Major Changes to the ACA How Will They Affect Your Language Access Program?

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1 Major Changes to the ACA How Will They Affect Your Language Access Program? PART 3: Leveraging Technology as Part of Your Compliance Strategy

2 Major Changes to the ACA E-book Series: PART 1: What Are the New Regulations? PART 2: How to Comply With the New Regulations PART 3: Leveraging Technology as Part of Your Compliance Strategy

3 Major Changes to the ACA How to Comply with the New Regulations PART 3: Leveraging Technology as Part of Your Compliance Strategy AUTHORED BY: Andrew Drake COO and Co-founder of InDemand Interpreting & David B. Hunt, J.D. President and CEO, Critical Measures

4 This e-book will cover: 1. Introducing the new regulations for video interpreting 2. Explain what primary consideration for deaf and hard of hearing people means 3. Describe how to reduce your risk 4. Describe how to control quality 5. Suggested compliance strategies

5 ACA Section New standards for video interpreting

6 ACA Section 1557 New standards for video interpreting DHHS signaled its concerns about the quality and safety aspects of providers use of video remote interpreters. While the final revisions support providers use of qualified remote medical interpreters, there are new standards for providers use of video remote interpreters. According to the final rule, providers who provide a qualified medical interpreter to LEP individuals through video remote interpreting shall provide: Real-time, full-motion video and audio over a dedicated high-speed, wide bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images or irregular pauses in communication; A sharply delineated image that is large enough to display the interpreter s face and the participating individual s face regardless of the individual s body position; A clear, audible transmission of voices; and Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the video remote interpreting

1 Real-time, full-motion video and audio over a dedicated high-speed, wide bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy,

7 1 Real-time, full-motion video and audio over a dedicated high-speed, wide bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images or irregular pauses in communication; The InDemand Clarity application delivers the highest quality high definition video and audio available today. Powered by industry-leading Vidyo, InDemand s next generation application for video remote interpreting (VRI) enables better communication between patients and providers to support better outcomes. InDemand Interpreting has strict guidelines for wireless connectivity and will perform network evaluations prior to working with a prospective customer and will work with them to make sure their network is able to run our application. This process ensures real-time fullmotion video and audio over a dedicated highspeed wide bandwidth video connection. We are committed to ensuring the best possible patient/provider experience and are dedicated to compliance with the new ACA regulations.

2 A sharply delineated image that is large enough to display the interpreter s face and the participating individual s face regardless of the individual s body position InDemand Interpreting has a

Both our InDemand Envy and InDemand Essential devices integrate a flexible and large high-definition display with mobile convenience for a powerful VRI experience.

8 2 A sharply delineated image that is large enough to display the interpreter s face and the participating individual s face regardless of the individual s body position InDemand Interpreting has a suite of VRI devices that meet these newly defined requirements. Both our InDemand Envy and InDemand Essential devices integrate a flexible and large high-definition display with mobile convenience for a powerful VRI experience. Providers are able to easily adjust the height and angle the screen to make sure patients can fully see their interpreter on the screen whether sitting up or laying down. The pre-assembled medical cart is designed for demanding, high-traffic environments right out of the box adjustable and easy to use. InDemand is concerned that neither ipads nor iphones meet the new stricter ACA regulations for Deaf and hard of hearing patients.

$3 A clear, audible transmission of voices \ A number of InDemand VRI devices are fitted with Jabra speakers that leverage HD voice and wideband audio.$

9 3 A clear, audible transmission of voices \ A number of InDemand VRI devices are fitted with Jabra speakers that leverage HD voice and wideband audio. HD Voice lets you have crystal clear, vibrant conversations. Providers and patients won t have to struggle to hear what the other person is saying. The built-in omnidirectional microphone allows listeners to hear and be heard with a 360-degree microphone that picks up sounds from any angle. Embedded in the InDemand Clarity application is Speex, a high-quality, ultrawideband voice compression and sampling technique that ensures the most high-definition sound regardless of the device used.

4 Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the video remote interpreting InDemand Interpreting

10 4 Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the video remote interpreting InDemand Interpreting understands that a well-trained staff is the key to succeeding in the adoption of new technologies within a healthcare environment and we are dedicated to our clients success. To ensure success we have a unique five-point process that we call 5-to-Thrive. As part of this comprehensive program we work with our clients to make sure that their staff is fully trained on and excited about their new system. We have built a comprehensive toolkit that enables healthcare organizations to quickly and efficiently train their staff to utilize InDemand VRI. The toolkit includes: Live Training Sessions Web-based Training Sessions On-demand Training Videos Informational Literature

11 Who Decides What Language Access Accommodation Should Be Used for Deaf and HOH Patients? Despite pressure from providers, HHS maintained that providers should give primary consideration to the choice of an aid or service requested by the individual with a disability. Note: this standard is contrary to the discretion given to providers to decide what type of language access methods will provide meaningful access to LEP patients.

12 Providers Obligations to Deaf and HOH Patients As of July 18, 2016, Section 1557 of the Affordable Care Act (ACA) will impose more stringent requirements on healthcare providers to accommodate the language access needs of deaf and hard of hearing patients. The ACA now requires providers to give primary consideration to the deaf person s preference regarding language access accommodation. Primary Consideration means that the provider must honor the choice of the Deaf or hard of hearing patient unless the provider can demonstrate that: Another equally effective means of communication is available The use of the means chosen would result in a fundamental alteration in the service, program, or activity Is an undue financial and administrative burden to the provider Note: Requiring providers to give primary consideration to the preferences of patients with disabilities is not the same as saying that the provider must adopt the patient s preferred accommodation. Further, the term primary consideration implies that there are other legitimate, contextual variables that could and perhaps should be considered when deciding which interpreter modality to select but that primary consideration should generally be given to the patient s preference.

Reducing Risk Through Careful Vendor Selection Look for Vendors Who Have: Control over the complete VRI solution Technology expertise Customer

13 Reducing Risk Through Careful Vendor Selection Look for Vendors Who Have: Control over the complete VRI solution Technology expertise Customer references Qualitymetrics Implementation experience 24/7/365 support Interpreters with control over audio levels A Try it before you buy it option

14 If you can't measure it, you can't manage it.

15 Reducing Risk Through Key Performance Indicators (KPI) Build KPIs with your VRI vendor or create internal KPIs to ensure quality is maintained No one metric will ensure compliance. Use as many relevant metrics as you can. Examples include: Ratings by providers (1-5 stars). Ratings by interpreters Survey data Complaint rates Issue resolution time System up time

16 Controlling for quality: Operational best practices Make VRI (and language access) a priority for someone in your organization Obligate the vendor to comply with metrics Audit your vendor against these quality metrics Survey staff and patients If issues exist that can't be fixed, shut it down

17 Suggested Compliance Strategies

18 Suggested ACA Section 1557 Compliance Strategies Conduct a legal language access audit of systems, policies and procedures related to language access. Compare current practices against federal and state law and emerging national best practices (such as Joint Commission standards) Conduct a provider cultural and linguistic competence assessment of provider knowledge and use of best practice language access methods and knowledge of/compliance with language access laws. Train providers on language access policies, correct use of qualified medical interpreters, the law of language access and best practice techniques (example: the teach-back method ) Insist that medical staff set goals for reducing the use of unqualified interpreters. Employ stop the line procedures to assure that LEP and Deaf and Hard of Hearing patients have access to qualified medical interpreters and translators. System-wide monitoring of providers use of qualified medical interpreters as part of electronic medical record (EMR) Develop and implement a language access plan. Make sure your video interpreting solution meets new Section 1557 ACA regulations.

19 Creating a Language Access Plan (LAP) An effective LAP contains five core elements: Identify individuals who have limited English proficiency and need assistance Decide on how best to meet language access needs (both oral interpreters and written translated documents) Train Staff Notify LEP patients of legal right to an interpreter and written translated materials at no cost to them Monitor and update your policy frequently

20 Summary of New Section 1557 Changes to the ACA Section 1557 of the ACA prohibits discrimination on the basis of race, color, national origin, sex, disability and age by any health program/activity that receives federal funding. (Failing to provide interpreters is a form of national origin discrimination.) First federal civil rights law to prohibit sex discrimination in health care. (Impacts LGBTQ, sexual identity, and transgender individuals) Gives LEP patients a new, private, right to sue under ACA for language access violations. Significantly expands the universe of patients to whom providers owe a legal duty to provide language access services. Providers must serve all LEP patients who are eligible to be served not just those who are likely to be encountered. Creates major changes in the law of language access. Most notably: providers must now use qualified interpreters to provide language access services to LEP and Deaf and Hard of Hearing patients unless there is an emergency involving an imminent threat to the safety or welfare of patient where no qualified interpreter is immediately available. Untrained (and therefore unqualified) bilingual staff, adult family and friends and minor children may not be used as medical interpreters in most instances. By moving the legal standard from competent interpreters to qualified interpreters, DHHS is increasing the standard of care and legal duty owed to LEP and Deaf and Hard of Hearing patients. Effective date: July 18, 2016.

Andrew helped to create the first VRI system based on a PC platform, and has experienced first hand the difficulties with delivering high-quality VRI

21 INTRODUCING Andrew Drake InDemand Interpreting COO and Co-Founder Mr. Drake has been with InDemand since 2009 and leads interpreting, product development, and IT operations at InDemand. Andrew helped to create the first VRI system based on a PC platform, and has experienced first hand the difficulties with delivering high-quality VRI in a healthcare environment. Andrew is passionate about improving access to quality language services and his experience in language services and technology make him a perfect fit for InDemand Interpreting. He has an engineering degree from The University of Michigan.

InDemand Video Remote Interpreting 22 (VRI) meets the new ACA Video Interpreting Requirements. Instantly Connect to Experienced Medical Interpreters 24/7, 365 days a year, in over 200 languages.

22 InDemand Video Remote Interpreting 22 (VRI) meets the new ACA Video Interpreting Requirements. Instantly Connect to Experienced Medical Interpreters 24/7, 365 days a year, in over 200 languages. InDemand provides instant access to high-quality Video Remote Interpreting (VRI) for limited English proficient (LEP) and Deaf patients at the touch of a button. Just select the patient s preferred Language, and within seconds a medically trained interpreter will be online to assist. PHONE 1 (877) Info@IndemandInterpreting.com

23 Better Communications, Better Outcomes

Major Changes to the ACA How Will They Affect Your Language Access Program? Sponsored by InDemand Interpreting

Major Changes to the ACA How Will They Affect Your Language Access Program? Major Changes to the ACA E-book Series: PART 1: What Are the New Regulations? PART 2: How to Comply With the New Regulations?