Preproposal statement of inquiry was filed as WSR 98-01-188.

Title of Rule: Chapter 388-555 WAC, Interpreter services.

Purpose: This supplemental filing amends rules for interpreter services which were initially filed as WSR 98-07-050. The rules were revised to clarify existing policies and procedures regarding: (1) The definition of qualified interpreter for ASL; (2) services provided to family members; (3) eligible providers for interpreter agencies; (4) interpreter services at Federally Qualified Health Centers. This CR-102 also notes that, because the proposed rule is not a significant legislative rule, Medical Assistance Administration is not preparing a cost benefit analysis.

Statutory Authority for Adoption: RCW 74.08.090, 74.04.050.

Statute Being Implemented: RCW 74.04.025, 45 CFR Sec. 80.1 and 80.03; 45 CFR Sec. 605.52; 28 CFR, part 35.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting: Barbara Davis, Medical Assistance Administration, 617 8th S.E., Olympia, WA 98504, (360) 586-2337, or bdavis@dshs.wa.gov; Implementation and Enforcement: Nora Guzman-Dyrseth, Medical Assistance Administration, 617 8th S.E., Olympia, WA 98504, (360) 586-4195.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is necessary because of federal law, 42 USC Sec. 2000d; 29 USC Sec. 794; 42 USC Sec. 12101.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal does not change existing rules.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Because this proposed rule codifies existing policies, procedures, operational relationships and arrangements, it has no economic impact on small businesses

RCW 34.05.328 does not apply to this rule adoption. The proposed rule does not meet the definition of "significant rule" in RCW 34.05.328 (5)(c)(3)[(iii)].

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on June 9, 1998, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by May 29, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, or pwall@dshs.wa.gov, by June 9, 1998.

Date of Intended Adoption: No sooner than June 10, 1998.

May 5, 1998

Marie Mycherin-Redifer, Manager

Rules and Policies Assistance Unit

Chapter 388-555 WAC

INTERPRETER SERVICES

NEW SECTION

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

"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 the medical assistance administration (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" - a business entity, organized under and permitted to operate by the laws of the state of Washington. The main objective or purpose of the agency is 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 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.

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NEW SECTION

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.

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NEW SECTION

WAC 388-555-1100  Noncovered services. Interpreters and/or interpreter agencies shall not receive payment 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.

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NEW SECTION

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.

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NEW SECTION

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.

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NEW SECTION

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

(1) Facilitate coordination of the 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.

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NEW SECTION

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.

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NEW SECTION

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.

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NEW SECTION

WAC 388-555-1400  Record keeping 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.

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NEW SECTION

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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