiscrimination, including all of the following information:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								The health insurer provides language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner pursuant to Section 10133.8, including how to access these services. This information shall be provided in the top 15 languages spoken by limited-English-proficient individuals in California as determined by the State Department of Health Care Services.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The health insurer provides
						appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner, when those aids and services are necessary to ensure an equal opportunity to participate for individuals with disabilities.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The health insurer does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								How to file a discrimination complaint with the
						health insurer, including the name, telephone number, address, and email address of the health insurer representative who may be contacted about the complaint, and how to submit the complaint to the department for investigation and review.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								How to file a discrimination complaint with the United States Department of Health and Human Services Office for Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The information required to be provided pursuant to this section shall be provided to an insured with individual coverage upon initial enrollment and annually thereafter upon renewal, and to insureds with group coverage upon initial enrollment and annually thereafter upon renewal. A health
						insurer may include this information with other materials sent to the insured. The information shall also be provided in the following manner:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								In a conspicuously visible location in the evidence of coverage.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								At least annually, in or with newsletters, outreach, or other materials that are routinely disseminated to the health insurer’s insureds.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								At a conspicuous place on the internet website published and maintained by the health insurer, in a manner that allows insureds, prospective insureds, and members of the public to easily locate the information.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Upon request.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								In clear and prominent physical locations, in font no smaller than 20-point sans serif font, where it is reasonable to expect individuals seeking service from a health insurer to be able to read
						or read and hear the notice.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								A health insurer shall incorporate a notice that contains a statement indicating the health insurer provides language assistance services, as described in paragraph (1) of subdivision (a), into all of the following written communications or forms, whether delivered by postal mail, electronically, or by other means, when a health insurer provides these written communications or forms:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								A notice of privacy practices, as required by Section 164.520 of Title 45 of the Code of Federal Regulations.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Application forms.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notice of termination, eligibility, benefits, or services, including an explanation of benefits, and notices of appeal and grievance rights.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Communications related to an individual’s rights, eligibility, benefits, or services that request a response from an insured or applicant for health care coverage.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								Communications related to a public health emergency. Communications related to a public health emergency that are delivered by text message, including short message service (SMS) or multimedia messaging service (MMS), may incorporate the notice of language assistance services, as described in paragraph (1) of subdivision (a), by referencing a uniform resource locator (URL) linked to the information.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Communications related to the cost and payment of care with respect to an individual including medical billing and collections
						materials, and good faith estimates required by Section 2799B-6 of the federal Public Health Service Act.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Complaint forms.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								Member and insured handbooks. 
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A specialized health insurance policy that is not a covered entity, as defined in Section 92.4 of Title 45 of the Code of Federal Regulations, subject to Section 1557 of the federal Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18116) may request a waiver from the requirements under this section.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The department shall not grant a waiver under this subdivision to a specialized health insurance policy that arranges for mental health or behavioral health benefits.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The department shall provide information on its internet website about any waivers granted under this subdivision.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								This section does not require an individual with limited English proficiency to accept language assistance services. 
							</html:p>
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			<ns0:Num>SEC. 11.</ns0:Num>
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					No reimbursement is required by this act pursuant to Section 6 of Article XIII
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					B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII
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					B of the California Constitution.
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