AB843 - Health care coverage: language access.

Enrolled September 12, 2025 Passed IN Senate September 09, 2025 Passed IN Assembly September 10, 2025 Amended IN Senate September 05, 2025 Amended IN Senate July 07, 2025 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Assembly Bill No. 843 Introduced by Assembly Member Garcia February 19, 2025 An act to amend Sections 1367.04, 1367.041, 1367.042, and 1367.07 of, and to add Section 1367.071 to, the Health and Safety Code, and to amend Sections 10133.8, 10133.9, 10133.10, and 10133.11 of, and to add Section 10133.91 to, the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 843, Garcia. Health care coverage: language access. (1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance, which is under the control of the Insurance Commissioner. Existing law requires the Department of Managed Health Care and the commissioner to develop and adopt regulations establishing standards and requirements to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services and covered benefits. Existing law requires the Department of Managed Health Care and commissioner, in developing the regulations, to require health care service plans and health insurers to assess the linguistic needs of the enrollee and insured population, and to provide for translation and interpretation for medical services, as indicated. This bill would require a health care service plan or health insurer to take reasonable steps to provide meaningful access to each individual with limited English proficiency, including companions with limited English proficiency, eligible to receive services or likely to be directly affected by its programs and activities. The bill would require a health care service plan or health insurer to offer a qualified interpreter or to utilize a qualified translator when interpretation or translation services are required, as specified. The bill would prohibit a health care service plan or health insurer from requiring an individual with limited English proficiency to provide or pay for the costs of their own interpreter. The bill would require a health care service plan or health insurer to comply with specified requirements when providing remote interpreting services. The bill would make a health care service plan or health insurer that violates these provisions liable for administrative penalties, as specified. (2) Existing law requires certain vital documents containing enrollee- or insured-specific information to include a written notice of the availability of interpretation services in certain threshold languages. Existing law requires a health care service plan or health insurer, upon request, to provide a written translation of those documents within a specified timeframe. For those documents that also relate to expedited plan review of a grievance for a case involving an imminent and serious threat to the health of the patient, existing law authorizes a health care service plan or health insurer to satisfy the requirement by providing notice of the availability of oral interpretation services. This bill would authorize a health care service plan or health insurer to satisfy the notice requirement by taking reasonable steps to inform the enrollee or insured of any required actions, including by providing a sight translation of a document. (3) Existing law requires a health care service plan or health insurer that advertises or markets products in a non-English language, as specified, to provide specified documents in the same non-English language. This bill would add to the list of documents required to be provided in the advertised or marketed non-English language, (A) notices related to any termination of coverage and change in covered services, (B) complaint forms to file a grievance or appeal, and (C) communications related to costs and payment of covered services, as specified. (4) Existing law requires a health care service plan or health insurer to notify enrollees or insureds, as applicable, and members of the public of nondiscrimination policies, grievance or complaint procedures, as applicable, and the availability of language assistance services and appropriate auxiliary aids and services, as specified. This bill would require a health care service plan or health insurer to also provide the information to persons seeking coverage. The bill would require a health care service plan or health insurer to notify enrollees or insureds, persons seeking coverage, and members of the public that the plan or insurer provides language assistance services and appropriate auxiliary aids and services, as specified. Existing law requires this information to be provided upon initial enrollment, upon renewal, and annually in or with materials that are routinely disseminated. This bill would require a health care service plan or health insurer to also provide the above-described information in clear and prominent physical locations, as specified, and upon request. The bill would require a health care service plan or health insurer to provide information regarding the provision of language assistance services, as described above, in a notice when specified forms or communications are provided, as specified. (5) Existing law requires a health care service plan or health insurer to report to the applicable department on internal policies and procedures relating to cultural appropriateness in specified contexts. This bill would require a health care service plan or health insurer to additionally report to the applicable department on internal policies and procedures relating to language access, as specified. (6) Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. Section 1367.04 of the Health and Safety Code is amended to read: 1367.04. (a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services. (b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and interpretation for medical services, as indicated. The regulations shall include the following: (1) Requirements for the translation of vital documents that include the following: (A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows: (i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when 1 percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or 5 percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (B) Specification of vital documents produced by the health care service plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following: (i) Applications. (ii) Consent forms. (iii) Letters containing important information regarding eligibility and participation criteria. (iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal. (v) Notices advising individuals with limited English proficiency, as defined in Section 1367.071, of the availability of free language assistance and other outreach materials that are provided to enrollees. (vi) Translated documents shall not include a health care service plan’s explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee. (C) (i) For those documents described in subparagraph (B) that are not standardized but contain enrollee-specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of interpretation services in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan subject to the requirements in Section 1367.042 shall also include with the documents a written notice of the availability of interpretation services in the top 15 languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services. (ii) Upon request, the enrollee shall receive a written translation of the documents described in clause (i). The health care service plan shall have up to, but not to exceed, 21 days to comply with the enrollee’s request for a written translation. If an enrollee requests a translated document, all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees under the provisions of this chapter and under any regulations adopted pursuant to this chapter shall begin to run upon the health care service plan’s issuance of the translated document. (iii) For grievances that require expedited plan review and response in accordance with subdivision (b) of Section 1368.01, the health care service plan may satisfy this requirement by taking reasonable steps to inform the enrollee of any required actions, including by providing a sight translation of a document, or providing notice of the availability and access to oral interpretation services or auxiliary aids and services. (D) A requirement that health care service plans advise individuals with limited English proficiency of the availability of interpreter services. (2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document. (3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years. (4) Requirements for individual access to interpretation services that include the following: (A) A requirement that an interpreter meets, at a minimum, all of the following qualifications: (i) Demonstrated proficiency in both English and the target language. (ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems. (iii) Adheres to generally accepted interpreter ethics principles, including client confidentiality. (B) A requirement that the individual with limited English proficiency shall not be required to provide their own interpreter or rely on a staff member who does not meet the qualifications described in subparagraph (A) to communicate directly with the limited-English-proficient enrollee. (C) A requirement that the individual with limited English proficiency shall not be required to rely on an adult or minor child accompanying the enrollee to interpret or facilitate communication except under either of the following circumstances: (i) In an emergency, as described in Section 1317.1, if a qualified interpreter is not immediately available for the enrollee with limited English proficiency. (ii) If the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances. (5) Standards to ensure the quality and timeliness of oral interpretation services provided by health care service plans. (c) In developing the regulations, standards, and requirements, the department shall consider the following: (1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and [Text truncated for display. Full text available on Congress.gov.]