Comprehensive Description of Quality Management Program Elements

Date: 08/01/18

California Health & Wellness Plan’s (CHWP’s) quality improvement (QI) program is designed to monitor and evaluate the adequacy and appropriateness of health and administrative services on a continuous and systematic basis. The QI program includes the development and implementation of standards for clinical care and service, measurement of conformance to the standards, and implementation of actions to improve performance. The scope of the program includes:

• Quality improvement projects.
• Quality measures and surveys.
• Wellness and disease management.
• Integrated care management.
• Clinical practice and preventive health guidelines.
• Initial health assessments.
• Access to care.
• Medical record documentation standards.
• Medical record, facility site and physical accessibility reviews.
• Utilization management processes.
• Pharmaceutical management.
• Rights and responsibilities.
• Member appeals.
• Privacy and confidentiality.
• Interpreter services.

OPEN CLINICAL DIALOGUE

CHWP’s Provider Participation Agreement (PPA) includes a statement that participating providers can communicate freely with members regarding their medical conditions and treatment alternatives, including medication treatment options, regardless of coverage limitations.

QUALITY PERFORMANCE IMPROVEMENT PROJECTS

CHWP conducts quality performance improvement projects (PIPs) targeting specific health care issues that impact a significant number of members. PIPs may also address utilization of health services to enhance health outcomes and include testing small-scale change at the provider-, member- and health plan-level to ultimately improve the quality of members’ health care and outcomes.

Throughout 2017 and continuing in 2018, the current PIPs focus on child immunizations and controlling blood pressure. Both PIPs require frequent reporting to the Department of Health Care Services (DHCS) and specific expectations completing a process map, failure modes effect analysis, intervention analysis, and monthly progress monitoring. Depending on the progress of the initiatives, CHWP may expand the interventions across all counties. PIP evaluations are targeted in the third quarter of 2018.

QUALITY MEASURES AND SURVEYS

CHWP measures quality of care and services provided to members in a number of ways, including Healthcare Effectiveness Data and Information Set (HEDIS^®) performance measures for care and service, the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) for member satisfaction, member appeals and grievances, and access and availability surveys. In addition, CHWP conducts an annual provider satisfaction survey to identify opportunities to better serve its participating providers.

The Department of Health Care Services (DHCS) uses a performance-based auto-assignment algorithm for managed care plans in Two-Plan and Geographic Managed Care counties. Distribution of Medi-Cal default enrollment is determined based in part on comparative plan performance on six HEDIS measures. The following six key preventive measures support DHCS and CHWP’s interest in quality of care and service for our members:

• Well-child visits for members ages three to six (annually) per the American Academy of Pediatrics (AAP) guidelines.
• Childhood immunizations, including four DTP, three IPV, one MMR, three HIB, three Hep B, one VZV, and four pneumococcal vaccines by the child’s second birthday.
• Prenatal care visits (first visit is within the first trimester).
• Cervical cancer screening for females ages 21 to 64 (Pap test performed at least every one to three years).
• Comprehensive diabetes care for hemoglobin A1c testing.
• Controlling blood pressure (BP) less than 140/90 for ages 18 to 59 and ages 60 to 85 with diabetes, and when BP is less than 150/90 for ages 60 to 85 without diabetes.

Appropriate timeliness of services, outreach to members, clinical documentation, correct coding, as well as timely and complete encounter submissions are important elements of meeting preventive care guidelines. CHWP offers provider office training materials, member outreach calls, member newsletters, and an online provider newsletter all designed to help providers and members accomplish these preventive measures.

DISEASE MANAGEMENT PROGRAM

The Disease Management program provides disease-specific management for members with asthma, diabetes, hypertension, lower back pain, heart failure (HF), and more. The goal of CHWP’s Disease Management program is to utilize telephonic outreach, education and support services to improve member knowledge and self-management of these diseases leading to lower risk, improved quality of life, and overall better functional status. Additionally, the program aims to empower members to manage their diseases in accordance with nationally recognized evidence-based guidelines published by the National Institutes of Health and to ensure that members receive necessary screenings and monitoring services.

CHWP sends an introductory mailing to all targeted members and health plan physicians announcing the program and informing members they will receive a phone call. CHWP health coaches conduct outbound telephonic outreach to identify clinical risk, education needs and assign the member to the appropriate health coach for an individualized care plan.

Providers should use the CHWP Case Management Referral Form referenced in the Integrated Care Management section of this update to refer members. Members may also self-refer into the program or may opt out of this program at any time.

ADULT WEIGHT MANAGEMENT PROGRAM

CHWP offers the weight management program to members ages 18 and older who have a body mass index (BMI) of 25 or greater. The program provides telephonic outreach, education and support services to eligible members to reduce the risk of obesity-related health concerns (heart disease, diabetes and certain cancers) by reducing weight, promoting regular physical activity, and improving dietary intake. The health coach will complete an assessment and develop an individualized care plan based on the member's knowledge of their condition, lifestyle behaviors and education needs. Members who decline telephonic coaching programs or are lost to follow-up may call in at any time to speak with a health coach to ask questions regarding their condition and/or to enroll in telephonic coaching. Eligible members are identified for

enrollment by health plan physicians, health risk assessments and case management referrals. Eligible members may also self-enroll into the program by calling Member Services at 1-877-658-0305.

TOBACCO CESSATION PROGRAM

CHWP has partnered with the California Smokers’ Helpline to provide its tobacco cessation program for its members. The program offers free telephone counseling, self-help materials and online help in six languages (English, Spanish, Cantonese, Mandarin, Korean, and Vietnamese) to help members quit smoking and stay tobacco-free. CHWP members can enroll in the telephonic tobacco cessation program by calling the California Smokers’ Helpline at 1-800-662-8887 or 1-800-NO-BUTTS, or online at www.nobutts.org/Medi-Cal. Members may request a referral to group counseling by calling the Health Education Department at 1-800-804-6074. The program provides additional support through texting. Members receive customized daily texts during the first important weeks of quitting and staying tobacco-free. Members may enroll at nobutts.org/ and select Texting Program.

CHWP members who are using tobacco products, and are willing to set a quit date within 30 days, could also participate in the CHWP tobacco cessation program. The program provides telephonic outreach, education, and support services to reduce the risk of tobacco-related health conditions, such as hypertension, heart disease and certain cancers, by promoting cessation of all tobacco products. Eligible members can self-refer to the program by calling Member Services at 1-877-658-0305. Members may also be identified and referred into the program by health plan physicians, case managers or other health plan programs.

PUFF FREE PREGNANCY PROGRAM

CHWP provides the Puff Free Pregnancy Program to pregnant members who use tobacco products and plan to quit within 30 days. The program provides telephonic outreach, education and support services to reduce the health risks associated with smoking during pregnancy, such as low birth weight and perinatal mortality, by reducing the use of tobacco products. Eligible members are identified through the Notification of Pregnancy Report. Eligible members may also be referred to the program by a health plan physician or case manager. Members can self-refer into the program by calling Member Services at 1-877-658-0305.

ELECTRONIC HEALTH EDUCATION PROGRAMS

T2X is a Web and mobile technology platform that educates and motivates individuals to adopt healthier lifestyles by addressing topics, such as nutrition, fitness, smoking cessation, depression, vaccination, anti-bullying, and sexual health. The goal of T2X is to increase participants’ capacity to access and appropriately use their health coverage, become more engaged in their health care and health behavior decisions, and develop pro-health attitudes. Individuals ages 13 and older, regardless of health coverage status, can join for free online at www.t2x.me.

CASE MANAGEMENT PROGRAM

Case management is available to eligible CHWP members. The goal of case management is to address the holistic needs of each member through their individual continuum of health care. There are different levels of case management within the case management program, designed to address the varying complexity of the member’s needs.

Complex Case Management

Complex case management focuses on members identified as having multiple comorbidities, being at high risk for hospitalizations or poor outcomes, or in need of extensive use of resources related to catastrophic illness or injury (such as transplants, HIV/AIDS, cancer, serious motor vehicle accidents), and high-risk pregnancy. This criteria is not all inclusive; clinical judgment is used to determine a member’s appropriateness for each level of case management, considering such factors as stability of the condition(s), available support system and current place of residence. The program utilizes a member-focused, goal-directed, evidence-based approach to develop, implement and monitor the care plan. Trained nurse care managers and licensed clinical social workers, in collaboration with a multidisciplinary team, provide coordination, education and support to the member in achieving optimal health, enhancing quality of life, and accessing appropriate services.

Case Management

Case management is appropriate for members needing a higher level of service, with clinical needs. Members in case management may have a complex condition or multiple comorbidities that are generally well managed. Members in case management typically have adequate family or other caregiver support and are in need of moderate to minimal assistance from a care manager. Services included at this level of case management include the level of coordination along with identification of member agreed-upon goals and progress towards meeting those goals.

Care Coordination

Care coordination is designed to assist members with primarily psychosocial issues, such as housing, financial, lack of family or social support, with need for referrals to community resources, or assistance with accessing health care services. In addition, this level of case management is used for continuity of care transitions and supplemental support for members managed by the county. Care coordination typically involves non-clinical activities performed by non-clinical staff. Clinical staff may provide assistance if minor medical or behavioral health concerns arise.

Program Components

This program supports CHWP members, families and caregivers by coordinating care and facilitating communication between health care providers. Once a member is selected to participate in the program, a care manager contacts the member’s primary care physician (PCP) to coordinate care. This helps facilitate an appropriate personalized level of care for members, which may include:

• Telephonic and face-to-face (as needed) interactions.
• Comprehensive assessment of medical, psychosocial, cognitive, medication adherence, and durable medical equipment (DME) needs.
• Development of an individual care treatment plan in collaboration with the member and the health care team that reflects the member’s ongoing health care needs, abilities and preferences.
• Consolidation of treatment plans from multiple providers into a single plan of care to avoid fragmented or duplicative care.
• Coordination of treatment plans for acute or chronic illness, including emotional and social support issues.
• Coordination of resources to promote the member’s optimal health or improved functionality with referrals to other team members or programs as appropriate.
• Education and information about medical conditions and self-management skills, compliance with the medical plan of care, and other available services to reduce readmissions and inappropriate utilization of services.
• Communication to the provider and medical home.

On an ongoing basis, CHWP evaluates the efficacy of this program by reviewing and comparing specific member outcomes and utilization before and after case management intervention.

Referrals

Providers may refer a member by faxing the completed Care Management Referral Form to 1-855-556-7909 or mailing it to California Health & Wellness, 1740 Creekside Oaks Drive, Suite 200, Sacramento, CA 95833. The Care Management Referral Form is available on www.cahealthwellness.com/providers under Provider Resources > Manuals, Forms and Resources > Forms. Members may self-refer to the program by calling CHWP at 1-877-658-0305, option 1 and request Case Management.

CLINICAL PRACTICE GUIDELINES

CHWP’s evidence-based clinical practice guidelines are from nationally recognized sources and form the foundation for its disease management programs. All guidelines are reviewed and updated at least biannually and when new scientific evidence or national standards are published. Centene’s Corporate Clinical Policy Committee and the California Health & Wellness Medical Advisory Council (MAC) adopt the clinical practice guidelines and tools, which are available at www.cahealthwellness.com under For Providers > QI Program > Practice Guidelines. Guideline sources include, but are not limited to, the following:

• Disease management – Clinical guidelines and overview summaries are available for providers to quickly reference information about chronic conditions, which include asthma, diabetes and HF. Sources are found within the guidelines.
• Behavioral health – Clinical guidelines are available for such disorders as attention deficit hyperactivity disorder (ADHD) and substance use disorder.

PREVENTIVE HEALTH GUIDELINES

CHWP recommends that participating providers follow the preventive guidelines adopted from the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), and the American Academy of Family Physicians (AAFP) in the treatment of adult, senior, prenatal, and postpartum members. The guidelines of AAP and the Advisory Committee for Immunization Practices (ACIP) are recommended for the preventive care and treatment of infants, children and adolescents. A member’s medical history and physical examination may indicate that further medical tests are needed. As always, the judgment of the treating physician is the final determinant of member care.

Current recommended guidelines of the specialty boards, academies and organizations used in the development of

CHWP preventive health guidelines are available on the following websites:

• USPSTF – www.uspreventiveservicestaskforce.org
• CDC – www.cdc.gov
• ACOG – www.acog.org
• ACS – www.cancer.org
• AAP – www.aap.org
• AAFP – www.aafp.org

INITIAL HEALTH ASSESSMENTS

New Medi-Cal members must receive an initial health assessment (IHA), which includes an age-appropriate history, physical examination and Individual Health Education Behavioral Assessment (IHEBA) within 120 days after the date of enrollment. In addition to assessing the member’s health, this examination should be used to determine health practices, values, behaviors, knowledge, attitudes, cultural practices, beliefs, literacy levels, and health education needs.

Members under age 18 months require a health assessment within periodicity timelines established by AAP for ages two and younger, whichever is less. All new pediatric plan members receive preventive services in accordance with the AAP Periodicity Table for Wellness Examination. Newly enrolled adult plan members receive preventive services in accordance with the latest edition of the Clinical Preventive Services published by USPSTF.

DHCS’s approved IHEBA is the Staying Healthy Assessment (SHA). The SHA is the established assessment tool that enables PCPs to assess Medi-Cal members’ current acute, chronic and preventive health needs. The SHA includes standardized questions to assist PCPs in:

• Identifying and tracking high-risk behaviors of individual Medi-Cal members.
• Assigning priority to individual health education needs related to lifestyle, behavior, environment, culture, and language.
• Initiating discussion and counseling regarding high-risk behaviors.
• Providing tailored health education counseling, interventions, referrals, and follow-up care.

All SHA questionnaires must include the PCP’s name, signature and date. The SHA should be completed at age-related intervals, as appropriate. If a member refuses to complete the SHA, the PCP must make note of the refusal in the member’s medical record.

Providers can access SHA training and download or print electronic versions of the SHA directly from the DHCS website at www.dhcs.ca.gov/formsandpubs/forms/pages/stayinghealthy.aspx, where it is available in nine threshold languages. The SHA is also available in Farsi and Khmer at www.cahealthwellness.com/providers/resources/forms-resources.html.

Providers are encouraged to contact the Health Education Department at 1-800-804-6074 for more information about SHA.

NOTICE OF ACCESS STANDARDS

CHWP has established access and availability standards, reviewed and revised annually as needed, that strive to ensure compliance with all applicable state, federal, regulatory, and accreditation requirements, and that members have a comprehensive provider network and timely access to care.

CHWP is committed to monitoring the network and evaluating whether members have sufficient access to practitioners and providers who meet members’ care needs. These include timeliness standards for waiting times for regular and routine appointments, urgent care appointments and after-hours care, as well as provisions for appropriate back-up for absences. The access standards are reviewed annually against applicable state and federal regulations and mandates, and are revised as needed. CHWP recommends providers review these periodically. Additionally, CHWP makes after-hours scripts available that include examples on how to implement the script for live voice, auto attendant or answering machine messaging.

The complete set of access standards and revised after-hours scripts are available on www.cahealthwellness.com under For Providers > Provider Resources. Providers who do not have access to the Internet may contact the CHWP Provider Services Center to request printed copies of these standards and after-hours scripts.

MEDICAL RECORD DOCUMENTATION STANDARDS

CHWP has established standards for the administration of medical records to ensure medical records conform to good professional medical practice, support health management and permit effective member care. A good medical records management system not only provides support to clinical participating providers in the form of efficient data retrieval but also makes data available for statistical and quality of care analyses.

The medical record serves as a detailed analysis of the member’s history, a means of communication to assist the multidisciplinary health care team in providing quality medical care, a resource for statistical analysis, and a potential source of defense to support information in a lawsuit. It is the participating provider’s responsibility to ensure not only completeness and accuracy of content but also the confidentiality of the health record. CHWP requires that the provider adhere to the standards for maintaining member medical records and to safeguard the confidentiality of medical information.

Participating providers are responsible for responding to demands for information while protecting the confidentiality interests of CHWP members. All participating providers must have policies and procedures that address confidentiality and the consequences of improper disclosure of protected health information (PHI). Providers should refer to www.cahealthwellness.com under For Providers > Provider Resources > Manuals, Forms and Resources > Manuals > Provider Manual/Billing Manual to review specific levels of security of medical records that must be addressed by the participating provider’s policies and procedures governing the confidentiality of medical records and the release of members’ PHI.

CHWP monitors medical record documentation compliance and implements appropriate interventions to improve medical recordkeeping. Medical record guidelines are available through www.cahealthwellness.com or upon request by contacting CHWP Provider Services.

MEDICAL RECORD AND FACILITY SITE REVIEWS

CHWP’s Facility Site Review Compliance Department conducts periodic medical record reviews (MRRs) and facility site reviews (FSRs) to measure PCP compliance with current DHCS medical record documentation and facility standards. These reviews are initially conducted prior to assignment of Medi-Cal members and then periodically every three years thereafter in accordance with DHCS requirements, or as needed for monitoring, evaluation or corrective action plan (CAP) issues. In an effort to decrease duplicative MRRs and FSRs and minimize the disruption of patient care at participating provider offices, CHWP and all other Medi-Cal managed care plans are required to collaborate in conducting FSRs and MRRs. On a county-by-county basis, the plans cooperatively determine which plan is responsible for performing a single audit of a PCP and administering a CAP when necessary. The responsible plan shares the audit results and CAP with the other participating health plans to avoid redundancy.

DHCS reviews the results of CHWP’s site reviews and may also audit a random sample of provider offices to ensure that they meet DHCS standards. Detailed information about audit criteria, compliance standards, scoring, and CAPs is available at www.cahealthwellness.com.

PHYSICAL ACCESSIBILITY REVIEW SURVEYS

A component of the FSR is the Physical Accessibility Review Survey (PARS). PARS is conducted for participating PCPs, high-volume specialists, ancillary providers, community-based adult services (CBAS) providers, and hospitals. All PCP sites must undergo PARS. Based on the outcome of PARS, each PCP, high-volume specialist, ancillary, CBAS or hospital provider site is designated as having basic or limited access along with the six specific accessibility indicator designations for parking, exterior building, interior building, restrooms, examination rooms, and medical equipment (accessible weight scales and adjustable examination tables).

Basic access demonstrates facility site access for members with disabilities to parking, building access, elevator, physician’s office, examination rooms, and restrooms. Limited access demonstrates facility site access for members with disabilities as missing or incomplete in one or more features for parking, building access, elevator, physician’s office, examination rooms, and restrooms.

Results of PARS are made available in the provider directory, health plan website and to CHWP’s Member Services Department to assist members with selecting a PCP who can best serve their health care needs.

UTILIZATION MANAGEMENT

To determine medical appropriateness, CHWP uses recognized guidelines and criteria sets that are clearly documented, based on sound clinical evidence and include procedures for applying criteria based on the needs of individual CHWP members and characteristics of the local delivery systems. CHWP uses the following criteria:

• Title 22 of the California Code of Regulations (CCR).
• Medi-Cal Managed Care Division (MMCD) policy letters.
• DHCS Manual of Criteria for Medi-Cal Authorization.
• DHCS Medi-Cal Provider Manuals.
• Hayes Medical Technology Directory.
• InterQual^® Care Planning Criteria.
• Centene clinical policies and CHWP medical policies.
• California Health & Wellness’s Medi-Cal contract with DHCS.

When a decision results in a denial, the criteria used to arrive at the determination are identified in the denial letter. Each denial letter explains CHWP’s appeal process. A CHWP physician reviewer is available to discuss denial decisions. Copies of specific CHWP criteria are available on request by contacting CHWP Provider Services at 1-877-658-0305. Participating providers contracting with the Community Care Independent Practice Association (CCIPA) must contact the CCIPA’s utilization management (UM) department for the UM criteria.

Under California Health & Safety Code Section 1367(g), medical decisions regarding the nature and level of care to be provided to members, including the decision of who renders the service (for example, PCP instead of specialist, or in-network provider instead of out-of-network provider), must be made by qualified medical providers, unhindered by fiscal or administrative concerns.

Providers may contact CHWP’s UM staff through the Provider Services Center at 1-877-658-0305. CCIPA providers must contact UM staff through the CCIPA.

UM decisions are based only on appropriateness of care, service and existence of coverage. CHWP does not specifically reward participating providers or other individuals for issuing denials of coverage for care or service. There are no financial incentives for UM decision-makers to encourage decisions that result in underutilization.

PHARMACY MANAGEMENT

CHWP pharmaceutical management includes the CHWP Preferred Drug List (PDL) and prior authorization criteria. This information is available to members and participating providers. The CHWP PDL serves as a reference for physicians to use when prescribing pharmaceutical products for CHWP members. It provides a comprehensive selection across therapeutic classes. Unlike the state Medi-Cal list of contract medications, the CHWP PDL does not limit prescriptions to six per month. In addition, select over-the-counter (OTC) medications comparable to those approved by DHCS are covered on the CHWP PDL, and generic medications are not limited to selected manufacturers. Providers can access the CHWP PDL and other provider resources at www.cahealthwellness.com/providers/pharmacy.

The CHWP Pharmacy & Therapeutics (P&T) Committee maintains the CHWP PDL. The P&T Committee, which consists of actively practicing pharmacists and practitioners, evaluates the safety profile, effectiveness and affordability of the medications. The medications listed are approved by the U.S. Food and Drug Administration (FDA) and are reviewed by the P&T committee. The CHWP PDL is continually reviewed and revised in response to recommendations from participating providers and as new clinical data and medication products become available.

RIGHTS AND RESPONSIBILITIES

CHWP is committed to treating members in a manner that respects their rights, recognizes their specific needs and maintains a mutually respectful relationship. In order to communicate this commitment, CHWP has adopted member rights and responsibilities, which apply to members’ relationships with CHWP, its practitioners and providers, and all other health care professionals providing care to its members. The member rights and responsibilities are available at www.cahealthwellness.com under Member Resources > Member Rights and Responsibilities, or upon request by contacting CHWP Provider Services.

MEMBER APPEALS

A member or member representative who believes that a determination or application of coverage is incorrect has the right to file an appeal. CHWP responds to standard appeals within 30 calendar days. A 72-hour appeal resolution is available if waiting could seriously harm the member’s health.

Additionally, a Medi-Cal member may request a fair hearing from the California Department of Social Services (DSS) at any time during the appeal process by calling the Public Inquiry and Response Unit at 1-800-952-5253 (TTY: 1-800-952-8349) or in writing via mail or secure fax to:

California Department of Social Services

State Hearings Division

Mail Station 19-17-37, PO Box 944243

Sacramento, CA 94244-2430

Fax: (916) 229-4110

In addition to the appeal process described above, members may contact the California Department of Managed Health Care (DMHC). DMHC is responsible for regulating health care service plans. DMHC receives complaints and inquiries about health plans via a toll-free number at 1-888-466-2219 (TTY: 1-877-688-9891). DMHC’s website has complaint forms and instructions online at www.dmhc.ca.gov. CHWP does not delegate member grievances or appeals. All grievances and appeals should be forwarded immediately to the CHWP Medi-Cal Member Services Department.

PRIVACY AND CONFIDENTIALITY

CHWP members’ PHI, whether it is written, oral or electronic, is protected at all times and in all settings. CHWP practitioners and providers can only release PHI without authorization when:

• Needed for payment.
• Necessary for treatment or coordination of care.
• Used for health care operations (including, but not limited to, HEDIS reporting, appeals and grievances, utilization management, quality improvement, and disease or care management programs).
• Where permitted or required by law.

Any other disclosure of a CHWP member’s PHI must have a prior, written member authorization.

Particular care must be taken, as confidential PHI may be disclosed intentionally or unintentionally through many means, such as conversation, computer screen data, faxes, or forms. Participating providers must maintain the confidentiality of member information pertaining to the member’s access to these services. CHWP requires the CCIPA to obtain Health Insurance Portability and Accountability Act (HIPAA) Business Associate agreements from people or organizations with which the CCIPA contracts to provide clinical and administrative services to members.

Special authorization is required for uses and disclosures involving sensitive conditions, such as psychotherapy notes, AIDS or substance abuse. To release a member’s PHI regarding sensitive conditions, CHWP participating providers must obtain prior, written authorization from the member (or authorized representative) that states information specific to the sensitive condition may be disclosed.

INTERPRETER SERVICES

Interpreter services are available at no cost to CHWP members and providers without unreasonable delay at all medical points of contact. The member has the right to file a complaint or grievance if linguistic needs are not met.

Provider Guidelines

• Providers may not request or require an individual with limited English proficiency (LEP) to provide his or her own interpreter.
• Providers may not rely on staff other than qualified bilingual/multilingual staff to communicate directly with individuals with LEP.
• Providers may not rely on an adult or minor child accompanying an individual with LEP to interpret or facilitate communication.
• A minor child or an adult accompanying the patient may be used as an interpreter in an emergency involving an imminent threat to the safety or welfare of the individual or the public where there is no qualified interpreter for the individual with LEP immediately available.
• An accompanying adult may be used to interpret or facilitate communication when the individual with LEP specifically requests that the accompanying adult interpret, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances.
• Providers are encouraged to document in the member’s medical record the circumstances that resulted in the use of a minor or accompanying adult as an interpreter.

To obtain interpreter services, members and providers can contact the Customer Contact Center at the telephone number located on the member’s ID card.

ADDITIONAL INFORMATION

If you have questions regarding the information contained in this update, contact your Provider Relations representative or call 1-877-658-0305.