Request for Bids for Scan of Cultural and Linguistic Services
at Local Initiatives and County Organized Health Systems in California

Background
In 1996, as past of the transition from a Medicaid fee-for-service system to mandatory Medicaid managed care, California became a leader in the nation in including cultural and linguistic services requirements for the MediCal managed care organizations. As part of their managed care contracts, MediCal managed care organizations were required to ensure language access, conduct group needs assessments and implement cultural competency training for their staff. Similar contractual requirements were required by the Managed Risk Medical Insurance Board (MRMIB) as California implemented the State Children's Health Insurance Program through the Healthy Families program.

Recent legislation and administrative regulations issued by the Department of Managed Health Care and the Department of Insurance have now expanded these language access requirements to all managed care organizations operating in California (SB 853). In addition, there is continued interest by federal government agencies and national accreditation organizations in culturally and linguistically appropriate services. For example, in 2000, the U.S. Department of Health and Human Services Office of Minority Health issued standards for Culturally and Linguistically Appropriate Services (CLAS).¹ That same year, Executive Order 13166 reiterated and clarified the requirement under Title VI of the 1964 Civil Rights Act for health care providers to ensure language access. More recently, with funding from The California Endowment, the National Committee for Quality Assurance has established its Innovations in Multicultural Health awards for health plans demonstrating excellence in advancing language access and cultural competence and reducing health care disparities. In the first annual awards, four California managed care organizations (and two national organizations operating in California) were recognized for their excellence in multicultural health.

As part of the implementation of MediCal managed care, California also created a "two-plan" model, establishing new managed care organizations called "local initiatives" to compete with commercial plans. MediCal managed care also was implemented in counties which had "county organized health systems", transforming these systems into managed care organizations.

The Local Initiatives are Alameda Alliance for Health, Contra Costa Health Plan, Health Plan of San Joaquin, Inland Empire Health Plan, Kern Family Health Care, LA Care Health Plan, San Francisco Health Plan and Santa Clara Family Health Plan.

The County Organized Health Systems are CalOptima, Central Coast Alliance for Health, Health Plan of San Mateo, Partnership Health Plan, and Santa Barbara Regional Health Authority.

Since both the local initiatives and county organized health systems included many safety net providers which served many diverse populations, including racial and ethnic minorities and persons with Limited English Proficiency and lower health literacy, many of these managed care organizations were early pioneers and innovators in establishing cultural and linguistic services. These services included establishing comprehensive language assistance services, conducting detailed group needs assessments, establishing member advisory committees and providing cultural competency and other training for its staff.²

TCE recently convened the Cultural and Linguistic Coordinators from the local initiatives and county organized health systems to discuss their current work and TCE's objectives in building Culturally Competent Health Systems. Nine of the thirteen local initiatives and county organized health systems participated in the April 23, 2007 convening. The coordinators identified the need for uniform systems for recording member data on race, ethnicity and language; strategies for working more effectively with their provider networks; more trainings for medical office staff on health care interpretation and other issues; and internal organizational effectiveness issues, e.g. making the business case for cultural competence.

As interest in these issues increases and the importance of cultural and linguistic services also increases with the continued demographic diversity of California's population, the time is ripe for a comprehensive assessment of the progress and best practices among California's local initiatives and county organized health systems as well as current challenges and limitations to ensuring culturally and linguistically appropriate services for all Californians.

Request for Bids
This Request for Bids seeks a qualified individual, team or organization ("applicant") to conduct a comprehensive assessment of the current best practices as well as challenges and limitations among the thirteen California local initiatives and county organized health systems in implementing cultural and linguistic services for their members. While the specific methodologies used to conduct the assessment may be determined by the applicant, the following components should be included:

1. Identification and description of best practices to ensure language access for their members at the plan/organizational and provider levels
2. Identification and description of best practices to improve culturally competent health care services for their members at the plan/organizational and provider levels
3. Identification and description of best practices to collect and use data about members' race, ethnicity and primary language to ensure culturally and linguistically appropriate services
4. Identification and description of best practices to identify and reduce racial and ethnic disparities in health care among their members at the plan/organizational and provider levels
5. Estimate of the annual level of human resources and budgetary resources expended on implementing cultural and linguistic services for their members
6. Assessment of the organizational position, degree of relevant authority and impact of the staff position(s) responsible for cultural and linguistic services (and if this organizational position has been located elsewhere in the past, an assessment of the impact of organizational position on authority and impact)
7. Assessment of the knowledge, attitudes and commitment to cultural and linguistic services of the executive leadership of each of the local initiatives and county organized health systems, including but not limited to the Chief Executive Officer (or equivalent), Chief Medical Officer (or equivalent) and Chief Financial Officer (or equivalent)
8. Identification and description of how the use of information and other technologies facilitates the implementation of cultural and linguistic services for their members
9. Recommendations for improving cultural and linguistic services provided by local initiatives and county organized health systems

This scope of work should begin on November 1, 2007 and be completed no later than October 31, 2008. The total cost of the proposed scope of work should not exceed $200,000.

Application Procedure and Deadlines
Interested individuals, teams or organizations should use The California Endowment's Grant Application Guide³ to prepare an application for review, with the following modifications:

• Complete the application cover sheet and check "Culturally Competent Health Systems" for the goal
• Include a brief description of the applicant's prior working relationships with the local initiatives and county organized health systems
• Use the components listed above to guide proposed objectives and outcomes
• Complete the budget using the budget template; if there are subcontractors on the team, these are "Other Costs" (indirect costs may not be charged for the costs of the subcontractors)
• Include a project timeline as an attachment
• Include a curriculum vitae or brief summary of past and current relevant work for individuals and key team members as attachments

Applications must be submitted by mail to The California Endowment at 1000 North Alameda Street, Los Angeles, CA 90012 (no faxed or electronically submitted applications will be accepted). Applications are due by Noon on Wednesday, September 19, 2007. Applications submitted after this deadline will NOT be eligible for consideration.

A bidders' conference call to ask and answer questions about this Request for Bid will be held on Monday, August 6, 2007 from 1:00PM – 2:00PM. Please dial 877-240-6337 and use participant code 568 275 4144 to join the bidders conference call. While you do not have to participate in the bidders' conference to submit an application, you are strongly encouraged to do so. Any additional questions or requests for technical assistance regarding this Request for Bid should be directed to Ignatius Bau, Program Director, at ibau@calendow.org or phone 415-343-0222.

Qualified applications will be reviewed by an expert panel convened by The California Endowment, which will rank the bids and make a recommendation for funding. However, staff of The California Endowment will make the final selection of the successful bid. The successful applicant will be notified no later than October 19, 2007, with the project to begin November 1, 2007.

¹The Office of Minority Health has supported two assessments of how managed care organizations have implemented the CLAS standards, one a national scan and one an intensive assessment of a local initiative, the Alameda Alliance for Health. See http://www.cosmoscorp.com/Docs/FR-CLAS-1_ManagedCare.pdf and http://www.omhrc.gov/assets/pdf/checked/CLAS_healthcare.pdf

²In 1999, The California Endowment provided grants to two local initiatives, the Alameda Alliance for Health and LA Care, to further develop some of their cultural and linguistic services. Among the completed were member assessments of the organization's responsiveness to cultural and linguistic needs, assessment of staff knowledge and attitudes about cultural and linguistic services, trainings about health care interpreting, trainings for health care interpreters, translations of managed care "glossaries", collection and dissemination of translated forms and trainings of providers on cultural competency.

³Available at: http://www.calendow.org/grant_guide/index.stm