CULTURAL COMPETENCE IN HEALTH CARE IN NEW JERSEY
Why is cultural competence in health care important in New Jersey?
Diverse population
CULTURAL COMPETENCE & EQUITY IN HEALTH CARE
Health Maintenance Organizations (HMOs) are covered by the NJ Department of Health & Senior Services
Application of Health Maintenance Organizations must include a description of the methods it will use to facilitate access to services for culturally and linguistically diverse members
Cultural Competence
Health insurance applications may NOT include questions regarding race, creed, color, national origin, ancestry
NJ Statutes prohibit the use of any form of policy of health insurance that expresses, directly or indirectly, any limitation or discrimination as to race, creed, color, national origin or ancestry
NJ requires data collection & reporting by HMOs on extent of coverage by protected categories to ensure equitable access to health coverage
Cultural Competence & Equity
NJ Department of Health & Senior Services has a Healthcare Data Committee that assists in the development of quality improvement programs and monitors quality of care provided to HMO members
Performance & outcome measures include population-based indicators of quality, access, & satisfaction
Elements of performance measures required to be submitted by NJ HMOs include:
NJ DHSS regulations make the New Jersey Law Against Discrimination in "public accommodations" applicable to all HMOs
NJ Department of Human Services administers NJ Care, NJ Family Care, & NJ Family Care-Children’s Program
NJ collects racial data on its application for NJ Family Care (Black, Hispanic, White, American Indian/Alaskan Native, Asian/Pacific Islander, Other)
DHS HMO contracts require:
Each HMO to participate in DHS’ Cultural & Linguistic Competency Task Force
Take any & all steps necessary to provide culturally appropriate services
Review correlations between culture, language & health care outcomes
DHS HMO contracts require:
Provide 24 hour access to interpreter services
Provide other language-based services, including translated written materials, to enrollees if they exceed 5% of overall Medicaid enrolled population or 200 enrollees, whichever is greater
DHS HMO contracts require:
HMOs to assess the linguistic & cultural needs of enrollees who speak a primary language other than English
Submit the assessment to DHS, along with a plan designed by the HMO to deliver linguistically appropriate health services
The contract defines cultural competence as a set of interpersonal skills that allow individuals to increase their understanding, appreciation, acceptance of & respect for cultural differences & similarities within, among & between groups, & the sensitivity to how these differences influence relationships with enrollees.
This requires a willingness & ability to draw on community-based values, traditions & customs, to devise strategies to better meet culturally diverse enrollee needs, & to work with knowledgeable persons of & from the community in developing focused interventions, communications & other supports.
HMOs must:
Accept any individual for enrollment without regard to race, ethnicity, color, national origin, or ancestry
Provide equal access, ie., equal opportunity and consideration for needed services without exclusionary practices of providers or system design because of race, etc.
The HMO must forward to DHS within 3 business days of receipt copies of any grievances alleging discrimination
HMOs must also require their providers & subcontractors to follow these rules
Hospitals must provide all patients the right to treatment without discrimination
Nursing home residents must be treated without discrimination
DHSS collects racial & ethnic data for specific conditions & diseases:
NJ is one of the few states that has an express prohibition against collecting race or ethnic data on health insurance application forms
NJ is one of the few states that expressly prohibits the use of ANY policy of health that indirectly or directly limits coverage based on discriminatory categories
NJ requires HMOs participating in Medicaid managed care to examine the correlation between culture, language & health outcomes