Contractor shall conduct a group needs assessments, as specified below, to identify the health education and cultural and linguistic needs of its’ Members; and utilize the findings for continuous development and improvement of contractually required health education and cultural linguistic programs and services. Contractor must use multiple reliable data sources, methodologies, techniques, and tools to conduct the group needs assessment.
1) Contractor shall conduct an initial group needs assessment (GNA) within 12 months from the commencement of operations within a Service Area and at least every five (5) years from the
commencement of operations thereafter. For Contracts existing at the time this provision becomes effective, the next GNA will be required at a time within the five (5) year period from the effective date of this provision, to be determined by DHCS.
2) Contractor shall submit a GNA Summary Report to the DHCS within six (6) months of the completion of each GNA. The summary report must include:
a) The objectives; methodology; data sources; survey
instruments; findings and conclusions; program and policy implications; and references contained in the GNA.
b) The findings and conclusions must include the following information for Medi-Cal plan Members: 1) demographic profile; 2) related health risks, problems and conditions; 3) related knowledge, attitudes and practices including cultural beliefs and practices; 4) perceived health education needs including learning needs, preferred methods of learning and literacy level; and 5) culturally competent community
resources.
3) Contractor shall annually update the GNA summary report,
including a current update on the information required in item 2) b) above. Contractor shall maintain, and have available for DHCS review, the GNA summary report updates.
4) Contractor shall demonstrate that GNA and summary report findings and conclusions in item 2) b) above are utilized for continuous development of its health education and cultural and linguistic services program. Contractor must maintain
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program goals/objectives as they are revised to meet the identified and changing needs of the Member population.
D. The results of the group needs assessment shall be considered in the development of any Marketing materials prepared by the Contractor. E. Cultural Competency Training
Contractor shall provide cultural competency, sensitivity, or diversity training for staff, providers and subcontractors at key points of contact. The training shall cover information about the identified cultural groups in the Contractor’s Service Areas, such as the groups’ beliefs about illness and health; methods of interacting with providers and the health care structure; traditional home remedies that may impact what the provider is trying to do to treat the patient; and, language and literacy needs.
F. Program Implementation and Evaluation
Contractor shall develop and implement policies and procedures for assessing the performance of individuals who provide linguistic services as well as for overall monitoring and evaluation of the Cultural and Linguistic Services Program.
14. Linguistic Services
A. Contractor shall comply with Title 22 CCR Section 53853(c) and ensure that all monolingual, non-English-speaking, or limited English proficient (LEP) Medi-Cal beneficiaries and potential members receive 24-hour oral interpreter services at all key points of contact, as defined in Paragraph D of this provision, either through interpreters, telephone language services, or any electronic options Contractor chooses to utilize. Contractor shall ensure that lack of interpreter services does not impede or delay timely access to care.
B. Contractor shall provide, at minimum, the following linguistic services at no cost to Medi-Cal Members or potential members:
1) Oral Interpreters, signers, or bilingual providers and provider staff at all key points of contact. These services shall be provided in all languages spoken by Medi-Cal beneficiaries and not limited to those that speak the threshold or concentration standards languages.
2) Fully translated written informing materials, including but not limited to the Member Services Guide, enrollee information, welcome packets, marketing information, and form letters including notice of
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action letters and grievance acknowledgement and resolution letters. Contractor shall provide translated written informing materials to all monolingual or LEP Members that speak the identified threshold or concentration standard languages. The threshold or concentration languages are identified by DHCS within the Contractor’s Service Area, and by the Contractor in its group needs assessment.
3) Referrals to culturally and linguistically appropriate community service programs.
4) Telecommunications Device for the Deaf (TDD)
TDDs are electronic devices for text communication via a telephone line used when one or more of the parties have hearing or speech difficulties. TDDs are also known as TTY, which are telephone typewriters or teletypewriters, or teletypes in general
C. Contractor shall provide translated materials to the following population groups within its Service Area as determined by DHCS:
1) A population group of mandatory Medi-Cal beneficiaries residing in the Service Area who indicate their primary language as other than English, and that meet a numeric threshold of 3,000.
2) A population group of mandatory Medi-Cal beneficiaries residing in the Service Area who indicate their primary language as other than English and who meet the concentration standards of 1,000 in a single zip code or 1,500 in two contiguous zip codes.
D. Key points of contact include:
1) Medical care settings: telephone, advice and urgent care
transactions, and outpatient encounters with health care providers including pharmacists.
2) Non-medical care setting: Member services, orientations, and appointment scheduling.
15. Community Advisory Committee
Contractor shall form a Community Advisory Committee (CAC) pursuant to Title 22 CCR Section 53876 (c) that will implement and maintain community
partnerships with consumers, community advocates, and Traditional and Safety- Net providers. Contractor shall ensure that the CAC is included and involved in
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policy decisions related to educational, operational and cultural competency issues affecting groups who speak a primary language other than English. 16. Out-of-Network Providers
A. If Contractor’s network is unable to provide necessary services covered under the Contract to a particular Member, Contractor must adequately and timely cover these services out of network for the Member, for as long as the entity is unable to provide them. Out-of-network providers must coordinate with the entity with respect to payment. Contractor must ensure that cost to the Member is not greater than it would be if the services were furnished within the network.
B. Contractor shall provide for the completion of covered services by a terminated or out-of-network provider at the request of a Member in accordance with the continuity of care requirements in Health and Safety Code Section 1373.96.
C. For newly enrolled SPD beneficiaries who request continued access, Contractor shall provide continued access for up to 12 months to an out- of-network provider with whom they have an ongoing relationship if there are no quality of care issues with the provider and the provider will accept Contractor or Medi-Cal FFS rates, whichever is higher, in accordance with W & I Code 14182(b)(13) and (14).An ongoing relationship shall be
determined by the Contractor identifying a link between a newly enrolled SPD beneficiary and an out-of-network provider using FFS utilization data provided by DHCS.
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