On March 1, 2023, the American Translators Association (ATA) informed its membership that it had written to the Oregon legislature expressing its opposition to Senate Bill 584. The bill tasks the Oregon Health Authority (OHA) with setting up a web-based platform for scheduling and paying interpreters who render services for publicly funded healthcare. As a longtime ATA member and former ATA Interpreters Division administrator, I was dismayed. I am also the founding president of the Oregon Society of Translators and Interpreters (www.ostiweb.org), and I was a member of the Oregon Council on Health Care Interpreters (OCHCI) for over seven years.
How does Oregon pay for healthcare interpreters now?
Unfortunately, the way Oregon reimburses healthcare providers for interpreter expenses is chaotic, cumbersome, and full of intermediaries who take a cut of the interpreters’ pay. First, the federal Centers for Medicaid Services (CMS) sends funds to the OHA. Then, instead of paying specifically for interpreting services, the OHA gives coordinated care organizations (CCOs) an administrative expense budget that includes interpreting. Finally, there are many ways that CCOs pay for interpreting. Some reimburse their provider network if the language company or interpreter providing the service has a contract with the CCO. Others pay interpreters directly when the interpreter uses a CMS 1500 form to bill the CCO. Yet others pay language companies directly, rather than having clinics pay interpreters and then seek reimbursement.
To make things more complicated, clinics receive a $60 reimbursement from the OHA under code T-1013 when they use an interpreter on the OHA registry. Some clinics in the CCO provider network book interpreters through language companies and then seek reimbursement from the CCO. In all cases, language companies keep a portion of the money received from the CCO or the clinic.
How would SB 584 improve this system?
In contrast to OHA’s byzantine system, the Washington State Health Care Authority has a contract with a scheduling vendor for a flat amount (ca. $1.5M per year). The payments for interpreters simply pass through the vendor’s platform. For Medicaid enrollees, healthcare providers can enjoy free interpreting services from state-credentialed spoken language interpreters, provided they schedule through the vendor’s portal. If not, the healthcare provider is responsible for 100% of the interpreting expense. After paying interpreters, HCA seeks reimbursement from CMS through its federal matching funds program at 75% for children and 50% for adults.
The Oregon system proposed in the bill would be even simpler since it would bypass the scheduling vendor. And although Oregon would have the upfront cost of creating the platform, in the long run, it would be saving quite a lot of the annual leasing fee Washington State pays to its vendor. Platform maintenance and upgrades would be done in-house, presumably at a lower cost.
An online portal would:
- streamline the scheduling and payment processing of interpreters by eliminating intermediaries;
- ensure that only Oregon-vetted interpreters render interpreting services for publicly funded healthcare services;
- automatically keep track of fill rates proving compliance with DOJ language access requirements;
- keep track of complaints for poor interpreting services; and
- likely increase interpreters’ take-home pay by reducing administrative costs through automation.
SB 584 would ensure qualified interpreters
Besides having the support of many freelance interpreters, the bill is supported by the Limited English Proficient farmworkers (PCUN – Pineros y Campesinos Unidos del Noroeste), the Oregon Nurses Association (ONA), and the American Federation of State, County and Municipal Employees of Oregon (AFSCME Council 75). Each of these groups has clear visibility of the importance of working with qualified interpreters and the terrible consequences of working with unqualified interpreters.
The system in SB 584 would give Medicaid healthcare providers transparency regarding the qualifications of interpreters who work with them. This would avoid problems such as the latest 911 interpreting disaster in New Orleans by a language company “vetted” Spanish interpreter.
SB 584 would help interpreters make a living wage
As I served Oregon interpreters through OSTI and OCHCI, I heard from many healthcare interpreters who were unable to make a living. Interpreters end up bearing the cost of language access instead of being paid for providing language access. I have spoken to countless interpreters who left the profession because of their inability to make a living out of their chosen profession.
In recent testimony to the legislature regarding this bill, interpreters state they are paid a maximum of $30/hour, a minimum of one hour, and no drive time or mileage reimbursement. If the appointment takes less time than scheduled, interpreters are paid only for the time they worked. Because of the need to drive from one appointment to the next, they generally cannot do more than 20 hours of work in a week.
In next-door Washington State, interpreters are currently paid $43.48/hour and expect to be compensated $46.09/hour as of July 2023 for services rendered to Medicaid enrollees. This is an increase of 45% to 50% over the highest rates paid in Oregon. To accomplish this, Washington State has been using a web portal to schedule and process payments to freelance interpreters as the bill recommends. This web portal applies to all interpreters rendering services to Medicaid/Apple Health system enrollees, the equivalent of the Medicaid/Oregon Health Plan.
The online portal in Washington State is highly effective
Thanks to the web portal, Washington State collects information on how often interpreting requests have been met (fill rates). This information is publicly available. For languages of high demand, the fill rate is about 90%. For languages of medium demand, the fill rate is about 70%. In 2017, the interpreters’ union (Interpreters United AFSCME 28) published a report on Medicaid interpreting services. Within the context of over 600,000 paid appointments, there were complaints regarding only 1.76%, out of which 0.69% were valid (page 5 of the report). This means that the overwhelming majority of appointments covered by Washington State vetted interpreters are successfully completed under this web portal system.
Who submitted comments in opposition?
The comments in opposition to the bill were generally from language companies (intermediaries) and by interpreters who work for them. David Bracket, owner and president of Linguava, submitted his testimony as an “OHA certified healthcare interpreter” even though his primary concern is as a language company owner with a very large market share in Oregon. Freelance interpreters often mentioned “my company,” “the company I work for,” and similar phrases. Asking freelancers to submit company boilerplate letters in opposition to a bill is using the power of the purse to get others to do their political work. I really hate to see that because…
… the vast majority of the work (89%) [is] done by freelance interpreters/translators […] The high reliance of the language services industry on independent contractors coupled with the very small size of these companies underscores the high level of interdependence between companies and freelancers as well as the precariousness of the interpreting and translation professions.” (Review of the ALC 2015 Industry Survey, ATA Interpreters Division Blog, March 29, 2016)
I read through about 20 comments in opposition to the bill and found that they were generally boilerplate comments based on those made by ATA. Why would ATA side with intermediaries in opposition to the actual service providers, the interpreters?
If the bill becomes law, interpreters would be paid directly by the state. This would eliminate intermediaries from the publicly funded interpreting services marketplace, which explains the strong opposition by language companies.
Interpreters would have the opportunity to negotiate directly with the payer (Oregon) for their rates and working conditions. They would have just as much work as before, and they would not be subject to a hiring entity (language company) pressuring its workers to make political statements on their behalf, living in fear of retaliation if they don’t.
I support SB 584
I believe Oregon SB 584 is a good bill and should pass. I hope the legislature sees the wisdom in doing so. The regulation process will work out the details, as stated in the bill. They have set up a balanced committee to represent the perspectives of all relevant stakeholders. This bill will improve patient outcomes by ensuring the quality of interpreters rendering services in publicly funded healthcare, and it will provide needed data to improve language access services and the supply of healthcare interpreters. The web portal has had a tremendously positive result in Washington State, and I believe it would benefit Oregon enormously.