WSR 98-15-054




(Medical Assistance Administration)

[Filed July 10, 1998, 9:28 a.m., effective July 10, 1998]

Date of Adoption: July 10, 1998.

Purpose: To codify into WAC existing policies regarding interpreter services for limited-English proficient, deaf, blind, and hard of hearing clients.

Statutory Authority for Adoption: RCW 74.04.050, 74.08.090.

Other Authority: RCW 74.04.025, 45 CFR Sec. 80.1 and 80.03; 45 CFR Sec. 605.52; 28 CFR, part 35.

Adopted under notice filed as WSR 98-10-107 on May 6, 1998.

Changes Other than Editing from Proposed to Adopted Version: A definition of "client" was added to WAC 388-555-1000 for clarification purposes.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 9, amended 0, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 9, amended 0, repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 9, amended 0, repealed 0.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: The earlier effective date of July 10, 1998, is necessary because the emergency rule expires on July 11, 1998. Without a rule in place, the department's ability to continue to provide interpreter services to MAA clients would be jeopardized and, therefore, would imperil the health and welfare of the public, per RCW 34.05.380 (3)(c). With limited funding, MAA must codify its policies to assure funds for the program do not run out.

Effective Date of Rule: July 10, 1998.

July 10, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit


Chapter 388-555 WAC



WAC 388-555-1000  Definitions. For the purposes of this chapter, the following definitions apply:

"Client" means any individual who has been determined eligible for medical or health care services for any of the medical assistance administration (MAA) programs.

"Consecutive appointments" means appointments beginning or scheduled to begin within fifteen minutes of the last completed appointment.

"Family member" means any person who is related to the client: a spouse, child, grandmother, grandfather, grandchild, mother, father, sister, brother, cousin, niece, nephew, aunt, uncle, step relations and/or in-laws.

"Federally qualified health center" (FQHC) means:

(1) A facility that is receiving grants under section 329, 330, or 340 of the Public Health Services Act; or

(2) Receiving such grants based on the recommendation of the Health Resources and Services Administration within the Public Health Service as determined by the secretary to meet the requirements for receiving such a grant; or

(3) A tribe or tribal organization operating outpatient health programs or facilities under the Indian Self Determination Act (P.L. 93-638). Only Health Care Financing Administration-designated FQHCs will be allowed to participate in MAA's Medicaid program.

"Independent interpreter" means any fluent, bilingual/multilingual person, certified by language interpretation services and translation (LIST) in medical terminology, who provides interpreter services for payment and who is not employed by, or a contractor of, any interpreter agency enrolled with MAA. Independent interpreter also means any person fluent in American Sign Language, certified by the National Association for the Deaf (NAD) or Registry for Interpreters for the Deaf (RID).

"Interpreter" means a person who speaks English and another language fluently or signs American Sign Language fluently. Fluency includes an understanding of nonverbal and cultural patterns necessary to communicate effectively. An interpreter enables clients and medical/health care providers to communicate effectively with each other.

"Interpreter agency" means a business entity, organized under and permitted to operate by the laws of the state of Washington, which offers as one of its main objectives or purposes to procure interpreter services by employing or contracting with bilingual/multilingual persons on a permanent or part-time basis to provide medical interpreter services for payment to MAA clients. For purposes of this chapter, interpreter agency does not include:

(1) A business entity that employs a person exclusively or regularly to perform other duties, or to perform interpreter services solely in connection with the affairs of that employer; or

(2) A person who is self-employed and is the only bilingual/multilingual employee contracting for the purpose of providing interpreter services to others.

"Language interpretation services and translation" (LIST) means the section within the department of social and health services (DSHS) that is responsible for certifying and qualifying spoken language interpreters.

"Limited English proficient (LEP)" means a limited ability or an inability to speak, read, or write English well enough to understand and communicate effectively in normal daily activities. The client decides whether he/she is limited in his/her ability to speak, read, or write English.

"Primary language" means the language identified by the client as the language in which he/she wishes to communicate. This may also be referred to as the preferred language.

"Qualified interpreter for American Sign Language" means a certified NAD, RID, or noncertified interpreter who is determined to be competent, both receptively and expressively by the consumer to be qualified to effectively meet his/her communication needs, both receptively and expressively.

"Qualified interpreter for spoken languages" means an interpreter who has passed DSHS screening tests in languages other than the DSHS certificated languages as specified in RCW 74.04.025.

"Unit" means a billable amount of time for interpreter services equal to fifteen minutes.



WAC 388-555-1050  Covered services. Interpreters and/or interpreter agencies shall receive payment for interpreter services that are:

(1) Provided for a client who is:

(a) Deaf;

(b) Deaf-blind;

(c) Hard of hearing; or

(d) Limited English proficient.

(2) Provided during a necessary medical service performed by an eligible provider; and

(3) Covered under a MAA program for which the client is eligible. For exceptions, see WAC 388-555-1100, Noncovered services.



WAC 388-555-1100  Noncovered services. Interpreters and/or interpreter agencies shall not receive payment from MAA for interpreter services related to:

(1) Inpatient hospital services;

(2) Nursing facility services;

(3) Community mental health center services;

(4) The provision of any noncovered service;

(5) Interpreter services funded or paid for by any other source;

(6) Interpreter services provided by an interpreter to the interpreter's own family members;

(7) Any person other than an eligible MAA client;

(8) Medical assistance client no-shows;

(9) The interpreter's failure to appear for scheduled services;

(10) The interpreter's transportation costs or travel time;

(11) Waiting time before the scheduled appointment; or

(12) Any block of time when interpreter services are not required by the medical provider to communicate with a medical assistance client.



WAC 388-555-1150  Eligible providers. (1) To provide services other than at FQHCs, independent interpreters and/or interpreter agencies are considered eligible providers when they:

(a) Are enrolled with MAA to provide interpreter services;

(b) Meet the criteria in WAC 388-87-007, Medical provider agreement, and WAC 388-87-010, Conditions of payment--General.

(2) To enroll as an independent interpreter for MAA clients, interpreters shall submit the following to the department:

(a) Proof of certification which may be either:

(i) Number and date of medical certificate from LIST; or

(ii) A copy of a RID or NAD certificate for certified sign language interpreters.

(b) A Social Security Number, if the interpreter has one;

(c) A completed interpreter services core provider agreement;

(d) A signed confidentiality pledge;

(e) A completed provider information form; and

(f) Verification of errors and omissions liability insurance at or over one hundred thousand dollars per occurrence.

(3) To enroll with MAA as an interpreter agency, the agency shall submit to the department:

(a) A completed interpreter services core provider agreement;

(b) Verification of errors and omissions liability insurance at or over one million dollars per occurrence;

(c) A completed provider information form; and

(d) A list of interpreters employed/contracted to provide services to MAA clients, including the following information for each interpreter:

(i) A signed confidentiality pledge; and

(ii) Number and date of medical certificate from LIST; or

(iii) A copy of a current RID or NAD certificate for certified sign language interpreters or written description of evaluation process for qualified interpreter status.

(4) To qualify as an eligible provider, an interpreter agency shall have the capacity to provide interpreter services in:

(a) American Sign Language; or

(b) At least three spoken languages; or

(c) Fewer than three spoken languages if the languages provided are reflective of a majority of the LEP clients residing within the county(ies) served by the agency. DSHS reports will be used to identify the languages needed in the demographic area.



WAC 388-555-1200  Provider requirements. (1) An interpreter or interpreter agency shall not determine the need for interpreter services, nor shall the interpreter market interpreter services to MAA clients. See WAC 388-555-1250, Coordination of services.

(2) An interpreter or interpreter agency shall not require a client to obtain interpreter services exclusive of other interpreters or interpreter agencies.

(3) An interpreter or interpreter agency shall adhere to department policies and procedures regarding confidentiality of client records as stated in WAC 388-501-0150.

(4) An independent interpreter shall enroll with the department as provided in WAC 388-555-1100 and obtain a current medical assistance provider number.

(5) An interpreter or interpreter agency must participate in an orientation which will be scheduled and given by MAA within their first year of contracting with the department. The department may terminate contracts with any provider who does not participate in the orientation.

(6) Interpreter agencies shall assume full legal and financial liability for interpreter services provided by employees and contractors.



WAC 388-555-1250  Coordination of services. An interpreter and/or interpreter agency shall:

(1) Coordinate appointment dates and times with the medical provider and the client as requested by the medical provider; and

(2) Notify the medical provider of any changes to scheduled appointments at least twenty-four hours in advance.



WAC 388-555-1300  Payment. (1) Eligible interpreters and/or interpreter agencies shall only provide services when the following conditions are met:

(a) The client or the medical provider determines that an interpreter is necessary in order for the client to appropriately access necessary medical and health care services covered by the client's medical assistance program;

(b) The medical provider has informed the client that interpreter services are available at no cost to the client; and

(c) The interpreter presents a current identification card with his/her name, such as a driver's license, prior to providing interpreter services.

(2) To the extent permitted under federal law and regulation, the department may provide federal financial participation to match funds expended by public agencies for interpreter services.



WAC 388-555-1350  Payment methodology. (1) An interpreter and/or interpreter agency providing services at facilities other than FQHCs shall receive payment for interpreter services based on:

(a) Funds legislatively provided for interpreter services;

(b) Department allocation of vendor rate increases appropriated by the legislature;

(c) Billable units of time; and

(d) Submitting claims to the department according to billing instructions provided by MAA. All eligible interpreters will be provided with billing instructions.

(2) An interpreter and/or interpreter agency providing services at an FQHC shall seek payment according to WAC 388-55-1450.



WAC 388-555-1400  Recordkeeping and audits. Interpreters and/or interpreter agencies shall maintain legible, accurate, and complete records in order to support and justify interpretation services provided to medical assistance clients. The types of records that must be maintained are described in the billing instructions.



WAC 388-555-1450  Services at federally qualified health clinics. (1) A federally qualified health center shall receive payment for interpreter services when the FQHC:

(a) Uses interpreters certified or qualified by LIST; and

(b) Bills MAA fee-for-service.

(2) Interpreters providing services at an FQHC shall:

(a) Be certified and qualified by LIST; and

(b) Meet the requirements described in WAC 388-555-1200 (1), (2) and (3), and 388-555-1250; and

(c) Seek payment from the FQHC.


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