- Develop a flexible system of Medicare payment for language services in hospitals. Evidence shows that hospitals frequently offer interpretation and other language services, but are rarely reimbursed for these expenses. This discourages broader availability of language assistance. A twophase system for development of payments could provide immediate financing for language services in inpatient and outpatient settings and provide time to develop a more refined payment system.
This information could be used to develop, in the second phase, a more refined system that adjusts individual inpatient and outpatient hospital payments (i.e., Diagnosis-Related Group-based and Ambulatory Payment Classification-based payments) on a claim-specific basis for LEP patients. It is important to develop a system that gives hospitals flexibility in determining how to provide language services, e.g., through in-person professional interpreters, through telephone language services or through increased availability of bilingual and multilingual clinicians.
- Offer grants to hospitals, schools that train health professionals and community groups to increase the recruitment and training of bilingual and multilingual medical interpreters and clinicians. To improve services, it will be necessary to increase the stock of appropriately trained medical interpreters and bilingual or multilingual clinicians. This could benefit not only Medicare patients, but the Medicaid and privately insured patients who will receive care from the same health professionals.
- To improve language services in physician settings, provide Medicare reimbursements to in-person interpreters and develop a system of federal contracts for telephone interpretation firms. This will increase the availability of interpretation services in primary and specialty care settings, but avoids making physicians the financial intermediaries for these services. A reimbursement system for payment of interpreters could be developed, like the reimbursement systems that exist for many other health professionals. The federal government could also arrange to contract with a number of telephone interpretation firms that physicians could call to get telephonic interpretation for Medicare patients. These firms would directly bill the federal government. There are many circumstances in which it is not feasible to arrange for in-person interpretation and telephone interpretation is the appropriate option.
- Improve monitoring and oversight of existing requirements to provide language services in Medicare managed care. Medicare managed care contracts already require that the health plans provide language assistance to LEP patients, but there is no organized system of monitoring how or whether health plans meet these requirements.
- Exempt language services from Medicare costsharing requirements. If there was no exemption, Medicare beneficiaries would be required to pay for a portion of the costs of interpretation in physician and outpatient settings. This might actually create a disincentive to the use of interpreters, reduce the quality of care provided and create additional liability risks for health care providers. This exemption would be akin to existing Medicare policies that exempt clinical laboratory tests from cost-sharing. It would assure consistency with existing federal civil rights laws and avoid creating a disincentive to not use language services.
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