WSRID Legislative Blog

WSRID Legislative Blog

Medical Interpreting Task Force Pushes Health Care Authority to Start Promised Legal Compliance

To: the Washington State Health Care Authority

From: the (Washington State) Medical Interpreting Task Force (MITF)

Re: Behavioral Health now going through HCA

May 27, 2016

 

This is to express our grave concern that not only has the HCA failed to resolve the low fill rate for ASL interpreter requests over the past 4 years, endangering the health and lives of deaf and deafblind people but now the HCA is expanding its responsibility to include drug and alcohol treatment through Behavioral Health endangering their sobriety and in some cases even their liberty. 

 

Until last month the cost of interpreters for inpatient and outpatient services was paid by the state agency Division of Behavioral Health and Recovery following the DSHS contract terms which was working (i.e. ASL interpreters were provided). While the current HCA system has clearly NOT been working for the past four years and there is no resolution in sight, this same system is now being applied i.e. co-opting another system (Behavioral Health) which has been working, thus inflicting a failed system and set of policies on yet another state entity. This despite multiple meetings and documents explaining the issues and promises of solutions.

 

Clark and Skamania Counties currently have 47 RID Certified Interpreters and to our knowledge only one has chosen to contract with HCA. She would now be responsible to fill all Medicaid doctor appointments AND all drug and alcohol treatment sessions for deaf and deafblind patients. Compounding the problem is the fact that Vancouver is home to one, of only a few deaf drug and alcohol treatment centers in the country. At this very moment there are treatment centers in desperate need of interpreter services for clients who are enrolled in outpatient services. One current client will be forced to return to prison if he is not allowed to start treatment, which the treatment center says is on hold because they cannot get an interpreter through HCA.  

 

Now, along with Medicaid patients, Medicaid addiction clients are being thrown under the bus, lost in the pool of people with limited English proficiency (i.e. those needing spoken language interpreting services)

 

You have assured us that you are working with ODHH to solve this problem but you have failed to give us any kind of a timeline, strategy or benchmarks and in the meantime you are expanding your failed system. This must stop!

 

Theresa B. Smith, Ph.D., CSC, MCSC, SC:L

Chair, Medical Interpreting Task Force, Washington State

 

 

Cc: Toby Olson, Executive Secretary on Disability Issues and Employment

Robert Crittenden, Governor’s Health advisor

Jason McGill, Governor’s Health advisor

Knight Sor, DOJ Region X

 

 

What’s Up with MITF? By Dr. Theresa B. Smith

    

The Medical Interpreting Task Force (MITF) is alive and well. We have been meeting with representatives from the Governor’s office on health care, with Toby Olson of GCDE, and from Health Care Authority (HCA) as well as the new ODHH Director, Deborah O’Willow and… we are making progress!

Decision makers in the HCA have come to realize that their system does not work for deaf, hard of hearing, and deafblind people, that they do not have the requisite expertise and this has caused great harm. They have now listened. We have therefore strongly urged that the responsibility to manage and oversee Medicaid interpreters be returned to ODHH and again, they have listened. Debbie O’Willow is also very interested in taking this responsibility back. They (HCA and ODHH) are currently in negotiations and we wanted to let you know that while this has taken a very long time, and we are not yet finished yet with our work, we have made significant progress.

We have also asked ODHH to assume responsibility for systems advocacy. This will hopefully be two tiered – through both the Regional Centers and at the statewide level i.e. a state level position within ODHH. We have requested that both sets of advocates (regional and statewide) initially focus on communication access in medical settings, and eventually do other, on-going systems advocacy as needed.

What will this mean? First, the internal state system will have to be adjusted to allow the contract terms for interpreters to be determined by ODHH and no longer come through the HCA (as part of the union interpreters contract). Second, it means that ODHH will be collecting data about patterns of use (of ASL and TASL interpreters) to better understand the big picture and be better able to solve problems. Finally, we hope that it means deaf, hard of hearing, and deafblind patients will have appropriate and timely communication access for both regular appointments and for urgent or emergency treatment.

I want to thank all the faithful MITF members who have contributed their time, energy and hard work, often as volunteers. Without your work, nothing would have happened – the finish line is in sight.

HB 2324 Hearing Tuesday, Jan 19, 2016 @ 1:30 pm, Olympia

It has come to our attention that there is a bill that would ammend the current educational interpreter standard in Washington, which will be heard by the education committee in the House of Represenatives on Tuesday January 19th at 1:30 pm. If you are able to join us, please e mail Whitney Hill at WSRIDLegCommittee@gmail.com. 

Below is the WSRID/WSAD letter to representatives that explains our position in English and ASL and a seperate vlog summarizing the bill

 
 

 

 

 

Letter opposing HB 2324

 

January 11, 2016

 

Representative Name

106 Legislative Building

Olympia, WA 98504-0600

 

Re: opposition to HB 2324: amendment of educational interpreter standard

 

Dear Representative Name,

 

We are contacting you on behalf of Washington State Association of the Deaf and Washington State Registry of Interpreters for the Deaf in opposition of HB 2324, a bill to amend our current educational interpreter standard codified in RCW 28A.410.271. Our organizations combined represent over 400 Deaf Washingtonians and professional sign language interpreters. Our organizations are non-profits, run by volunteers, with a common interest in advocating to ensure deaf children in this state are afforded equal access to our public education system.

 

Background

 

In 2013, you and your colleagues overwhelmingly supported the implementation of a standard for sign language interpreters in the K12 setting by passing HB 1144. That bill, which has been codified in RCW 28A.410.271, delegated the determination of which assessment to use to Washington Professional Educator Standards Board (PESB).[1] The PESB assembled a work group and extensively researched the available assessments, and ensured that the assessment chosen would be able to evaluate interpreters using both American Sign Language or other signing systems such as Signing Exact English.[2] The work group ultimately recommended the Educational Interpreter Performance Assessment and/or the National Interpreter Certification (EIPA and NIC) over the Educational Singed Skill Evaluation (ESSE, which is exclusively an assessment of Signing Exact English not necessarily interpreting skill or knowledge of professional ethics). The PESB voted in favor of this recommendation.[3]

 

The decision to use the EIPA and/or the NIC as the assessments was whole-heartedly endorsed by our represented organizations as well as Registry of Interpreters for the Deaf, the national professional organization for interpreters representing over 10,000 sign language interpreters nationwide.

 

 

Concerns

 

HB 2324 effectively accomplishes two things: 1) it makes the ESSE assessment available to interpreters who choose, and 2) it eliminates the certification available through a national professional interpreter organization. We do not support this amendment for the following reasons.

 

·      We believe the addition of the ESSE assessment to the standard would compromise the current interpreter standard. Proponents of HB 2324 would lead you to believe that the current standard of the EIPA and/or NIC assessment somehow excludes the use of a modality of Signing Exact English. This is blatantly false; the current EIPA assessment includes a wide spectrum of sign language modalities, including Signing Exact English. HB 2324 would allow interpreters trained in Signing Exact English, who may have no formal training in interpreting, language fluency, cultural competency, or ethical decision making, to bypass our current standard by allowing them to take an invalid assessment (the ESSE).

 

·      We believe the ESSE is not a valid assessment. When comparing the assessments, the EIPA is currently used as, or as part of, the state educational interpreter standard in 42 states (82% of 51 including Washington DC),[4] while the ESSE is only used in two states that we are aware of. The educational interpreter standard workgroup excluded the ESSE from their recommendation because the SEE Center was not able to produce data on the reliability and validity of the ESSE.[5]

 

·      The proponents of HB 2324 have a vested financial interest in this amendment. The ESSE is administered through the SEE Center, which has ties to Washington because the inventor of Signing Exact English, Gerilee Gustason, is a resident of Washington. Sources list Ms. Gustason as the current executive director of the SEE Center[6], and she is listed on the SEE Center’s website as a current “skillshop instructor.”[7] We, as organizations with no financial interest, feel strongly that the legislature has a duty to serve the best interest of constituents. This amendment may be in the best financial interest for Ms. Gustason and the SEE Center, but it does not serve the interest of the deaf students who deserve qualified interpreters.

 

·       174 qualified interpreters will no longer be eligible to work in the K12 setting in Washington. HB 2324 strikes language that allows for an “assessment and performance assessment that is offered by a national organization of professional sign language interpreters….” Registry of Interpreters for the Deaf has estimated this will bar 174 interpreters in this state who hold national certification from working in the K12 setting. We are concerned that by striking this language, we are excluding interpreters that a national professional organization has accredited to work in our courts, doctor’s offices, universities, etc. The NIC, administered by RID, is the nationally recognized generalist certificate for sign language interpreters and is considered the “gold standard” of possible generalist certificates in the field of sign language interpreting. Excluding interpreters that have a nationally recognized qualification is an arbitrary change that limits the eligible pool of qualified interpreters for the K12 setting.

 

 

Conclusion

 

While Signing Exact English has been a contentious issue in the world of deaf education for the last few decades, we are not here to debate educational philosophies. Fortunately, the standard we currently have of the EIPA and/or NIC as the minimum qualification for educational interpreters does not force a choice of Signing Exact English over any other educational philosophy. We strongly believe the needs of every deaf child, regardless of their parent’s preferred educational philosophy, will be met through the EIPA and/or NIC assessments and the current RCW. Again, we would ask you to support deaf education in Washington by opposing HB 2324.

 

Thank you for your time and consideration.

 

Sincerely,

 

 

Washington State Association of the Deaf

 

Washington State Registry of Interpreters for the Deaf

 

 



[1] RCW 28A.410.271(2)

[2] https://app.leg.wa.gov/CMD/Handler.ashx?MethodName=getdocumentcontent&documentId=

 HFRCqv2fAoY&att=false, State of Washington Professional Educator Standards Board

[4]http://www.unco.edu/doit/prospective/PDFs/EIPA%20Bolster_Schick_website.pdf, University of Northern Colorado

[5] https://app.leg.wa.gov/CMD/Handler.ashx?MethodName=getdocumentcontent&documentId=

 HFRCqv2fAoY&att=false, State of Washington Professional Educator Standards Board

[6] http://www.modernsignspress.com/people.htm “[Gerilee Gustason] is currently the Executive Director of the See Center For The Advancement of Deaf Children and lectures, conducts workshops and provides in-service training.”

[7] http://www.seecenter.org/page18.html

 

Medical Interpreter Task Force Sits Down for First Negotiation with the Health Care Authority

As you know, in 2012, the Health Care Authority (HCA), the State agency responsible for administering Washington’s Medicaid program, drastically changed how it contracts with sign language interpreters across the state. As a result of those changes, there have been numerous negative effects on communication access to medical providers for Deaf and Deafblind patients. The most noticeable is the sudden drop in the percentage of filled requests for ASL interpreters. The contractor charged with filling requests is currently only able to fill about 25% of requests for ASL interpreters in two counties (see map below). Providers and patients have no information about why their requests are not being filled, patients are forced to reschedule appointments numerous times because no interpreter could be found, many providers have stopped even attempting to get an interpreter, and frequently patients are forced to go through with an appointment without an interpreter. Because of their own frustration, many providers are contracting with VRI companies, which is only sometimes effective.

For more background information in ASL, click here.

The agenda for the meeting with representatives of the HCA was packed because we only had an hour. Of course, everyone at the table would have liked more time, but this meeting was an important step in initiating change.

 

Dr. Robert Crittenden, the Governor’s Policy Advisor, facilitated the meeting.

 

The attendees representing the Medical Interpreter Task Force (MITF) were

·      Theresa B. Smith, MITF Chair

·      Kristi Cruz, attorney with Northwest Justice Project

·      Kellie McComas-Shapard, representing Washington State Association for the Deaf

·      Jackie Engler-Morris, representing Washington State Deafblind Citizens

·      Angela Theriault, Director of Deaf Blind Service Center

·      Jenifer Mendoza-Morales, advocate from Abused Deaf Women’s Advocacy Services

·      Whitney Hill, Washington State Registry of Interpreters for the Deaf, legislative committee

·      Ellie Savidge, advocate, Lighthouse for the Blind

·      Allie Joiner, advocate, representing senior citizen patients and children

·      Jeannie Davis, deaf citizen

·      Luanne Conner, medical interpreter

 

From Office of the Deaf and Hard of Hearing (ODHH)

·      Eric Raff, Director of ODHH

·      Berle Ross, Manager of the sign language interpreter contract

 

 

Representing the HCA were

·      Vazaskia Caldwell, Unit Manager

·      Johnny Shults, Medical Assistance Program Specialist

·      Preston Cody, Assistant Director for Health Care Services

 

 

 

The negotiation started with background of the law and the current state of the problem., including the fact that there are important legal differences in laws that govern spoken language and sign language interpreters that may have been overlooked in the implementation of the HCA’s contract. Next, advocates from the Deaf and Deafblind community were able to tell impact stories about what struggles they and those they represent are encountering as patients in the medical system, including the ways in which a VRI system is inappropriate. The advocates emphasized the ripple effect this contract has had that effectively denies communication access to healthcare for Deaf and Deafblind patients regardless of whether they have Medicaid or private insurance. The HCA representatives recognized that there was an issue that needed to be fixed.

 

The HCA contract is soon up for renewal and representatives came prepared to announce they were considering raising the interpreter rate again (In 2013 the flat rate for ASL interpreters went from $50 per hour to $80 per hour with no change in contract terms, which resulted in little change to the number of interpreters in the pool) and initiating a pilot project using Video Remote Interpreting (VRI). 

 

MITF representatives made it very clear that

·      we have been very patient for three years,

·      now it is time for significant changes.

·      Any changes should be driven by feedback from the Deaf and Deafblind community.

·      A simple rate increase would not be sufficient to solve the problem because the terms of the contract are still the biggest barrier for interpreter’s willingness to sign up, and

·      VRI (as addressed earlier in the meeting ) is not “the solution”

HCA representatives agreed to revisit contract terms and seemed to take the VRI option off the table, at least for the time being, but there was no commitment not to pursue VRI for ASL.

 

Robert Crittenden, the Governor’s policy advisor, agreed that the current state of the contract is not acceptable, that the two issues are a) fill-rate and b) appropriate referral (appropriate interpreter and/or use of VRI). He encouraged the HCA to start communication with our group about changes going forward to which they agreed.

 

HCA representatives asked for more information from the MITF, they left saying they intended to meet with us again, stating they are committed to making this contract a success.

 

Two added notes: Eric Raff has resigned his position as Director of ODHH and is moving to North Carolina. Berle Ross at ODHH is continuing to actively advocate for individuals who have been denied interpreting service who contact her.

 

We will keep you informed of any future progress. Please stay tuned for future updates.

MITF group standing in the hot sun on the stairs of the Insurance Building on the Capital Campus in Olympia in front of some large, white pillars

MITF group chatting on the Capital Campus after the meeting

Number of Medicaid ASL interpreter requests filled from 2012 to 2014

Status   Clark Pierce King Spokane Snohomish Kitsap Whatcom Benton Cowlitz Yakima Franklin Thurston Lewis Skagit Multnomah Grays Harbor Chelan Skamania Stevens Whitman
Cancelled Appointment Percent of Requests 25.94% 35.31% 18.13% 8.13% 3.13% 1.56% 0.31% 0.94% 2.50% 0.31%   2.50% 0.31% 0.31%         0.63%  
Number of Requests 83 113 58 26 10 5 1 3 8 1   8 1 1         2  
Filled Request Percent of Requests 41.28% 38.63% 11.92% 3.97%   1.77%     1.77%           0.66%          
Number of Requests 187 175 54 18   8     8           3          
No Shows Percent of Requests 72.31% 18.46% 6.15% 3.08%                                
Number of Requests 47 12 4 2                                
Unfilled Request Percent of Requests 20.52% 13.89% 22.64% 16.85% 8.39% 3.03% 2.47% 2.05% 1.06% 2.12% 2.12% 1.34% 1.06% 1.06% 0.56% 0.42% 0.14% 0.14%   0.14%
Number of Requests 291 197 321 239 119 43 35 29 15 30 30 19 15 15 8 6 2 2   2

 

 

 

DeafBlind People Deserve More Choices

WSRID supports the efforts of DeafBlind people to receive federal funding for a new DeafBlind training center in Washington State. The efforts are led by DeafBlind community leaders across the Nation, with support from the Lighthouse for the Blind and the Deaf Blind Service Center, and WSRID.

 

On behalf of WSRID members, the board has submitted a letter of support (see below) to Senator Patty Murry asking for federal funding of a new training and support center for DeafBlind people. The training center will serve DeafBlind people from all over the US, and will be led by DeafBlind people, providing more training options and employment opportunities for Deaf and DeafBlind people.

 

YOU can make a difference too! Help send Jelica Nuccio and two other individuals to Washington, D.C. for a meeting with Rehabilitation Services Administration. Funds will cover: flight, lodging, SSP, transportation, interpreters (4)" Goal: $3,000.00.  Click here to donate to DeafBlind Power

For more information about the efforts to expand training opportunities for DeafBlind people, see http://www.deafblindpower.com/

 

 

 

 

Require Certification for ASL Teachers

At the request of WA ASLTA, WSRID wrote a letter to the WA Professional Education Standards Board (PESB) in support of increased standards for ASL teachers. WA ASLTA and WSRID jointly have proposed all ASL teachers be required to attain ASLTA certification.

Currently, WA State schools classifies ASL instruction as a trade to learn how to become an ASL interpreter. Most states in the US put ASL instruction in the foreign language category. Instructor standards for trades are typically tied to years of experience. Foreign language instructor standards is typically tied to level of education, usually an MA degree.

Here is the letter WSRID wrote to the PESB.

 

 

2014 Update: Medicaid Contract with ASL Interpreters

September 2011, the WA State Health Care Authority (HCA) took control of ASL interpreting services for Deaf and DeafBlind medicaid patients. Since medicaid covered ASL interpreting services moved from the Office of Deaf and Hard of Hearing (ODHH) to HCA, the fill rate has plummeted. 

 

January 2014 through August 2014, there were 1,076 requests for an ASL interpreter. The HCA contract is held by CTS, a spoken language referral agency. CTS only provided an ASL interpreter for 266 of the 1,076 requests, or 24%. Under the ODHH contract, requests for interpreters remained above 95%. Deaf and DeafBlind patients on medicaid rely on ASL interpreters for effective communication access to their medical provider.

 

 

 

ASL interpreters contend that the HCA contract does not meet standard terms and conditions for interpreters in the state. Only 6 ASL interpreters have signed the 2014 HCA contract across the state, or 2% of certified interpreters.. This is down from 13 interpreters who signed the 2013 contract. According to Registry of Interpreters for the Deaf (RID), there are about 378 RID certified interpreters in Washington State. 

Number of interpreters who have signed the HCA Medicaid contract.

 

DSHS Proposal for New ASL Interpreter Contract Could Mean Drastic Pay Cuts for Many Interpreters

 

ODHH released a Request for Qualifications and Quotations (RFQQ) dated April 30th, 2014 that could have a potential impact on interpreters in Washington State who work under the ODHH contract either as sub contractors through an agency, or as independent contractors. These changes will affect most interpreters working under this contract, and for many will have an impact on their income. Such significant impacts could potentially have unintended interruptions in service to Deaf, Deafblind, and Hard of Hearing DSHS clients and employees. The DSHS contract is used to provide interpreters for DSHS administrations such as Division of Vocational Rehabilitation appointments, Department of Children and Family Services, Department of Alcohol and Substance Abuse, and Western State Hospital just to name a few.

 

The RFQQ was originally released April 30th, 2014 with a deadline for questions by Monday, May 5th. Department of Enterprise services has since rescinded that RFQQ because of incorrect dates and will repost sometime in the week after May 5th, but the window for questions will still be very short.

 

 

Note: All questions and complaints must be submitted through WEBS (DSHS online contract management system) after the RFQQ is reposted https://fortress.wa.gov/ga/webs/home.html. If you have feedback it is imperative you provide feedback to DSHS about proposed changes as soon as possible. Subcontractors can easily register for a WEBS account as well, the process takes a minimal amount of time.

 

There are 4 major proposed changes to the ASL interpreter contract:

 

1)   Non certified interpreters are no longer able to work under this contract

2)   QDI’s (Qualified Deaf Interpreters) have until June 30, 2019 to obtain RID certification

3)   The contract service fee for independent contractors went from $30 to $15 per appointment

4)   There is a new pay metric for interpreters that could result in potentially lost or increased wages

 

Below is a comparison of the old metric for interpreter rates compared with the new metric. The new metric is broken down by years of service and certification level. There are still some questions not yet answered about the new metric but below is our best interpretation of what the potential impacts could be

 

Current Contract Rates

Proposed New Contract Rates

 

 

Certification                                                Potential Impacts

CDI

Hourly rate ranges from $40-60 depending on years of experience

CI and CT

Increase of $5 in hourly rate. Only opportunity for advancement is to obtain SC:L

CI or CT

Increase of $5-$10 hourly rate based on years of experience

CSC

Increase of $5 in hourly rate. Only opportunity for advancement is to obtain SC:L

IC or TC

Increase $5-$10 hourly rate based on years of experience

IC/TC

Rate will increase by $10 per hour

MCSC

Increase of $5 in hourly rate. Only opportunity for advancement is to obtain SC:L

NAD 3

Increase $5-$10 hourly rate based on years of experience

NAD 4

Same rate or potentially $5 less per hour based on years of experience

NAD 5

$5 less in hourly rate. Only opportunity for advancement is to obtain SC:L

NIC

Loss of $5 in hourly rate for less experience than 20 years

NIC 2012

$10 less in hourly rate

NIC A

$10 less in hourly rate depending on years of experience

NIC M

$5 less in hourly rate. Only opportunity for advancement is to obtain SC:L

QDI

$10 less in hourly rate. Must obtain certification by 2019

RSC

Increase of $5 in hourly rate. Only opportunity for advancement is to obtain SC:L

 

To give those changes some additional context:

 

An interpreter who works 20 DSHS jobs per month on average for a total 50 hours a month could expect to see the following changes in their annual income:

 

·      An independent contractor who is holds the NAD 5 certificate and no SC: L will lose half of their contract service fee pay and $5 in their hourly rate resulting in a total loss of $7,200 per year

·      A Qualified Deaf Interpreter or interpreter who holds NIC Advanced will both lose $10 in their hourly wage resulting in a loss of $7,200 per year (QDIs also have the additional expense of RID testing by 2019)

 

This proposed contract also does not reflect any costs of inflation since the last time the rate was increased in 2009. Inflation compounds 3% per year on average. (Smith 2014)

 

This contract does not reflect the rising cost of business expenses or benefits.

According to calculations from Theresa Smith the costs of doing business on average will include Seattle Business License, B & O Tax, Liability Insurance, Self Employed Social Security, annual mileage, parking, professional dues, conference registration, travel to national conferences, additional professional development, professional services (IE accountant), and other miscellaneous (computer, printer, smart phone etc.) totaling about $9,720 per year. (Smith, 2014)

 

Benefits on average for a comparable profession such as nursing or for interpreters who work full time for a company are $17,680.00 per year (Smith, 2014)

 

 

There is a group of concerned interpreters who have started an e mail group to distribute information to interpreters and their allies. To be added to their distribution list please e mail Interpreters for a Living Wage interpreters.for.a.living.wage@gmail.com. This group is inviting all interpreters who currently work on the DSHS contract and Deaf/Deafblind/Interpreter allies to join a community forum next Friday May 9th at 6 pm for information sharing and solution focused work. Location to be announced.

 

Please e mail interpreters.for.a.living.wage@gmail.com for accommodation requests as well. Forum will be in ASL only

 

* Smith, Theresa. Some Math for Liberal Arts Majors (February, 2014)

Legislative Reception 2014

The annual Community of People with Diabilites Legislative Reception happened this year on january 22, 2014. The reception gives an oppertunity for consituents with disabilites and their allies to speak with thier representatives about issues effecting thier lives and communities. This year there was quite a large turn out from Deaf and Deafblind community leaders. Many members of the Medical Interpreting Task Force (MITF) were there to talk about their findings regarding communication access in the medical setting. You can see thier talking points below. There were also members from the Deaf Political Action Coalition (D PAC) in attendance to speak with thier representatives.

Representative Habib talking with Yes Serious and Julia Petersen from the MITF

 

Representative speaking with Larry Petersen long time activist and DPAC member and Julia Petersen from the MITF

 

Representative speaking with Ray Bateh from the Deaf Political Action Coalition

 

Assistant to Representative Hargrove speaking with Jackie Engler-Morris from the Medical Interpreter Task Force

 

Representative speaking with longtime community activist and MITF member, Allie Joiner

 

Human Rights Commission Commission Chair Stephen Hunt and Executive Director Sharon Ortiz speaking with ODHH director, Eric Raff

 

Robbi Crockett and Theresa Smith both from the MITF

 

Representative speaking with Julia Petersen

 

Angela Therauilt from MITF speaking with representative

 

Senator Karen Frasier speaking with Ray Bateh from DPAC about communication access issues in the medical setting

 

Representative Freeman speaks with Jason Smith about medical interpreter issues

 

Representative Freeman was so struck by the medical interpreter issue he talked with community members for quite a long time and promised to follow up on the issue

 

Allie Joiner then speaks with Representative Freeman

 

 

 

Andres Aguilar, director of the Division of Vocational Rehabilitation then speaks to the community about systematic issues

 

Communication Access in Healthcare Settings for Deaf, Hard of Hearing, and Deaf-Blind Patients in Washington State

 

In 2011, the Medical Interpreter Task Force was formed because of significant concerns regarding the lack of quality communication access Deaf and Deaf-Blind patients are experiencing in healthcare settings. In interviews with 150 Deaf and Deaf-Blind patients from across Washington, the following startling status quo was reported:

 

·      Failure to provide an interpreter during medical appointments. In healthcare settings across the state, ranging from large hospitals to primary care clinics, deaf and deaf-blind patients are often denied interpreter services. The denial of interpreter service was often coupled with pressure on family members to 'interpret.'

 

·      Failure to provide appropriate communication access is leading to medical error and lack of informed consent. Patients reported being hospitalized and discharged with out ever having been provided an interpreter to communicate with their healthcare professional. Some only found out their diagnosis at the time of discharge, when they finally had an interpreter.

 

·      Hospitals often have no provision for on-call interpreting service for medical emergencies and after hours interpreter needs.

 

·      Lack of statewide standards for interpreters working in healthcare settings. There are no state standards for interpreters in the medical setting, which leads to a wide practice of utilizing underqualified “interpreters” in medical settings despite there being a national certification process for ASL interpreters and the availability of hundreds of qualified interpreters.

 

·      Lack of quality interpreter services impacts deaf patients statewide and many are suffering from effects of trauma. Experiencing a medical emergency can be frightening, but when you add on being left in the dark about your prognosis and treatment the additional trauma of not having communication access can leave scars that last for years.

 

·      Lack of statewide oversight and advocacy on access to healthcare services for deaf and deaf-blind individuals

   

·      Healthcare providers often rely on interpreter referral agencies for ASL interpreter services; however, there are no standards for referral agencies requiring expertise with working with deaf clients; and therefore the agencies do not understand how to serve these clients. Many interpreter referral agencies in Washington work primarily with spoken language interpreter requests and are wholly unprepared to serve Deaf and Deaf-blind individual’s communication needs.

 

·      Healthcare providers are increasing their reliance on video remote interpreting systems; however, these new technologies are often used in situations where there is not the technical capacity, or it is inappropriate for the situation. For example, a deaf-blind client was told that the only interpreter service available was through the video system.

 

 

 

·      For approximately 450 deaf Washingtonians on Medicaid, The Washington State Health Care Authority system for providing interpreter services is wholly inadequate and has created a barrier to their ability to access Medicaid services they are entitled to.

 

In 2011, HCA took over management of Medicaid Interpreter Services, including  ASL interpreters, which was previously managed by DSHS, Office for the Deaf and Hard of Hearing. HCA then contracted through an RFP with one vendor to schedule Medicaid interpreted appointments, both for spoken language and ASL interpreter needs. This change has resulted in a dramatic drop in the number of filled ASL interpreter requests (see chart below) resulting in most Deaf Medicaid patients not having access to their medical provider or quality health care. What this means is that Deaf and Deaf-blind Medicaid patients are overwhelmingly not provided with an interpreter by the process designed and created by the State for that very function. A 2013 OFM report highlighted this “unintended consequence” and recommended that the state review ASL services.

 

 

Recommendations:

1)    Develop statewide standard requiring use of Certified ASL interpreters in medical settings.

2)    Follow up on OFM recommendation to review ASL services currently being managed by HCA.

3)    Ensure that any future work to “consolidate” interpreter services within state agencies is done with full involvement of the deaf community and ASL interpreter services needs.

4)    Create a work group to survey how ASL interpreters are provided in healthcare settings statewide.

5)    Avoid expanding current mechanisms for interpreter services delivery for state agency needs that may further perpetuate the “unintended consequences” known to have resulted and that remain unresolved in the HCA context.

 

Contact Theresa B. Smith, Ph.D., SC:L at theresa-smith@comcast.net

Medicaid ASL Interpreter Fill Rate Still Abysmal 2 Years Later

The number of filled ASL interpreter requests for Medicaid appointments still drastically low.

 

In September 2011, the Health Care Authority (HCA) separated from the Department of Social and Human Services (DSHS). With that split the HCA decided they no longer wanted to use the Office of the Deaf and Hard of Hearing (ODHH) contract to procure ASL interpreter services and that they wanted to lump ASL interpreters into their spoken language contract, which is now with an agency called CTS. Before that separation, the number of ASL interpreter requests filled was steady between 90% to 95%.

 

That change in contract happened over 2 years ago and since then the number of filled request has fluctuated from 0 requests filled to 32% of requests filled at the most.

 

There has been a slight uptick in the number of filled requests starting in March 2013 when the HCA decided to change the flat rate for interpreters from $50/hr. to now $80/hr. The HCA changed the rate, but kept the terms that interpreters contended the same, which consist of:

 

§  1 hour minimum

§  30 minutes of pay for cancelations and no shows

§  Interpreters only reimbursed for half of mileage costs

 

The HCA now reports that it has 13 interpreters contracted to provide statewide services through CTS.

Report on the First Year of the Medical Interpreting Task Force

State of Washington

December 3, 2013

The Medical Interpreting Task Force for deaf, hard-of-hearing and deaf-blind people in the State of Washington (MITF) was convened in the Fall of 2012 to address increasingly serious concerns expressed by stakeholders.  After initial meetings in which the issues were outlined, representatives of the task force reported to the Washington State Registry of Interpreters for the Deaf (WSRID) where we were asked to conduct a series of town hall meetings across the state to ascertain the extent of the medical interpreting problems from the perspectives of deaf, hard-of-hearing and deaf-blind people, and that of interpreters.  The Washington Association of the Deaf (WSAD) endorsed the idea, and so reimbursed by these two stakeholder organizations for expenses, we then held town halls (one for deaf, deaf-blind, and hard-of-hearing people and a second separate meeting in each location for interpreters) in six community centers across the state: Pasco, Spokane, Tacoma, Seattle, Vancouver and Bellingham (centers sponsored by the Office of Deaf and Hard-of-Hearing Services (ODHH).

In these gatherings we learned that there are some common issues and some issues more specific to particular areas (related to access to medical services and qualified interpreters in medical settings).  Common problems included:

·      Failure to provide any interpreter during medical appointments. This lack of interpreter services was often coupled with pressure on family members to 'interpret,' including:

o   Asking sick children (i.e. when a deaf parent took a sick, but hearing, child to the Emergency Room, providers expected the sick child to interpret for their deaf parent - this was reported by multiple times by people across the state;

o   Pressuring a hearing sister to interpret for the deaf patient who was there for diagnosis

o   Pressuring a deaf man to lipread and interpret for his deaf-blind wife;

o   Simply ignoring the request (including repeated requests) and relying on writing notes;

o   Telling deaf patients that no interpreters were available, that they had tried calling the referral service but with no luck; this happened so regularly that one must question the truth of the statements or the viability of this process;

The failure to provide any interpreter was so widespread and ranged from initial contacts, to diagnosis, treatment, discharge orders, and even for follow up sessions when a patient was diagnosed with cancer that it is clear there is a crisis in medical care for deaf, hard-of-hearing and deaf-blind patients and their families.

 

·      Trying to make do with some sort of interpretation

o   Providing one interpreter for a deaf patient whose deaf-blind wife was there to support him but not providing an interpreter for the wife, thus asking the husband (the patient) to interpret for his wife despite the fact that he was there with an injured hand (which is his means of communication with his deaf-blind wife);

o   Using a telephonic Spanish interpreter to interpret for a hearing sister of a deaf-blind patient who was then to interpret for her deaf-blind brother - this despite the fact that she is not a fluent signer and was understandably upset and concerned about her brother's health.

o   Asking a deaf-visually impaired patient to 'read' the Sign Language of an interpreter on the laptop screen (i.e. a telephonic interpreter using video);

All of these so called solutions were inadequate and resulted in insult as well as poor communication.

 

·      Emotional trauma. Such treatment evinces a blatant disregard for both the law and a total lack of any sensitivity to its effects: emotional trauma that has lasted for years, witnessed by the testimony of Community members who came forward to tell of such incidents that had happened literally years earlier.

o   Assuming a deaf man was on Public Assistance or Welfare and had no insurance;[1]

o   A hearing wife was told that the "ADA laws are crap", that interpreting should be a familial responsibility, "YOU chose to marry him, so it's your job to take care of him, not mine" and that the idea that the government can force a  physician to provide this service is "socialist and wrong", … "I can decide for myself who I accept as my patients";

o   A deaf woman with cancer was refused interpreters even after she had been diagnosed with cancer; she eventually stopped going for treatment as it was her only means of 'resistance' to this demeaning, de-humanizing treatment;

o   One deaf volunteer filming multiple interviews during one of these town hall meetings said at the end of the evening (only half-joking)  "[Now] I need therapy for vicarious trauma."

 

·      Medical error and failure to ensure informed consent.

o   In one instance, a deaf patient was being discharged from the hospital after recovering from a heart attack which had been the result of medical error, i.e. medication prescribed without benefit of an interpreter;

o   A deaf patient admitted to the hospital in the evening for a heart attack and emergency surgery the next morning did not get any interpreting service until a nurse in post-op (who knew Sign Language) advocated for him.  An interpreter was then provided but could only stay for two hours during which the doctors were not available.

·      No provision for on-call interpreting service for medical emergencies, after hours, or last minute needs

o   Patients in emergency rooms had to wait upwards of two hours for any interpreter, and in one case for as long as 8 hours. 

 

This was virtually universal throughout the state.  While ER visits by deaf, hard-of-hearing and deaf-blind patients are not common, especially outside the major population centers, even in two cities (Spokane and Bellingham) where interpreters have volunteered to carry pagers and be available for emergencies[2], no system has been established and .

 

·      Lack of established standards for interpreters.  There is an apparent lack of understanding of interpreting as a profession resulting in using family members as mentioned above or anyone who  is perceived to 'know sign'.   

o   Missionaries were sometimes allowed by the hospital to provide volunteer interpreting services, who then took the opportunity to proselytize to deaf patients and interject their personal religious beliefs into the patient and doctor interaction. Individuals from around the state indicated they had been preached to by so-called “interpreters”  who, behind the back of medical providers, argued against medical advice (e.g. telling the patient to refuse a blood transfusion recommended by a doctor by telling the deaf patient that "God forbids it.");

o   Budget concerns trump qualifications/standards

§  Some state contracts deem interpreters "qualified" based on a letter of recommendation or passing a paper test on ethics despite having repeatedly failed a performance examination (i.e. they failed to perform the work).  

§  Deaf individuals from around the state reported that many times the 'interpreter' that was hired for an appointment was unqualified for the job, did not have the linguistic fluency to interpret the communications between doctor and patient.

The law mandates the interpreter be qualified,  “Qualified interpreter means an interpreter who, [regardless of medium] is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary,”  and that the interpreter be a "match" for the deaf person and the situation.

 

·      Absence of appropriate supervision and advocacy

 

o   Medical providers often (apparently) grossly underestimate the value of full communication as they seem satisfied with writing notes, using children or simply relying on test results;

o   Administrators either seem unaware of the law or rely on referral services to send qualified people (see conflict of interest under contract issues below); 

o   Non-certified interpreters seem to greatly over-estimate their ability to do the task, taking jobs for which they are not qualified;

o   The Registry of Interpreters for the Deaf (RID) who certifies interpreters is powerless to sanction people who are not certified;  

o   Deaf patients wishing to file a complaint are referred from one office to another until they are exhausted; formal complaints 'disappear' into the system with no apparent effect.  One deaf person interviewed reported filling out a formal complaint and receiving no reply but when the supervisor of interpreting services was interviewed she reported never receiving a complaint.  Another deaf person reported asking for an appointment with the risk management supervisor to file a complaint only to find it was the same person in charge of hiring the interpreters (i.e. the person against whom the complaint was being filed) and she simply blew it off.   

 

 

 

Contract Issues:

·      Conflict of interests: private, for-profit referral services with no legal mandate to provide qualified (or even certified) interpreters recruit and refer those who charge the least while hospital administrators (naively?) rely on these referral services to vet the interpreters they refer.

·      Most of these referral service agencies originally focused on spoken language interpreters and while they have added ASL (signed languages) to their roster they lack the background or knowledge to effectively screen, supervise or refer Sign Language interpreters with deaf patients.

·      Hospital administrators in turn contract with these for-profit agencies based on the amount they bid (primarily financial considerations), the convenience of having a single agency for multiple needs, and evaluate their performance based on 'efficiency' (saving the hospital time in getting an interpreter) rather than the effectiveness of the communication during appointments;

·      Contractual arrangements make it difficult or impossible to provide consistent (or appropriate) and timely interpreting service (e.g. one floor of a hospital contracts with referral service A, while a different floor of the same hospital contracts with referral service B, so that when a patient is transferred from one floor to another, an entirely different service and interpreter are used; one hospital in Bellingham contracted with a referral service in another state who had no business relations with the certified interpreters in Bellingham and sent interpreters from locations literally hours away).

Other issues, sometimes specific to a particular location include:

·      Individuals and agencies lying about the so-called interpreter's qualifications (e.g. one agency told a non-certified interpreter "We certify you, so if you are asked if you are certified you can answer 'yes.'"

·      So-called interpreters refusing to tell the patient their name, the name of their agency or their qualifications, citing "HIPPA confidentiality requirements" making it impossible for the deaf patient to look them up in registers of certified interpreters or report them by name to any advocate;

·      Indiscriminate use of video interpreting services regardless of the situation[3]

o   a patient lying on an examination table asked to visually read an interpreter on a laptop screen across the room, at her feet;

o   a deaf, visually-impaired patient being asked to read an interpreter on a computer screen that they could not really see;

o   a deaf visually-impaired patient going to a local ER being referred to a hospital in the next city because the original hospital has only a video-relay contract;

·      staff do not know how to readily use the equipment and waste valuable time trying to set it up; staff rotation/turn-over coupled with the relatively low incidence of deaf patients means that training staff to do so may be a losing battle.

The Washington State Health Care Authority

Meanwhile, Medicaid patients, served by the state's Health Care Authority (HCA) are blocked from getting qualified interpreters because of payment policies.  Spoken language interpreters joined the state workers' union (WFSE) which negotiated rates, de facto determining fees for Sign Language interpreters taking these jobs.  Sign Language interpreters are in general better educated, better trained and more professionally credentialed[4]  and have traditionally been paid at considerably higher rates than spoken language interpreters. The result is that qualified Sign Language interpreters choose other jobs rather than work for such low rates.[5]

The language of the bill that created this system actually clearly states that ASL interpreters are not included in the requirement to create this new one-level coordinating entity; indeed, the Office of Fiscal Management survey concluded by recommending that ASL interpreters not be managed under this contract.  HCA however, opted to include (and continues to include) ASL interpreters, and maintains they must retain similar provisions between contracts for spoken language interpreters and ASL interpreters[6].

The result is that two years after the institution of this system the fill-rate for Sign Language interpreters is still only 25%.  While the HCA contract with CTS requires a 95% fill-rate, the number of requests for Sign Language interpreters is such a small percentage of the pool that CTS was for a while able to satisfy the contract without providing interpreters to more than a small percentage of deaf people.  Requested changes to help undo this harm have gone unanswered.

Lack of Oversight and Enforcement

Underlying all these problems is the lack of appropriate oversight and enforcement.  The efforts of the Office of Deaf and Hard-of-Hearing Services (ODHH) within DSHS have proven ineffective for a number of reasons. 

Referral Services specializing in Sign Language interpreting have made numerous and on-going attempts to educate hospital administrators as well as individual clinics.  Deaf patients have made numerous attempts to educate their medical providers and failing this to file complaints. 

The Northwest Justice Project (NJP) currently has a grant to provide CLEAR intake services in ASL by video phone to learn about options for filing civil rights complaints and filing private lawsuits based on violations of the ADA. In addition to gathering information from deaf, hard-of-hearing and deaf-blind people across the state during 2012, we informed participants at these town hall meetings of this service, but there is an ongoing need for system advocacy beyond any individualized approach. Legal assistance for individuals in regard to their rights is an obvious need, but  this will be useful for only a few individuals who qualify, and will only provide them a remedy; it but does not address the systemic problem of lack of enforcement of the ADA and other laws mandating communication access. 

SUMMARY

 

·      Lack of any systemic approach to the issue (no on-call service, no oversight or enforcement of the law, or appropriate standards by state authorities);

·      Budget constraints and concerns (e.g. attempting to make one interpreter serve both deaf and deaf-blind persons in the same encounter, attempting to use a remote/video-interpreter service when it is inadequate for multiple reasons)

·      Conflation of spoken language interpreter services with signed language interpreter services (apples and oranges).

·      Profit motive of referral agencies who choose the least expensive (typically the least qualified) to maintain a profit margin within the context of no established standards for interpreters (i.e. certification based on performance skills).

 

Complaints to the Health Care Authority (HCA) and to the Office of Deaf and Hard-of-Hearing Services (ODHH) have not, to date, resulted in any change in practice although the ODHH has participated (ex-officio) in the MITF meetings and paid for interpreters for deaf-blind participants in our meetings and forums.

 

Where do we go from here? 

This Fall (2013) we reported back to the WSRID and WSAD who urged us to continue our work.  The MITF is moving forward specifically

  • to establish standards: i.e. to mandate certification by the national Registry of Interpreters for the Deaf (RID) as the minimum standard for all medical appointments in Washington[7],
  • to ensure on-call systems are established for ER needs, and
  • to pursue establishment of an appropriate oversight body to maintain data on hospitals and clinics vis a vis communication access for deaf, hard-of-hearing and deaf-blind patients and family members. 

Our next steps include:

  • Continuing to reach out to organizations protecting the rights of disabled people (including the NJP, Columbia Legal Services and the Department of Justice Barrier Free Healthcare Initiative),
  • Working with the WFSE interpreter members to reach equity,
  • Informing deaf, hard-of-hearing and deaf-blind patients of the importance of reporting to the Washington State Hospital Association (accrediting body) and to the state Department of Health,
  • Informing our legislators and the Governor of the problem, and
  • Engaging hospital administrative staff on a more formal basis to learn the barriers they face in hiring qualified interpreters and to engage them in the efforts to improve the system(s).

 

 



[1] The connection to interpreting services is complex and relates to both the funding for interpreting services and the relative availability of interpreters.

[2] The interpreters were volunteering to be "on-call" without compensation but did expect to be paid once they were called.

[3] Given economic and other pressures the use of technology to solve the communication problem is appealing to hospitals.  There are, however, many reasons Video relay is not a fix. 

·       the technology itself: most hospitals do not have the necessary bandwidth and the picture repeatedly freezes, interrupting and cutting out parts of what is said;

·       small video screens are difficult to read and when a patient goes to an Emergency Room, they are sick and not able to put in the extra energy and effort to understand  a greatly reduced image;

·       examination rooms were not designed with this accommodation in mind and there is no good place to locate the screen where it offers a good view to the patient and to the interpreter, without being blocked by the medical providers moving around the bed.  The VRI screen, unlike a live interpreter cannot move on its own.

[4] Spoken language interpreters do have certifications which are quite rigorous, but these are for court interpreting and not medical interpreting, while the RID offers a generalist certification (to which can be added a Specialist Certificate in legal work).  The RID certificate requires a B.A./B.S. degree to qualify for the certification examination as of 2012.

[5] Sign Language interpreting is a profession for which one studies and from which one intends to earn a living, not something one does "for the Community" to help out in addition to one's regular work.  The rates negotiated by the union are higher than those previously paid to spoken language interpreters and yet are not sufficient for one to make a living.

[6] A further point to be made is that "Sign Language interpreting" like "spoken language interpreting" is a cover term which includes multiple variations i.e. it designates the channel or modality: speech / sign,  but not the language itself.  While the cover term American Sign Language or ASL is used, the reality is, that for reasons too complicated to identify here, there are variations in the languages used by deaf people and the certified interpreter is expected to be aware of these variations.

[7] There is not yet a specialist certification for interpreting in medical settings although this is currently being discussed and there is specialist training available in some national centers.  While the generalist certification offered by the RID does not ensure that the interpreter would be qualified for a particular assignment, it would set a base-line and such certified interpreters would be subject to sanctions by the RID if they behaved unethically (e.g. did missionary work, or took work for which they were not qualified).

What is Currently Going on With Educational Interpreter Standard

 

PESB Narrowly Approves EIPA 3.5 to be set as Recommendation

On July 30 a contingent of Deaf community activists and allies attended the Professional Educator Standards Board meeting to support minimum qualification standards for educational interpreters in Washington state. This group (seen below) has decided to organize under the name the Deaf Political Action Committee and the group was pulled together by local Olympia activist, Ray Bateh.

The PESB approved the following PESB Workgroup recommendations (by a narrow margin of 5-4) and will forward to the Washington House and Senate Education Committees for final approval. In addition to the Deaf activists and allies testifying for the EIPA there was about an equal sized group of SEE users including parents, children, and educators who argued for adding a test called the ESSE to the standard, given by the SEE center. The reason the board voted to pass the EIPA by such a narrow margin is because many of the board members were swayed by the argument that the EIPA could not validly test a SEE interpreter and that the option of SEE would be taken away.

The PESB recommendation for the assessments and performance standard are:

1. Educational Interpreter Performance Assessment (EIPA) with a minimum score of 3.5 AND
Educational Interpreter Performance Assessment (EIPA) - Written Test – passing score; OR
2. Interpreting Certificate (NIC) with RID certification AND Educational Interpreter Performance
Assessment (EIPA) - Written Test – passing score

In the next couple weeks, PESB will be working to upload the proceedings to Youtube and make transcripts available. Minutes of the meeting will be available after the next PESB board meeting in September when edits are complete and the minutes are approved. For details on the transcripts, please contact David Brenna at David.Brenna@k12.wa.us or visit the PESB website at:http://www.pesb.wa.gov/ 

Thank you to those who attended the meeting and supported efforts to improve communication access in the classroom and provide Deaf children with qualified interpreters. Also, thank you to RID president, Shane Feldman, for writing a letter to the board in support of a EIPA 4.0. The board took this under serious consideration and will revisit the 4.0 option in the near future.

Below you will find the YouTube audio of the hearing with real time captioning (the captioning is not great). Also, pictures of most who came to testify in support of EIPA. This hearing spurred a great wave of political activism lead by Ray Bateh, this lead to a newly formed group called D-PAC (Deaf Political Action Committee). See pictures of the members of committee below.

YouTube audio with captioning of the whole hearing

 

First meeting of DPAC

 

DPAC members Allie Joiner and Karen Philo

 

DPAC meeting discussing strategies for PESB hearing

 

First to testify is Rep Dahlquist, the original sponsor of HB 1144. She also mentioned she has never attended a hearing like this but is passionate about this bill

 

Carol Carrothers testifying for the EIPA

 

Gerilee Gustason testifying in support of ESSE (with  impromptu ASL interpreter)

 

Terry Sasser testifying for the EIPA

 

Brenda Aron testifying for the EIPA

Most of the Professional Education Standards Board

 

Ray Bateh testifying for the EIPA

 

Lance Forshay testifying for EIPA

Katie Roberts shows support for the EIPA

 

Mark Hoshi testifies for the EIPA

 

Karen Philo testifying about the importance of interpreters. Supporting the EIPA

 

Allie Joiner, who also testified at all of the hearings for HB 1144, returns to testify about the importance of the EIPA in this standard

Eric Raff, director of the Office of the Deaf and Hard of Hearing, comes to testify for the EIPA

Audience (mostly DPAC members)

 

Larry Petersen, another longtime activist who came to testify at legislative hearings, testifying in support of EIPA

 

Whitney Hill, testifying on behalf of WSRID for the EIPA

Jeannie Davis testifying in support of the EIPA

 

Cindy Crawford (an EIPA certified interpreter) and Carol, both testified in support of EIPA

David Brenna and Cheryl Johnson giving final report and answering the board's questions

The EIPA Needs Your Support!

Please come and join the WSRID legislative committee and our Deaf allies in testifying to the Professional Education Standards Board. They will meet to decide the recommendation for what test should be used for educational interpreter standards here in Washington. The two tests that came from the work group report are essentially the EIPA with a 3.5 or the ESSE. The ESSE is a SEE test that is currently only accepted in two states, but they have a very strong base of support here and we have heard they also plan on testifying at the board meeting. Of course, you do not have to testify but having as many supporters of the EIPA would help our case. If you are unable to attend but would still like to send a letter of support to the board please send it to  %20pesb@k12.wa.us

 

The board meeting will be held at:

 

The Phoenix Inn Suites

 

415 Capitol Way North
Olympia, WA 98501

 

Tuesday July 30th, 2013

Educational Interpreter Standards is currently slated for 3:00 pm and is open to the public. You can see the full agenda here

https://docs.google.com/file/d/0B5d85w3Eol73R0VDQ1oyTzBQNzA/edit

HCA Fill Rate for ASL Interpreter Requests Improves Some but is Still Dismal

 

     The above graph shows the average fill rate for ASL interpreter requests under the old ODHH contract compared to the monthly average under the newer CTS contract (CTS is the statewide interpreter referral agency for all Medicaid appointments, spoken and sign language).

 

     You can see from the chart that the average number of filled ASL interpreter requests went from 97% to 0% and has slowly risen to now 25%.

     

     One explanation for the rise in filled requests is that in January 2013 CTS announced that they would raise the rate for ASL interpreters to $80 per hour (but still keep the objectionable terms in tact). According to a recent public disclosure request, the HCA reports there are currently 8 interpreters signed up with CTS. Those interpreters are in Clark, King, Spokane, Pierce, and Thurston counties. So while there has been a significant rise in the number of filled appointments, there are still too many gaps to call the new contract a success.

     

      Another interesting phenomena is the average number of requests for ASL interpreters was 229 per month on average under the ODHH contract and since the contract change in September of 2011 that number has slowly decreased and is now well under 100 requests per month. There could be various reasons for that decline.

Work Group Report to the Professional Education Standards Board is Released

 

*click here to see full report in PDF format

 

 

Greeting everyone! I’m pleased to present for your consideration the final draft report of the Deaf Education Interpreter Workgroup. Please send me any feedback or comments with a reply email. Cheryl DeConde Johnson and I will review all email comments and make a determination about edits to the final document. This will be presented to the PESB in July (30). Remember that the meeting is an open public event and the board welcomes testimony or feedback at that time. You may also submit a letter to the board for their consideration. The board, unlike a legislative committee, does not ask questions of individuals providing feedback, but your testimony is considered in their deliberations. The board will act to either accept the recommendations, or reject them and vote for a different assessment and score.

 

A word of thanks to all that have helped, directly or indirectly on this report! Job well done! David

David Brenna

Senior Policy Analyst

Professional Educator Standards Board

360-725-6238

www.pesb.wa.gov

 

 

CTS Surveys Interpreters about Industry Standards

Below is an e mail sent from this e mail address, hcainterpr​eters@ctsla​nguagelink.​com. CTS is the referral agency providing ASL/spoken language interpreter services for Medicaid and spoken language interpreter services for DSHS state wide. It is not clear how they decided which interpreters to send this to, or how many interpreters received this survey. The link to the survey could not be included or forwarded but the content of the survey was related to hourly rates, minimums, milage, and the window for cancelations and no-shows. 

 

WSRID and the Medical Interpreting Task Force did write letters to the Health Care Authority in 2011 concerning the same issue of contracting outside of standard business practices, you can reference the WSRID letter here and the ASL version of the MITF letter here

 

 

 

As you may know, we (CTSLanguageLink) are servicing the HCA contract for state paid Medicaid interpretations which includes coverage for ASL services as well. Currently, we understand that there are aspects of this contract that do not coincide with current rates and parameters for ASL interpretation. It is our goal to provide the state with information about the current industry standards for ASL as it relates to private-pay interpretation. 

To help us with this, we have used information provided in previous outreach to ASL interpreters to develop a questionnaire that goes over the aspects of the contract that seem to be the most in disagreement with the current industry standards. We would ask that you answer the following questions as they relate to your current rates for ASL interpretation. The information gathered will be given to the state and will allow HCA to make some decisions with the goal of increasing the number of ASL interpreters available to Medicaid clients. Note: It is very important that you answer these questions based on your current private-pay guidelines. 

 

Governor Signs Educational Interpreter Standard Bill

 

In front: Harley Applin, Harley wrote the bill last year as part of a project at his high school, while the bill didn't make it last year it became HB 1144 this year and has now has been signed to law. Governor Jay Inslee, Representative Cathy Dahlquist the original sponsor of the bill  

 

Standing in back left to right: Kris Ching, Rick Hauan, Carol Carrothers (all from the Center for Childhood Deafness and Hearing Loss), sister Madison, mom Pearl, and mom's partner (all family of Harley"s), Toby Olsen (Executive Secretary for the Governor's Committee on Disability Issues and Employment), Whitney Hill (WSRID Legislative Committee), Eric Raff (Director of the Office of the Deaf and Hard of Hearing), Allie Joiner (long time community advocate who also testified on behalf of this bill), Polly McLean (interpreter supporter), Ray Dominguez (community advocate), Paul Bert (CDHL and interpreter), unknown, David Brenna (Professional Educational Standards Board), Larry Scholenberg (community advocate), unknown

 

 

Below is a message from David Brenna with the Professional Interpreter Standards Board about the signing of the bill:

 


Greetings! Governor Inslee signed HB 1144, as amended by the Senate, into law on May 10th. The signing ceremony was well attended and cause for celebration. Representative Dahlquist was present and thanked the many individuals that came for the ceremony. It was a moving experience and I was honored to be part of it. Thanks again to all the fine people involved in getting Washington State moving toward support of the effective education of deaf children!

The amended version asks PESB to do additional work and recommend action to the Legislature. There will be more information on that effort soon, but right now we’re completing the draft report to the board. Within the week, the draft will be available for review and comment by everyone receiving this email. Your comments will all be considered in finalizing the report to the board. The PESB will meet in Olympia on July 30 to receive the recommendations of the workgroup. David

David Brenna
Senior Policy Analyst
Professional Educator Standards Board

 

 

Harley Applin speaking with Governor Inslee (interpreter Stewart Tennis)

 

Representative Dahlquist and Harley Applin

 

Harley Applin, Carol Carrothers (Carol has been working to pass an educational interpreter standard for 19 years),  and Eric Raff

 

Allie Joiner chatting with Paul Bert while waiting to be called in for the signing

 

 

Governor to Sign Educational Interpreter Standards Bill

HB 1144, regarding educational interpreter standards, will be signed by Governor Inslee on May 7th, at 1:30 at the Governor’s Conference Room in the Capital Building

Thank you to all those who were involved in this landmark legislation to improve educational access for Deaf and DeafBlind children

Hope to see you all there!

Legislation Concerning ODHH's Funding Source

2013 Legislative Session 
CONTACT YOUR STATE REPRESENTATIVE TODAY 
**information at the end of this post on what you can do

House Bill 1971 and Senate Bill 5034

House Bill - HB1971 – Concerning communication services reform
Description: Provides communication services tax reform. Establishes a state universal communications services program to support continued provision of basic telecommunications services under rates established by the utilities and transportation. Creates the universal communications services account. 
Status: Mar 15 Public hearing in the House Committee on Finance at 8:00 am 
*Note: This bill proposes to eliminate ODHH TRS fund and replace it with state appropriations. 

Senate Bill - SB5034 - Making 2013-2015 operating appropriations.
For more information on budget proposal(s) go to:http://leap.leg.wa.gov/leap/default.asp 


Legislative Alert!

Continuing Telecommunication Relay Service (TRS) and other services for the deaf, hard of hearing and deaf-blind

With Funding From Uniform Telecommunications Taxes

(Engrossed Second Substitute House Bill 1971 and the Engrossed Substitute Senate Bill 5034)


Background:
As you may know, ODHH revenue is based on a Telecommunication Relay Service surcharge billed to landline telephone subscribers which is rapidly decreasing because of cellular/wireless telephone services. ODHH had to propose budget reductions in the annual FY14 budget and in FY15, would have to keep telecommunication services and reduce or eliminate all other services. 

However, Engrossed Second Substitute House Bill 1971 (E2SHB1971) would change the way that telecommunications services are taxed, using a uniform sales tax on all telecommunication services to replace the patchwork of different taxes and fees currently in place for the telephone land lines, wireless cellular communications, and cable / voice over internet protocol (VOIP) sectors. The legislation would generate an estimated $33.5 million in new state revenue for the 2013-15 biennium, plus $16 million for local governments, and $73.1 million in new state revenue in 2015-17, plus $31.4 million for local governments.

E2SHB1971 eliminates the dedicated surcharges currently collected on traditional telephone land lines and replaces it with state General Fund revenues generated by the uniform sales tax on telecommunication services. However it must be appropriated via the House operating budget proposal which amends the Senate operating budget, ESSB 5034. 

If E2SHB1971 (Communication Services Reform) and the House operating budget proposal to ESSB 5034 (2013-2015 operating appropriations) passes, ODHH will get most of its’ funding back. This funding is for several telecommunications services, including:

Telecommunication Relay Service (TRS), specialized Telecommunication Equipment Distribution (TED), and services for the deaf, hard of hearing and deaf-blind.
Washington Telephone Access Program (WTAP);
Community Voice Mail;
Washington Information Network (WIN 211)
The House operating budget proposal to Engrossed Substitute Senate Bill 5034 (ESSB 5034) was amended and passed by the House:

Section 207, subsection 9 of the House operating budget directs $11,458,000 to the combined purposes of WTAP, Community Voice Mail, and WIN 211, with $3 million of these funds specifically allocated for WIN 211.

Section 209 of the of the House operating budget directs $10.1 million of General Fund revenues “for services and support to individuals who are deaf, hard of hearing, or deaf-blind.”

http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Amendments/House/5034-S.E%20AMH%20ENGR%20H2378.E.pdf

What do I need to do?

The legislative session ends on April 28th but Governor Inslee is expected to call the legislators back for one or more Special Sessions. There is time to address ODHH funding for essential telecommunications and other services! The Senate has to approve the House amendment to the operating budget bill. You can contact your Senator to request full funding from the new state General Fund revenues generated by the uniform sales tax on telecommunication services, as provided in E2SHB 1971 and appropriated in the House operating budget proposal which amends ESSB 5034. 

If you don’t know who your Senator is, district maps are available by clicking on the district numbers in the table below, or you can check here:http://app.leg.wa.gov/DistrictFinder/

Message to your Senator:

“Please support ES2HB1971 and Section 209 of the House operating budget proposal, amending ESSB5034, which would allow the Office of the Deaf and Hard of Hearing to continue and fund telecommunication relay service (TRS), a federal mandate, and other services and support to individuals who are deaf, hard of hearing and deaf-blind.”

HB 1144 passes!

HB 1144 has now passed and is now on its way to the governor's desk for signature. The bill passed unianimously which is such a huge triumph considering there has been 30 years of work into making this happen. 

 

The amendment added in the senate, that many groups had concerns with, is still in tact. This amendment removes the requirment for certification until the legislative education committees come to a decision about how certification (and which certification) should be used in our state. 

 

The next step legislatively for this bill is to watch for when the professional education standards board releases thier recommendations for certification and participate in calls for public comment to ensure we have a rigorous and high quality certification standard recommended for adoption in this state.

Letter Endorsed by WSRID to the Governor in Regards to HB 1144

 

Please sign HB 1144 without the Senate Amendment. 

 

Hopefully HB 1144 will soon come to your desk for signature.  'SEE advocates' against this bill are passionate but mis-informed.  Their argument does not focus on standards but on ideology regarding methods of teaching deaf children.  The current bill does not engage these ideological issues but rather attempts to establish minimum standards for the position of 'interpreter' in public schools.  Currently these positions are typically filled by people who “know some sign”.  Without meaningful standards deaf, hard-of-hearing and deaf-blind children will not reliably have access to ANY language, English, ASL or anything else.

 

1.     The bill does not exclude SEE interpreting but rather requires minimum certification as established by the Professional Education Standards Board (PESB) which includes certifications of interpreting using SEE.

2.     The RID itself includes the Educational Certificate (Ed K-12) specifically intended for public school interpreters.  This test was developed by the Educational Interpreter Proficiency Assessment (EIPA).  Please see their website http://www.classroominterpreting.org/eipa/index.asp

3.     While Dr. Gustafson and her cohort assert that the Manually Coded English (MCE) tested by the EIPA "is not really SEE Signs" she is either misinformed or promoting a specific testing protocol in which she is personally involved (ESSE). 

 

Currently, each district is making it up as they go along, and most of the people hired to interpret for deaf children are not qualified to interpret period. Some are recent high school graduates who "took some Sign Language in school", "have a Sign Language book" or learned 'Sign Language' at church. 

 

Deaf, hard-of-hearing and deaf-blind adults and RID certified interpreters all want deaf children to be fully supported in their education and learn analytical thinking, social skills and content, as well as English.  We want them to have everything they need to learn in order to be happy, healthy, functioning adults.  Without mandated, legislated minimum standards for interpreters most deaf children outside major metropolitan areas will not have interpreters skilled in SEE signs or anything else. 

 

Thank you for your consideration,

Theresa B. Smith, Ph.D.

Interpreter Educator

Educational Interpreter Standards Bill Passes the Senate! but...

The Educational Standards Bill 1144 has now passed the senate unanimously with 45 yeas, 0 nays. In the senate there recommendation was a last minute twist. Senator McAuliffe proposed an amendment that would strike the national certification requirement from the bill which was:

 

(4) By the beginning of the 2019-20 school year, educational interpreters who are employed by school districts must meet the requirements of subsection (3) of this section, plus achieve national interpreter certification by the national association of the deaf registry of interpreters for the deaf.

 

here is what the amendment says now in the bill information:

 

By December 31,2013 the professional educator standards board shall recommend to the education committees of the house of representatives and the senate, how to appropriately use the national interpreter certification and the national interpreter performance assessment for educational interpreters in public schools"

 

Effect: Removes the requirement for educational interpreters in school districts to achieve by the 2019-20 school year the national interpreter certification of the National Association of the Deaf and Registry of Interpreters for the Deaf. Adds the requirement that the Professional Educator Standards Board must recommend to the education committees the appropriate use of the National Interpreter Certification and Educational Interpreter Performance Assessment for educational interpreters in Washington public schools

 

http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Amendments/Senate/1144-S%20AMS%20MCAU%20S2618.1.pdf

 

This is all still very confusing, but it seems that the decision about how the EIPA should be used in our state will be up to the professional educator standards board. They will come up with a recommendation by the end of the year, that will go to the house and senate education committees, then the legislature can follow or ignore the recommendations. 

 

Senators did reach out to community members this past week in regards to this amendment. It seems that the purpose of the amendment is to leave more room open for SEE advocates to lobby against the EIPA.

 

Because the bill was amended in the senate, it must go back to the house for concurrence. If the house approves then it goes to the governor for final approval. Please contact your representatives and let them know why keeping the requirement for national certification is so important. You can find your local representatives here:

 

http://app.leg.wa.gov/DistrictFinder/

 

 

OFM Releases Interpreter Study Including Recommendations for ASL Interpreters

In 2012 the Legislature ordered the Office of Fiscal Management (OFM) to research how the state procures interpreter services and provide a study with recommendations regarding interpreter services to see if services could be consolidated to reduce cost. You can find the full report here. 

 

The one recommendation regarding ASL interpreters states:

 

"A workgroup should be formed to address the delivery of American Sign Language (ASL) interpreter services. ASL interpreters are currently refusing to provide services through the HCA interpreter procurement system due to the dissatisfaction with payment terms. Centralizing ASL interpreting contracts through DSHS' Office of the Deaf and Hard of Hearing should be explored."

 

The report also states on page 40:

 

"ASL and spoken word translation types are provided by different industries with different legal and training requirements, cultural focus, professional standards, and certifications. Those core differences have affected the market of those two industries and accordingly, the expected payment rates and terms differ substantially. The failure to recognize these differences has led to fewer deaf and hard of hearing Medicaid clients being served through the HCA system as few ASL interpreters are willing to participate in the HCA system. It is a cautionary example of how cost saving efforts and efficiency measures can have the effect of driving an industry away from working with the state.

Centralizing and streamlining in ODHH interpreting contracts for ASL for all state agency use, including HCA, should be explored. Like the courts, ODHH has a unique relationship with an interpreter sector. ODHH has successfully managed the DSHS ASL contracts for over seven years. ODHH has subject matter experts in ASL modalities and service settings, client communication needs, and interpreting practice. Relationships have already been established between the deaf community, ASL interpreters, and ASL interpreter agencies. HCA does have concerns related to federal Medicaid reimbursement rules and has a desire to maintain a single procurement system, but these need further attention than this study could address. Therefore, we recommend that a workgroup be formed to review ASL interpreter services."

 

If you would like to contact your legislator to ask them to follow up with the recommendations you can find your representatives contact information  here

Spoken Language Interpreter Bill Passed Committee. Now Has Amendment Excluding ASL Interpreters

HB 1753, which would consolidate spoken language interpreter services between Labor and Industries, Department of Enterprise Services, and the Health Care Authority, passed the House Committee on Government Appropriations and Elections narrowly with a vote of 6 to 5. This bill was passed with an amendment that would specifically exclude ASL interpreters. Many showed up to testify.

 

-In favor were the spoken language interpreter union and spoken language interpreter advocates.

 

-Opposed or neutral with concerns included a VRI interpreter, In Demand (VRI business) with the Independant Business Association, a representative from the hospital association. Representing the concerns of the Deaf community were Theresa Smith and Shawn Broadrick. Watch the hearing below:

 

House Committee on Government Appropriations and Elections (2/20/13)

 

and the actual vote is below at 34 minutes

 

House Committee on Government Appropriations and Elections (2/21/13)

 

Here is a report from advocate Allie Joiner about the hearing:

 

-Present were: Dino, WSAD President; Larry Petersen; Ray Bateh; myself (AJ); Ray Dominquez; Larry Schoenberg; Shawn Broderick; and Theresa Smith.

 

Two hearings took place Feb 20 – HB 1753 was interesting… as quite a few individuals testified along with Theresa Smith.  That bill was related to extending the system currently used for obtaining spoken language interpreters (now used by the Health Care Administration) to other state agencies, specifically Labor and Industries (L & I).  Before yesterday, there were several amendments so it became the "Substitute Bill 1753".  One of the big changes was removing Sign Language interpreters (interpreters for the sensory impaired") from the bill and saying they would continue to be managed by DSHS (which means ODHH). 

Theresa emphasized the fact the system was not broken under ODHH… Deaf Medicaid patients received interpreting services… the rate of filling requests with ODHH was 95% or 97%...whereas under HCA (contracted with a referral center called CTS) was  0 %.  Some people blamed interpreters for refusing to work with HCA but it is more related to the agreement – terms that were not accepted by ASL interpreters.  The more we learn of the terms we would agree with ASL interpreters.  The substitute bill was more tailored to spoken language interpreters.  The ones who spoke in favor of the bill said that the state saved $13 million dollars therefore HCA was more cost effective. Theresa pointed out to the fact that perhaps one reason the monies were saved was because NO interpreting services were provided to Deaf Medicaid patients during that period when HCA took over and then Theresa asked  the Government Operations committee to reject the original bill, but supported it with amendments (removing Sign Language interpreters) and supporting the addition of an advisory committee re spoken language interpreters.  Shawn followed with his testimony:  He explained about his business and matching an interpreter with a client appropriately meeting the latter's needs/wants.  Not just any interpreter is appropriate.  Some patients are deaf-blind and need tactile interpreting or signing in a small space, sometimes it is only appropriate for a female or male interpreter and so on so there is a lot of consideration in matching interpreters.

Hospital representatives also objected to the state change explaining that their in-house system worked fine in the past dealing with I think CMS – Center of Medicare/Medicaid Services – abbreviated to CMS.

One spoken language medical interpreter – believed to own his own business was not happy with the new system – explaining that he used remote means like our VRI – stating he did not have to travel – would not be exposed to sick people-contagious affected patients – etc   (we thought NO NO NO NO not for our people).  This was added to the substitute bill so that telephonic or video interpreting can also be used.

Interpreters United – the interpreter union - many of them wearing green T-shirts – took up probably ½ of the room –their representative favored the bill.  They were upset that we (Deaf people and Sign Language interpreters) did not support them.  This was partly a misunderstanding that will have to be worked out as we go forward.

 

Educational Interpreter Bill Passed House, Now on to Senate

The Educational Interpreter Standards bill, SHB 1144, has now passed the house with a unanimous vote in favor of the bill and we are awaiting its move to the senate. You can watch the testimony of James Christainson, Larry Peterson, and spoken language interpreter advocates here:

 

House Appropriations Sub Committee on Education (2/20/13)

 

The spoken language interpreter union president, Leroy Mould testified in favor of the bill. Then Doug Nelson, representing PSE, (this could stand for Public School Employees he does not clarify that) also testified in favor of the SEE amendment being recognized by the committee formed to set the standard instead of excluded from the standard. This sparked a hot discussion between Representative Susan Fagen (R) 9th district and the union representative. Here is a quote from Representative Fagen in regards to SEE:

 

"it's (SEE) called a convienence for hearing people because that's how we want to talk...Have you asked the Deaf community what they think?"

 

Below is a report from advocate, Allie Joiner about how the session went:

 

 At 3:30 PM HB 1144 was summarized by a team of 2 legislative staff members – they gave a brief report more in our favor…  Larry P and Dino testified explaining that if the bill did not pass, the state would be wasting taxpayer monies as the result etc etc –due to poor or lack of quality education.   An "Interpreter United" representative sat along and asked the committee to support the bill.  Some questions were asked but the neat committee member by name of Susan Fagan and I think the chair both said that it was not necessary to discuss the controversy (ASL –SEE) but that assessment of all interpreters made sense.  Representative Dahlquist came down and shook the hand of each deaf person there and thanked them for coming in support.

It was short and sweet … we got the impression the bill would pass fine.

Then guess what!  Representative Susan Fagan came out in the hallway and met us personally – saying she wants to know MORE and for us to contact her by email.  She said she has a Deaf daughter – at WSD, we did not get more info as she hurried back into the hearing room.  She was warm – bade us goodbye with the Deaf symbol “I love you”…  I thought, HORRAY, we got an ally inside the legislature.

 

 

New House Bill 1753 Could Negatively Impact Sign Language Interpreters

A new bill (HB 1753) was introduced Febuary 7th, see current bill information  here . This bill would consolidate all spoken language interpreting for Department or Health and Human Serices (DSHS), Health Care Authority (HCA), and Labor and Industries (L & I) into one centralized system and there is no protections to ensure ASL interpreters not be included. Communication access for the Deaf community has been severly impacted by the HCA and DSHS consolidating interpreter services and trying to lump ASL interpreters into a spoken language interpreter system. Hence, WSRID Legislative Committee and the Medical Interpreting Task Force have contacted all of the sponsors of this bill with the following talking points:

 

HB 1753

We as a collective group of professional sign language interpreters and advocates of the Deaf community are strongly opposed to HB 1753, as written without protections to ensure that ASL interpreter services will not be included in the new delivery system mandated by HB1753. In 2010, ESSB 6726 was passed by the legislature mandating a new approach to the delivery of spoken language interpreter services. Even though ASL interpreters were excluded from that legislation by the definition of language service provider, the repercussions to ASL interpreters and hence Deaf Medicaid patients in Washington State have been severe. For reasons unknown and unexplained to date, the Health Care Authority (HCA) chose to take over the ASL interpreter contract previously held by the Office of the Deaf and Hard of Hearing (ODHH) and change the terms of the contract to reflect the spoken language interpreter contract. A contract negotiated by and for spoken language interpreters with no input from ASL interpreters and no consideration to the impact that the contract changes would have on the State’s ability to continue to serve Deaf Medicaid recipients. HCA unilaterally and without consulting community groups took over ASL interpreter service delivery in September 2011 and placed those services with the Brokers who were wholly unprepared to serve Deaf clients. The result was a dramatic reduction in the State’s ability to provide ASL interpreters to deaf, hard of hearing, and deaf-blind Medicaid recipients. Community advocates reached out to HCA, but were asked to wait for the new system in September 2012. Since September 2012, when CTS took over as the statewide coordinating entity, zero ASL interpreter request have been filled. (See attached chart). As a result, Deaf Medicaid patients have struggled to receive communication access with their healthcare providers.

THE PROBLEMS

 

1.  HCA unilaterally took ASL interpreter services from ODHH’s control in 9/2011 resulting in an immediate decrease in access to services for deaf Medicaid recipients.

Further decreases to access to services have come about after the new coordinating entity took over services in 2012 so that now the state is providing ZERO ASL interpreters to deaf Medicaid patients. This change was not mandated by any legislation and has caused great harm to the community. See chart.

 

2.  HCA has designated CTS as the statewide interpreter coordinating entity and since September 2012 they have filled zero ASL interpreter requests.

This is not a scarcity issue. There are plenty of certified, qualified ASL interpreters ready to interpret for medical appointments. The reason the State is not able to provide interpreters for these recipients is that the terms of the contract are so very far below industry standards that HCA / CTS have not been able to find interpreters willing to work for those terms.

 

3.   Advocacy efforts have proven ineffective in convincing HCA to change their approach to improve the quality of services provided to deaf, hard of hearing, and deaf-blind.  

HCA recently raised their rate for ASL interpreters to $80 per hour, the highest in the country, still interpreters have reported being resistant to signing the contract because the terms of the contract, including the cancelation policy, are so out of line with industry standards.

 

4.   HB 1753’s expansion to Labor and Industries and other DSHS services will further harm deaf, hard of hearing, and deaf-blind recipients unless explicitly exempted from this system in the legislation.

 

Solutions

Even though this legislation does not include ASL interpreters, the repercussions from ESSB 6726  and the actions by HCA to unilaterally include ASL interpreters into terms that do not fit the current practices of the field have caused great harm to Deaf Washingtonian and have undermined the State’s obligation to provide access to these services. We ask that HB 1763 be amended to explicitly exempt ASL interpreter services from this delivery system and to amend ESSB 6726 to include the same exemption.

This group does not purport to have all of the solutions; however, it seems obvious that an interim step would be to return to contract terms and delivery providers that understood the nature of providing services to deaf, hard of hearing, and deaf-blind individuals. That was accomplished with a 90 % fill rate under the management of ODH. Unless HCA can improve upon those numbers, then the logical and rational approach would be to return these services to the delivery system that was effective until the changes mentioned above and allow them to remain there until an alternate approach can be developed that ensures access to certified ASL interpreters. Additionally, we believe any solution must include members of the Deaf and Deaf-Blind communities as advisors to ensure quality.

 

Sincerely,

 

Allie Joiner, (advocate at DBSC, for deaf-blind senior citizens)

Angela Theriault (Director of DBSC – member of WSDBC)

Char Parsley (Director Eastern Washington Center for the Deaf and Hard of Hearing)

Eloisa Williams (WSRID, President)

Julia Petersen (Deaf health care professional, Children's Hospital)

 Michael Gough (WSAD member, health care consumer)

James Christianson (WSAD, President)

Robbi Crockett (President ASLIN)

Shawn Broderick (Owner SLISNW, researcher)

Theresa B. Smith, Chair (interpreter educator)

Whitney Hill (WSRID legislative committee chair)

 

Educational Interpreter Bill Approved by House Education Committee

The 2nd hearing for the educational interpreter standards bill (HB 1144) in the House education committee, happened last Friday in an executive session. Because this was in executive session, it was closed and not available for public comment. You can watch the hearing on TVW here  starting at minute 13. The good news is that the education committee voted to recommend this bill with 21 in favor 0 opposed. Below is a diagram of where exactly this bill is in the legislative process:

 

The bad news is that this bill was passed with the following amendment:
(5)The provisions of this section do not apply to educational interpreters employed to interpret a sign system or sign language for which no educational interpreter assessment has been identified by the professional educator standards board." EFFECT: Provides that the assessment requirements of the bill do not apply to educational interpreters who are employed to interpret a sign system or sign language for which no educational interpreter assessment has been identified by the Professional Educator Standards Board.
This could mean that the standard the Professional Educator Standards Board adopts this summer might not apply to interpreters hired by school districts to provide SEE because there is no assessment available for SEE.
 
*Please note this diagram reflects bills on the national level, but the system at the state level is essentially the same if you substitute   President for   Governor. For Washington State specific information, click   here
 
 

 

Educational interpreter bill given 2nd hearing but there are concerns

The second hearing for the educational standards bill (HB 1144) is now scheduled for this Friday, 2/8/2013 at 1:30. This will be an excecitive session meaning it will not be open to the public and this raised some red flags for a few Deaf community advocates. 

 

Deaf advocates have reported that when an executive session is called, this usually means that an opponent has got the attention of legislators. Recently Larry Peterson was contacted by some SEE representatives that were asking for a meeting.

 
If your representative is on the Education committee listed below we ask you please contact them and let them know you are a constituent and support this bill. Talking points for this bill can be found on this site's homepage. Finding out who your representatives are and how to contact them can be found here
 
Education Committee
Santos, Sharon Tomiko (D) Chair (360) 786-7944      Stonier, Monica (D) Vice Chair (360) 786-7994
Dahlquist, Cathy (R) (360) 786-7846                             Magendanz, Chad (R) (360) 786-7876
Bergquist, Steve (D)(360) 786-7862                               Fagan, Susan (R) (360) 786-7942
Haigh, Kathy (D)(360) 786-7966                                     Hargrove, Mark (R) (360) 786-7918
Hawkins, Brad (R)(360) 786-7832                                  Hayes, Dave (R) (360) 786-7914
Hunt, Sam (D)(360) 786-7992                                         Klippert, Brad (R) (360) 786-7882
Lytton, Kristine (D)(360) 786-7800                                  Maxwell, Marcie (D)(360) 786-7894
McCoy, John (D)(360) 786-7864                                    Orwall, Tina (D) (360) 786-7834
Parker, Kevin (R)(360) 786-7922                                   Pike, Liz (R) (360) 786-7812
Pollet, Gerry (D) (360) 786-7886                                    Seaquist, Larry (D)(360) 786-7802
Warnick, Judy (R) (360) 786-7932
 
 
 

Community of People with Disabilities Legislative Reception Recap

First of all, thank you to all who took the time to contact your representatives and invite them to the reception. There was very good legislative turn out and the committee really appreciates your help.
Also, a big thank you to fellow committee members, Emily Deleon and Dawn Piegdon, for all your help with preparation for the event, taking the time out of your weekday to attend, and your lobbying efforts.
 

Representative Shelly Short with legislative committee member, Whitney Hill

 

The WSRID Legislative Committee was there to discuss two issues currently affecting interpreters (talking points are attached to site home page):

 

·      Lack of access to qualified ASL interpreters in the education setting. HB 1144 is a bill that addresses this issue by making Washington the 43rd state to have a certification standard for ASL interpreters in public schools and we as interpreters as well as the Deaf community are strongly in favor of this bill. 

·      Lack of access to any ASL interpreters in the medical setting is the second significant issue. Due to contract changes, the Health Care Authority has filled zero requests for ASL interpreters for Medicaid appointments since September 2012 and has no plans of changing the status quo. There are also significant barriers to ASL requests going unfilled for patients with private/ no insurance and the attached talking points outline a possible legislative solution we are interested in perusing.

 

We were also thrilled to see signifigant represenation from the Deaf community and other supporters of the educational interpreter standards bill.

 

Announcing of the Representatives

We did recieve good feedback about the two issues we were there to support. Some of the highlights were:
  • Senetor Maralyn Chase said she was planning to sponsor a companion bill to HB 1144 in the senate sometime during the current session.
  • My own representative Jeannie Darneille was already on board with educational interpreter standards. She was shocked and appalled to find out about Medicaid not providing ASL interpreters and said she would immediately make some calls.
  • Representative Hargrove (who also serves on the house education committee) said he knows an interpreter from church and would ask her what she thinks. If you watch the hearing from yesterday (see link in previous blog post) he asked about what language the certification test is for. He seemed favorable to the bill even though he wasn't thrilled about another unfunded mandate.
  • Senetor Ed Murray's representative was there and after a passoinate spiel from Allie Joiner, he finally realized why the difference in spoken and sign language interpreters is so crucial.

Wide shot of the reception wrapping up. You may recognize a few working interpreters in the crowd

Bob Lichtenberg (Office of the Deaf and Hard of Hearing) and interpreter Paul Bert. Paul was there supporting HB 1144

 

We have now followed up with all of the legislators we met and gave them a quick summary of the issues, reattached the talking points, and thanked them for their time.

 

 

 

Watch Todays Ed Interpreter Bill Hearing

Here is the link to TVW for today's hearing on the educational interpreter standard bill HB 1144

http://www.tvw.org/index.php?option=com_tvwplayer&eventID=2013010131

Great testimony given by Larry Peterson and Allie Joiner! Also, great work to the interpreter Paul Bert.

HB 1144 slated to be heard January 29th, 2013

HB 1144 is scheduled to be heard January 29th at 1:30 (subject to change). These hearings are open to the public so if you happen to be near the captial that day please come to show your support. Check in here after the hearing and a link will be posted to the TVW clip. Below is the digest of the bill. And here is the link to the bill in the legislature website for the most up to date information http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1144&year=2013

 

Requires the professional educator standards board to adopt performance standards for educational interpreters.

Creates timelines for educational interpreters to meet certain performance and certification requirements. I

Educational Interpreters Bill Back in the Legislature

Below is proposed bill HB 1144. A current link to the status of this bill is here http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1144&year=2013

As always you can find your legislators here to let them know we want educational interpreter standards in Washington state!

http://app.leg.wa.gov/DistrictFinder/

State of Washington 63rd Legislature 2013 Regular Session


By Representatives Dahlquist, Lytton, Fagan, Haigh, Moscoso,
Magendanz, Liias, Ryu, and Santos
Read first time 01/16/13.   Referred to Committee on Education.


AN ACT Relating to qualifications for educational interpreters; adding
a new section to chapter 28A.410 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that although the
professional educator standards board has begun work on standards and
assessments for educational interpreters as directed by the 2012
supplemental operating budget, there is a need formally to codify this
as an ongoing responsibility. The legislature also intends to specify
how the standards and assessments will be used to improve learning
opportunities for students who are deaf, deaf-blind, or hearing
impaired.

NEW SECTION.  Sec. 2   A new section is added to chapter 28A.410 RCW
to read as follows:
    (1) The definitions in this subsection apply throughout this section.
    (a) "Educational interpreters" means school district employees,
whether certificated or classified, providing sign language
translation and further explanation of concepts introduced by the
teacher for students who are deaf, deaf-blind, or hearing impaired.
    (b) "Educational interpreter assessment" means an assessment that
includes both written assessment and performance assessment that is
offered by a national organization of professional sign language
interpreters and transliterators, and is designed to assess
performance in more than one sign system or sign language.
    (2) The professional educator standards board shall adopt
standards for educational interpreters and identify and publicize
educational interpreter assessments that are available and meet the
definition in this section. The board shall establish a performance
standard for each educational interpreter assessment for the purposes
of this section, defining what constitutes a minimum assessment
result.
    (3) By the beginning of the 2016-17 school year, educational
interpreters who are employed by school districts must have
successfully achieved the performance standard established by the
professional educator standards board on one of the educational
interpreter assessments identified by the board.
    (4) By the beginning of the 2019-20 school year, educational
interpreters who are employed by school districts must meet the
requirements of subsection (3) of this section, plus achieve national
interpreter certification by the national association of the deaf
registry of interpreters for the deaf.

$80 per hour is offered to ASL interpreters for Medicaid appointments: here is what interpreters should also know

 

CTS Language Link, the current statewide coordinating entity for all of the spoken language interpreter union and for ASL interpreters for Medicaid appointments, has just sent out an e mail to ASL interpreters around the state offering $80 per hour flat rate to work under their contract. Here is what every interpreter should know before considering this contract.

 

The reason they have inflated the rate so high is because CTS currently has zero interpreters on their contract and has not filled any ASL interpreter requests since September 2012 (See previous blog posts). $80 is a massively inflated rate for most interpreters in this state.   Here are the terms of the contract:

 

·      Only 30 minutes will be reimbursed for cancelations under 24 hours   

·      Only 30 minutes will be reimbursed for no shows, no matter how long the interpreter was scheduled for

 

Now this may sound innocuous at first, but according to statistics gathered by public disclosure requests the no show/cancelation rate has remained consistently at an average of 23% for ASL Medicaid appointments. That 23% was even true before the contract terms changed back in September 2011. The rate of no shows/cancelations for spoken language interpreters has remained consistently at about 3% on average. One explanation for such a wide deviation is the spoken language interpreters are required to call patients before hand to confirm.

 

·      24 hour cancelation policy instead of following the 48 hour industry standard

·      Mileage is 50% of Federal rate and that is only if the job is over 10 miles from your home

·      1 hour minimum, on-site appointments lasting longer will be billed in 15 minute increments

Medicaid has Filled ZERO ASL Interpreter Requests Since September 2012

 

A full background of the current Medicaid situation can be seen by reviewing past blog posts, here is a concise background on the current situation:

 

Previous to September 2011 the Office of the Deaf and Hard of Hearing (ODHH) managed the contract for ASL interpreter requests for all of Department of Social and Human Services (DSHS) including Medicaid, which at that time went by the name Medical Purchasing Authority (MPA). In 2011, MPA formed its own agency separate from DSHS and changed its name to the Health Care Authority (HCA). From there, the HCA took control of the ASL interpreter contract. Under the ODHH contract, ASL interpreters were fairly happy with the contract terms and rate and there was only a 3% no fill rate for Medicaid appointments. When HCA took over the contract they claimed rules of CMS (their federal regulating body) forced them to change the terms of the contract, but to date no specific rules have been sited. This change also coincided with the formation of the spoken language interpreters union, Interpreters United. Some of the contract changes that ASL interpreters objected to included:

 

1.     Only 24 hour cancelation policy instead of 48

2.     Payment for cancellations and no-shows will be 50% of the first hour, regardless of how many hours were booked.

3.     Mileage reimbursement will be 50% of the federal rate and will be paid only if your appointment is more than 10 miles from your home.

4.     Minimum pay is one hour; additional time worked will be billed in 15-minute increments.

5.     If, by mistake, two interpreters are booked and show up for the same job, one will get full payment and the other will receive the cancellation payment.

6.     Requests for interpreters will go from the medical provider to the broker to a language referral agency to the interpreter.

7.     Payment will be submitted from Interpreter to language referral agency to broker to the state and then paid out through the reverse order. 

 

As you can see from the chart above, the contract was not what most would consider “successful”. In general, ASL Interpreters boycotted the contract.

 

September 2012 HCA designated CTS (a spoken language agency out of Vancouver WA) as the statewide coordinating entity for both spoken and sign language interpreters for all Medicaid appointments statewide. CTS had zero ASL interpreters on contract and since September has filled zero requests for ASL interpreters for Medicaid appointments. That is right, the HCA has not provided one ASL interpreter for a Deaf Medicaid appointment since September 2012.

 

The HCA still maintains that in the end it is the provider’s legal responsibility to provide interpreters.

Medical Interpreting Task Force is Formed

WSRID Members ~ in April of this year, a group of stakeholders within the deaf, deafblind, hard of hearing communities and interpreting communities organized to form a Medical Interpreter Task Force (MITF).  The immediate focus of the MITF was to address the impact of the Health Care Authority (HCA) contract and lack of communication access for Medicaid clients since the new contract was implemented Sept. 1, 2011. 

 
In July of 2012, the  MITF wrote a letter to HCA outlining concerns with the current broker system and the pending contract that would allow one entity to serve the needs of Medicaid clients across the state.  The new contract is set take affect Sept 10, 2012. 
 
The MITF received a reply from HCA and that document is attached.  You are encouraged to contact HCA and other government representatives directly with concerns and questions you may have regarding HCA's plans to provide ASL services to deaf, deafblind and hard of hearing Medicaid clients.  WSRID will continue to work with the MITF to consider options for effective and qualified communication access for medical appointments and updates will also be sent out as they become available.    
 
Respectfully, 
 
Eloisa Williams 
WSRID President

 

HCA now reporting up to 72% requests for Sign Language interpreters are going unfilled

2/29/2012

 

    Since September 1, 2011 the HCA (Health Care Authority) has taken over contracting with Sign Language interpreters (the contract was previously held by ODHH, the Office of the Deaf and Hard of Hearing). For more information about the events that transpired after that announcement please refer to earlier blog posts and WSRID's website http://www.wsrid.com/DSHS%20HCA%20Changes.shtml. The biggest concern was that the HCA would not be able to fill requests for Sign Language interpreters for Deaf Medicaid patients under the new contract. After filing a second public disclosure request, here is what we now know about how the new contract is going:

 

 

 

What this means is:

     When the ODHH used to manage the contract for Sign Language interpreters for Medicaid appointments, it seems that there were enough interpreters to fill most of the need with only 3% of appointments being unable to be filled. Now it seems 65% up to 72% of those same appointments are going without an interpreter at all.

     Currently, WSRID is formulating a response to the HCA about their concerns. If you look back on the HCA response letter to WSRID here:

http://www.wsrid.com/pdf/WSRID+20110901.pdf  you will notice that all the HCA’s predications about service to Deaf patients not being interrupted, are currently proving to be untrue. 

Educational interpreter bill public hearing held yesterday

2/17/12

 

    Below is the link to TVW and the clip of today’s public hearing about HB 2765, the bill currently in front of the legislature which would require  qualification standards to be set for  ASL interpreters in the K-12 educational setting. Even if you are not a K-12 educational interpreter, I  recommend watching it. It is very powerful to see a few High School students making use of their government to impact their state in a positive way. According to TVW’s website this is the most watched video of the day.  

 

http://www.tvw.org/scripts/iframe_video.php?eventID=2012020128&start=1668&stop=2711

 

Here is a summary of what happened today:

   Barbara McLain, a committee staffer, introduced the bills history and statistics about ASL educational interpreters. . She stated that the legislature had approved OSPI, (office of the superintendent of public instruction) to set a standard before, but no funding was provided so the standard was never set. Also, she sited that Washington was one of only 8 states with no set standards in required education for ASL interpreters in the K-12 setting.

  Next, a Deaf high school student, Harley and his hearing friend Amon testified about their experience of having interpreters in school who were not qualified and how it affected them. They talked about how Deaf students without qualified interpreters have to do twice the work of their hearing peers to be able to keep up in school. An administrator from the school also spoke about how he can see the benefits to having qualified professionals in those positions from both the administrative perspective and a teacher’s perspective.

  Only a few questions were asked by representatives, one question was to ask Harley to elaborate on his experience of using unqualified interpreters. The second question was: can interpreters be replaced by voice recognition software?

    Two testimonials were given in opposition of this bill by Jerry Bender and Miton Denning. Mr. Bender was representing the Association of Washington State Principals. It was unclear of Mr. Denning’s affiliations, but he appeared to be a  lobbyist representing a few different organizations. Their testimony was very brief.  To summarize their statement:  this bill should not be passed because school districts would not be able to afford to pay interpreters more.

    One question was asked of them which was if we require certification for teachers then why not require the same for interpreters? The two did not have a good response other than not being able to afford it.

 

Here is a link to the bill and where any action taken on the bill will be posted: http://dlr.leg.wa.gov/billsummary/default.aspx?year=2011&bill=2765.

Because the bill was introduced past the deadline we don’t expect it to go through in 2012 but it will automatically be reintroduced during the 2013 session next January.

In regards to the video clip:

  • If you would like to complain about why TVW, a state funded program, does not have to comply with the ADA to make their program accessible by adding captioning, you can send an email here: tvw@tvw.org.
  • Also, you can contact your representative and alert them to this issue. Find out who your representative is at: http://apps.leg.wa.gov/DistrictFinder/Default.aspx

 

 

Still Alive! Educational Interpreter bill not dead yet

2/10/2012

The following was sent from Rep Dahlquist's office

 

It looks like I was wrong when I wrote my last e-mail. Due to a dustup in the Senate Education Committee, the House Education Committee will have some extra time for hearings when they would have otherwise been hearing bills that would have passed the Senate. Representative Dahlquist was able to successfully get a hearing scheduled for HB 2765 on Thursday, February 16th at 8 am.

 

 

 

Educational Interpreter bill not going any further this year

 

2/9/2012

The following is from Rep. Dahlquist’s office

 

This will likely be my last update on the bill this year. The bill was introduced as HB 2765. You can find the bill summary page at http://dlr.leg.wa.gov/billsummary/default.aspx?year=2011&bill=2765. Notably, the chair, vice chair, ranking member, and assistant ranking member from the Education Committee are all sponsors. (That represents the top two Democrats and top two Republicans on the committee.)

 

Unfortunately, because we have passed the policy committee cutoff date, the bill is unlikely to move any further through the legislative process this year. However, with the bill language drafted and cosponsors already lined up, the bill should get off to a quick start in the 2013 legislative session.

 

Thanks again for bringing this issue to Rep. Dahlquist’s attention. As always, please feel free to contact me with any questions you may have about the bill or the process.

 

Updates on this bill will be given again at the beginning of the 2013 Legislative session.

Bill that would set standards for Educational Interpreters is in front of Legislature now

2/6/2012

  Here is the link to the current bill HB 2765

http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/House%20Bills/2765.pdf

  Basically, it orders a committee to be established to decide what the standard should be for Educational Interpreters in Washington state. All that is currently known is that HB 2765 is the result of the initiative brought forward by 3 students (one Deaf and 2 hearing) and 2 Educational Interpreters from Snohomish County. The WSRID Legislative Committee is very interested in supporting this bill, if anyone has any more information please leave  a comment or e mail to WSRIDLegCommittee@gmail.com.

HCA reports 67% of requests for ASL Interpreters go unfilled

 

12/28/2011

     Since September 1, 2011 the HCA (Health Care Authority) has taken over contracting with sign language interpreters (the contract was previously held by ODHH, the Office of the Deaf and Hard of Hearing). For more information about the events that transpired after that announcement, please refer to earlier blog posts and WSRID's website http://www.wsrid.com/DSHS%20HCA%20Changes.shtml. The biggest concern was that the HCA would not be able to fill requests for sign language interpreters for Deaf Medicaid patients under the new contract. After filing a public disclosure request, here is what we know about how the new contract is going:

 

      As you can see, the changeover in the contract produced staggeringly different results in obtaining interpreters for Medicaid appointments. As far as what the HCA will do, it is likely the HCA is going to wait for the legislature to begin their regular session, (Jan 9th-March 8th) where eliminating interpreter services from the HCA has been on the Governors list of proposed cuts. 

Statistics for appointments under the ODHH DSHS contract provided by ODHH, to contact:

(360) 902-8000 Voice/TTY (800) 422-7930 Voice/TTY (360) 902-0855 Fax Email Address: odhh@dshs.wa.gov

Contact ODHH by Video at: Video Phone IP Address: 65.113.246.110  VP200 Phone Number: 360-339-7382

 

To contact the HCA

Elena Safariants

Interpreter Services Program Manager Health Care Authority (360) 725-1315 elena.safariants@hca.wa.gov

Todd Slettvet Chief, Office of Community Services Health Care Authority (360) 725-1626 todd.slettvet@hca.wa.gov 

Update on recent legislative special session (December 2011)

 

Interpreting services for Medicaid clients

The Governor’s proposed budget HB 2058  (  http://www.ofm.wa.gov/budget12/bills/2012OperSupp.pdf  , see section 213)
eliminates funding for interpreter services, spoken and signed, for Medicaid appointments.  It strikes through the language on the new service delivery model (“east and west coordinating entities”) which gives the impression it is being eliminated.   
 
However on further analysis…

See  http://www.ofm.wa.gov/budget12/recsum/107.pdf  for details on HCA budget – there are two parts – First, it   delays the implementation of the new service delivery model to July 2012  and second,   it eliminates funding for interpreter services as of Feb 1, 2012.   HCA Section Manager, Todd Slettvet, was asked about this opposing information within the proposed budget.  This was his response:

“  HCA intends to amend to extend contracts up until June 30, 2012 with language included to eliminate the program earlier if directed by the legislature. As we all know, the budget has in the past, and could be in the future, extended during the regular legislative session. Our plan to extend contracts addresses all potential contingencies.
We are also moving forward, as directed by our leadership, with the RFP to implement a new IS delivery system no later than July 1, 2012. If funding is eliminated, obviously the RFP will be cancelled. Contingency language will also be included in the RFP scheduled to be releases January 17th.”

There are also two proposed substitute bills to HB 2058.   Interpreter services is not only left intact in these versions, but has its funding for interpreter services increased through 2013.

PSHB 2058:    http://apps.leg.wa.gov/CMD/showdoc.ashx?u=A2iGB9PMbwyP2X1C%2bw7qdVoo636n00r%2fAh888keMqQ2Vgi9SWMXQKjEsE%2b1ly%2fm0gUI2FKJJl%2fhiflVdgca0CJaiKxr3myzS&y=2011

The senate Version PSSB 5883 shows the same figures:
http://www.leg.wa.gov/Senate/Committees/WM/Documents/SenateBudget/2012/5883%20PSSB%20EASB.pdf

Basically what it means is that the legislature is not going along with the Governor’s recommendation to eliminate the funding for Medicaid interpreter services.

If you have questions regarding these proposed bills, please contact your state representative.  To find out who state representative is:  http://apps.leg.wa.gov/DistrictFinder/Default.aspx
You may also contact HCA representative Todd Slettvet   todd.slettvet@hca.wa.gov   and Elenda Safariants elena.safariants@hca.wa.gov  with questions related to Interpreting services for Medicaid clients.  
 
For a complete list of documents explaining changes made to the current Medicaid contract for interpreters see http://www.wsrid.com/DSHS%20HCA%20Changes.shtml
 

Open letter from WSRID to HCA

 

August 17, 2011

An Open Letter to:

Health Care Authority P.O. Box 42682
Olympia, WA 98504-2682

Attn:
Doug Porter, Administrator
Todd Slettvet, Chief, Office of Community Services Elena Safariants, Interpreter Services Program Manager

Re: HCA Sign Language Interpreter Delivery System for Medicaid Patients

It is the position of Washington State Registry of Interpreters for the Deaf (WSRID) to oppose the new HCA contract related to sign language interpreters. Our organization firmly believes this position is not only justified, but necessary.

WSRID is the Washington State chapter of RID (Registry of Interpreters for the Deaf.) RID is a national organization with a membership of over 20,000 professional interpreters, students, educators and transliterators. WSRID itself represents 250 interpreters from across Washington and bordering states.

WSRID’s mission is to educate, support and promote the RID certification of interpreters/transliterators and to inform the general public about the interpreting/transliterating profession. The intent of this correspondence to provide you with some information regarding our profession as well as address the upcoming changes in the interpreter delivery system recently announced by the Health Care Authority.

WSRID does not support the new contract and its terms for the following reasons:

First, the HCA contract stipulations do not reflect reasonable business practices for professional interpreters. As independent contractors, sign language interpreters bear the burden of business expenses that must be taken into consideration when negotiating payment for services. National and local standards of pay have made it possible for sign language interpreters to serve in a professional manner and ensure health care providers the opportunity to communicate with their patients with assurance of quality. The pay schedule offered by HCA regularly puts these small business owners into debt with each appointment they take. Elimination of the “Base Rate” pay, 50% pay for no-shows or cancellations and 50% reimbursement for mileage would result in at or below minimum pay for Medicaid jobs.

Second, HCA has a desire to streamline interpreter services in order to ensure that both spoken and sign language interpreters are paid in the same manner and with the same terms; this is a flawed concept. Job expectations and responsibilities of sign language interpreters differ from spoken language interpreters, as do the laws that provide for these services. A few examples include:

1. Certifiedsignlanguageinterpretershavestateandnationalprofessionalorganizationsthat oversee standards for certification, provide continuing education and uphold a code of professional conduct which includes a grievance system

2. Certificationforsignlanguageinterpretersincludesdegreerequirements

Washington State Registry of Interpreters for the DeafPO Box 20334Seattle, WA 98102 Email: wsrid@wsrid.com

3. Duetothephysicalandmentaldemandsofsignlanguageinterpreting,signlanguageinterpreters are unable to work for long periods of time. Appointments over (and sometimes under) 1 hour require a team of interpreters

Third, WSRID questions the motivation and doubts the benefits of placing sign language interpreters into a flawed Broker system that is in the process of being eliminated. Effective September 1, HCA is requesting sign language interpreters accept the terms of a Broker system that the Washington State Legislature has determined to have many problems. Then, HCA will require sign language interpreters to transition into a different system on January 1, 2012. Moving sign language interpreters into a floundering system for 4 months does not make sense!

Finally, the HCA Broker system does not take into consideration the needs and preferences of deaf, deaf-blind or hard-of-hearing individuals. Working in a system that does not allow for client/consumer preference goes against ethical standards that have been established in sign language interpreter’s National Code of Professional Conduct (http://rid.org/UserFiles/File/NAD_RID_ETHICS.pdf) Additionally, it is our belief that the Broker system has considerable pitfalls that leave it open to Americans with Disabilities Act (ADA) based complaints. Some of the areas we see having potential problems are as follows:

  1. The ADA provides that the individual with the disability shall have primary consideration for the type of auxiliary aid or services necessary to communicate. The Broker contract states only the medical provider can request a specific interpreter and only for medically necessary reasons.

  2. The ADA mandates appropriate steps be taken to ensure these communications are as effective as communications with others. Because of the inadequate reimbursement schedule for interpreters, we believe that very few certified sign language interpreters would be willing to sign this contract. The U.S. Department of Health and Human Services’ website https://www.cms.gov/MedicaidRF/ states that federal law requires Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid beneficiaries have access to care equivalent to that of the general population.

  3. The ADA provides that access services must happen in a timely manner. The Broker system adds untimely layers to requests; in addition, it has not yet contracted for services in all areas of Washington State.

With the above information in mind, WSRID strongly recommends HCA rescind the changes set to take effect September 1, 2011. HCA should continue to use the DSHS contract for sign language interpreters. With ODHH administering the DSHS contract, HCA can take advantage of an agency with knowledge and background on standards of practice for sign language interpreters and the unique needs of the deaf community. DSHS has a contract and system in place which takes into account national standards of reimbursement for sign language interpreting services; includes the recognition of professional sign language interpreters as an important component of access to medical care by deaf Medicaid clients and reflects sensitivity to the deaf, deaf-blind and hard-of-hearing citizens’ right to quality communication access as mandated under the ADA.

Further action by WSRID will include educating interpreters across the state on the stipulations of this contract and how those changes will compromise their professional standards and violate or impact the services we provide. WSRID will also collaborate with deaf stakeholders to make sure that deaf Medicaid recipients are aware of their legal rights under the ADA for access to competent, qualified interpreters in a timely manner for all of their appointments. Additionally, we will inform organizations, agencies, health care providers and other interested parties of the governmental decisions being made that affect the most vulnerable of Washington’s citizens.

Washington State Registry of Interpreters for the DeafPO Box 20334Seattle, WA 98102 Email: wsrid@wsrid.com

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As an organization representing professional interpreters, the WSRID Board of Directors and its members must emphatically support the provision of ethical and appropriate interpreting services that do not compromise the established minimum standards. We welcome dialogue with HCA representatives regarding these issues.

Respectfully,

WSRID Board of Directors
email:
wsrid@wsrid.com website: www.wsrid.com

cc Registry of Interpreters for the Deaf Washington State Association of the Deaf National Association of the Deaf
Office of the Deaf and Hard of Hearing Governor Christine Gregoire (via hard copy) Hearing Loss Center

Hearing, Speech and Deafness Center
South Eastern Washington Service Center of the Deaf and Hard of Hearing Southwest Washington Center of the Deaf and Hard of Hearing
Deaf-Blind Service Center
Deaf Bilingual Coalition
Washington State Department of Health, Complaint Intake
Washington State Human Rights Commission (via hard copy)
Disability Rights Washington (via hard copy)

cc under separate email to WSRID Membership

To read HCA's response click here: http://www.wsrid.com/pdf/WSRID+20110901.pdf

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Summary of Changes for ASL Medicaid Appointments

 

As of September 1, 2011, ASL interpreting services for Medicaid appointments will be changed to a Broker System under the Health Care Authority (HCA). More changes are scheduled for January 1, 2012, when instead of using brokers and referral agencies (the Broker System) HCA will use two Coordinating Entities- one for the Eastern and one for the Western part of the state to schedule interpreters. Resulting changes will include but are not limited to:

Under the HCA (starting September 1, 2011):

All hours will be paid at the current DSHS hourly rate Only appointments cancelled within 24 hours will be paid*.

*Payment for cancellations and no-shows will be 50% of the first hour, regardless of how many hours were booked.

Mileage reimbursement will be 50% of the federal rate and will be paid only if your appointment is more than 10 miles from your home.

Minimum pay is one hour; additional time worked will be billed in 15 minute increments.

To request a specific interpreter for an appointment, the medical provider (not the office staff) must contact the broker directly and explain the medically necessary reason for the request.

If, by mistake, two interpreters are booked and show up for the same job, one will get full payment and the other will receive the cancellation payment.

Requests for interpreters will go from the medical provider to the broker to a language referral agency to the interpreter.

Payment will be submitted from Interpreter to language referral agency to broker to the state and then paid out through in the reverse order. 

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