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Many
physicians have trouble complying with LEP requirements,
Minneapolis physician Kevin Larsen told a Congressional
briefing Dec. 9 on behalf of the American College of Physicians.
Larsen
usually must devote twice as much time to care for a non-English
speaking patient, but he receives no extra reimbursement
for these encounters. Also, research shows that physicians
often order more expensive tests for limited English proficiency
(LEP) patients. Hennepin County Medical Center, where Larsen
works, has established a full-time staff of 40 interpreters
to accommodate LEP patients.
Larsen
outlined "best practices" that HCMC uses, including
phone lines staffed by interpreters that any part of the
health care system can access, language-specific multi-specialty
clinics to organize care around interpreters, a city-wide
"consortium" that shares language materials via
the Internet to reduce costs, signs in multiple languages
and language-specific videotapes.
There
are two different federal laws governing Limited English
Proficient (LEP) patients, according to the Medical Group
Management Association. Title VI of the Civil Rights Act
of 1964 says impediments to communication may be considered
discrimination, and Title III of the Americans With Disabilities
Act requires you to make accommodations to Americans with
any type of disability.
Luckily,
the Department of Health and Human Services put out a "revised
LEP guidance" in August 2003 (www.usdoj.gov/crt/cor/lep/hhsrevisedlepguidance.html.)
According to HHS, your practice is required to comply with
LEP requirements if it accepts federal funds, such as Medicaid
or clinical trials funds. But a physician office that merely
bills Medicare Part B doesn't have to comply.
You're
only required to take "reasonable steps to ensure meaningful
access" to your care, HHS notes. This begins with an
assessment of your particular circumstances, including the
number or proportion of LEP patients you're likely to encounter,
the frequency with which LEP patients come into contact
with your program, the nature of your services and the resources
available to your patients.
If you're
having a hard time doing this assessment, you can call Medicaid
or your local Medicare office to learn the demographics
of your area, suggests consultant David Levins with Professional
Billing Inc. in Montgomery, AL.
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