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90_HB3269 New Act Creates the Health Care Professional Selection Act. Sets forth the manner and conditions under which a managed care plan shall select health care professionals for participation in the plan. Provides the procedures necessary for termination of health care professionals. Prohibits restrictions on disclosures by health care professionals to patients. LRB9011442JSmg LRB9011442JSmg 1 AN ACT concerning the selection of health care 2 professionals by managed care plans. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 1. Short title. This Act may be cited as the 6 Health Care Professional Selection Act. 7 Section 5. Definitions. For purposes of this Act, the 8 following words shall have the meanings provided in this 9 Section, unless otherwise indicated: 10 "Degenerative or disabling condition or disease" means a 11 condition or disease that is permanent or of indefinite 12 duration, that is likely to become worse or more advanced 13 over time, and that substantially impairs a major life 14 function. 15 "Department" means the Department of Public Health. 16 "Director" means the Director of Public Health. 17 "Enrollee" means a person enrolled in a managed care 18 plan. 19 "Health care professional" means a physician, registered 20 professional nurse, or other person appropriately licensed or 21 registered pursuant to the laws of this State to provide 22 health care services. 23 "Health care provider" means a health care professional, 24 hospital, facility, or other person appropriately licensed or 25 otherwise authorized to furnish health care services or 26 arrange for the delivery of health care services in this 27 State. 28 "Health care services" means services included in the (i) 29 furnishing of medical care, (ii) hospitalization incident to 30 the furnishing of medical care, and (iii) furnishing of 31 services, including pharmaceuticals, for the purpose of -2- LRB9011442JSmg 1 preventing, alleviating, curing, or healing human illness or 2 injury to an individual. 3 "Informal policy or procedure" means a nonwritten policy 4 or procedure, the existence of which may be proven by an 5 admission of an authorized agent of a managed care plan or 6 statistical evidence supported by anecdotal evidence. 7 "Life threatening condition or disease" means any 8 condition, illness, or injury that, in the opinion of a 9 licensed physician, (i) may directly lead to a patient's 10 death, (ii) results in a period of unconsciousness which is 11 indeterminate at the present, or (iii) imposes severe pain or 12 an inhumane burden on the patient. 13 "Managed care plan" means a plan that establishes, 14 operates, or maintains a network of health care providers 15 that have entered into agreements with the plan to provide 16 health care services to enrollees where the plan has the 17 obligation to the enrollee to arrange for the provision of or 18 pay for services through: 19 (1) organizational arrangements for ongoing quality 20 assurance, utilization review programs, or dispute 21 resolution; or 22 (2) financial incentives for persons enrolled in 23 the plan to use the participating providers and 24 procedures covered by the plan. 25 A managed care plan may be established or operated by any 26 entity including, but not necessarily limited to, a licensed 27 insurance company, hospital or medical service plan, health 28 maintenance organization, limited health service 29 organization, preferred provider organization, third party 30 administrator, independent practice association, or employer 31 or employee organization. 32 For purposes of this definition, "managed care plan" 33 shall not include the following: 34 (1) strict indemnity health insurance policies or -3- LRB9011442JSmg 1 plans issued by an insurer that does not require approval 2 of a primary care provider or other similar coordinator 3 to access health care services; and 4 (2) managed care plans that offer only dental or 5 vision coverage. 6 "Primary care provider" means a physician licensed to 7 practice medicine in all its branches who provides a broad 8 range of personal medical care (preventive, diagnostic, 9 curative, counseling, or rehabilitative) in a comprehensive 10 and coordinated manner over time for a managed care plan. 11 "Specialist" means a health care professional who 12 concentrates practice in a recognized specialty field of 13 care. 14 "Speciality care center" means only a center that is 15 accredited by an agency of the State or federal government or 16 by a voluntary national health organization as having special 17 expertise in treating the life-threatening disease or 18 condition or degenerative or disabling disease or condition 19 for which it is accredited. 20 Section 10. Health care professional applications and 21 terminations. 22 (a) A managed care plan shall, upon request, make 23 available and disclose to health care professionals written 24 application procedures and minimum qualification 25 requirements that a health care professional must meet in 26 order to be considered by the managed care plan. The 27 managed care plan shall consult with appropriately qualified 28 health care professionals in developing its qualification 29 requirements. 30 (b) A managed care plan may not terminate a contract of 31 employment or refuse to renew a contract on the basis of any 32 action protected under Section 15 of this Act or solely 33 because a health care professional has: -4- LRB9011442JSmg 1 (1) filed a complaint against the managed care 2 plan; 3 (2) appealed a decision of the managed care plan; 4 or 5 (3) requested a hearing pursuant to this Section. 6 (c) A managed care plan shall provide to a health care 7 professional, in writing, the reasons for the contract 8 termination or non-renewal. 9 (d) A managed care plan shall provide an opportunity 10 for a hearing to any health care professional terminated by 11 the managed care plan, or non-renewed if the health care 12 professional has had a contract or contracts with the managed 13 care plan for at least 24 of the past 36 months. 14 (e) After the notice provided pursuant to subsection 15 (c), the health care professional shall have 21 days to 16 request a hearing, and the hearing must be held within 15 17 days after receipt of the request for a hearing. The hearing 18 shall be held before a panel appointed by the managed care 19 plan. 20 The hearing panel shall be composed of 5 individuals, the 21 majority of whom shall be clinical peer reviewers and, to the 22 extent possible, in the same discipline and the same or 23 similar specialty as the health care professional under 24 review. 25 The hearing panel shall render a written decision on the 26 proposed action within 14 business days. The decision shall 27 be one of the following: 28 (1) reinstatement of the health care professional 29 by the managed care plan; 30 (2) provisional reinstatement subject to 31 conditions set forth by the panel; or 32 (3) termination of the health care professional. 33 The decision of the hearing panel shall be final. 34 A decision by the hearing panel to terminate a health -5- LRB9011442JSmg 1 care professional shall be effective not less than 15 days 2 after the receipt by the health care professional of the 3 hearing panel's decision. 4 A hearing under this subsection shall provide the health 5 care professional in question with the right to examine 6 pertinent information, to present witnesses, and to ask 7 questions of an authorized representative of the plan. 8 (f) A managed care plan may terminate or decline to 9 renew a health care professional, without a prior hearing, in 10 cases involving imminent harm to patient care, a 11 determination of intentional falsification of reports to the 12 plan or a final disciplinary action by a state licensing 13 board or other governmental agency that impairs the health 14 care professional's ability to practice. A professional 15 terminated for one of the these reasons shall be given 16 written notice to that effect. Within 21 days after the 17 termination, a health care professional terminated because of 18 imminent harm to patient care or a determination of 19 intentional falsification of reports to the plan shall 20 receive a hearing. The hearing shall be held before a panel 21 appointed by the managed care plan. The panel shall be 22 composed of 5 individuals the majority of whom shall be 23 clinical peer reviewers and, to the extent possible, in the 24 same discipline and the same or similar specialty as the 25 health care professional under review. The hearing panel 26 shall render a decision on the proposed action within 14 27 days. The panel shall issue a written decision either 28 supporting the termination or ordering the health care 29 professional's reinstatement. The decision of the hearing 30 panel shall be final. 31 If the hearing panel upholds the managed care plan's 32 termination of the health care professional under this 33 subsection, the managed care plan shall forward the decision 34 to the appropriate professional disciplinary agency in -6- LRB9011442JSmg 1 accordance with subsection (b) of Section 25. 2 Any hearing under this subsection shall provide the 3 health care professional in question with the right to 4 examine pertinent information, to present witnesses, and to 5 ask questions of an authorized representative of the plan. 6 For any hearing under this Section, because the candid 7 and conscientious evaluation of clinical practices is 8 essential to the provision of health care, it is the policy 9 of this State to encourage peer review by health care 10 professionals. Therefore, no managed care plan and no 11 individual who participates in a hearing or who is a member, 12 agent, or employee of a managed care plan shall be liable for 13 criminal or civil damages or professional discipline as a 14 result of the acts, omissions, decisions, or any other 15 conduct, direct or indirect, associated with a hearing panel, 16 except for wilful and wanton misconduct. Nothing in this 17 Section shall relieve any person, health care provider, 18 health care professional, facility, organization, or 19 corporation from liability for his, her, or its own 20 negligence in the performance of his, her, or its duties or 21 arising from treatment of a patient. The hearing panel 22 information shall not be subject to inspection or disclosure 23 except upon formal written request by an authorized 24 representative of a duly authorized State agency or pursuant 25 to a court order issued in a pending action or proceeding. 26 (g) A managed care plan shall develop and implement 27 policies and procedures to ensure that health care 28 professionals are at least annually informed of information 29 maintained by the managed care plan to evaluate the 30 performance or practice of the health care professional. The 31 managed care plan shall consult with health care 32 professionals in developing methodologies to collect and 33 analyze health care professional data. Managed care plans 34 shall provide the information and data and analysis to health -7- LRB9011442JSmg 1 care professionals. The information, data, or analysis 2 shall be provided on at least an annual basis in a format 3 appropriate to the nature and amount of data and the volume 4 and scope of services provided. Any data used to evaluate 5 the performance or practice of a health care professional 6 shall be measured against stated criteria and a comparable 7 group of health care professionals who use similar treatment 8 modalities and serve a comparable patient population. Upon 9 receipt of the information or data, a health care 10 professional shall be given the opportunity to explain the 11 unique nature of the health care professional's patient 12 population that may have a bearing on the health care 13 professional's data and to work cooperatively with the 14 managed care plan to improve performance. 15 (h) Any contract provision or procedure or informal 16 policy or procedure in violation of this Section violates the 17 public policy of the State of Illinois and is void and 18 unenforceable. 19 Section 15. Prohibitions. 20 (a) No managed care plan shall by contract, written 21 policy or written procedure, or informal policy or procedure 22 prohibit or restrict any health care provider from 23 disclosing to any enrollee, patient, designated 24 representative or, where appropriate, prospective 25 enrollee, (hereinafter collectively referred to as 26 enrollee) any information that the provider deems appropriate 27 regarding: 28 (1) a condition or a course of treatment with an 29 enrollee including the availability of other therapies, 30 consultations, or tests; or 31 (2) the provisions, terms, or requirements of the 32 managed care plan's products as they relate to the 33 enrollee, where applicable. -8- LRB9011442JSmg 1 (b) No managed care plan shall by contract, written 2 policy or procedure, or informal policy or procedure prohibit 3 or restrict any health care provider from filing a 4 complaint, making a report, or commenting to an appropriate 5 governmental body regarding the policies or practices of the 6 managed care plan that the provider believes may 7 negatively impact upon the quality of, or access to, patient 8 care. 9 (c) No managed care plan shall by contract, written 10 policy or procedure, or informal policy or procedure prohibit 11 or restrict any health care provider from advocating to the 12 managed care plan on behalf of the enrollee for approval or 13 coverage of a particular course of treatment or for the 14 provision of health care services. 15 (d) No contract or agreement between a managed care 16 plan and a health care provider shall contain any clause 17 purporting to transfer to the health care provider by 18 indemnification or otherwise any liability relating to 19 activities, actions, or omissions of the managed care plan 20 as opposed to those of the health care provider. 21 (e) No contract between a managed care plan and a health 22 care provider shall contain any incentive plan that includes 23 specific payment made directly, in any form, to a health care 24 provider as an inducement to deny, reduce, limit, or delay 25 specific, medically necessary and appropriate services 26 provided with respect to a specific enrollee or groups of 27 enrollees with similar medical conditions. Nothing in this 28 Section shall be construed to prohibit contracts that contain 29 incentive plans that involve general payments, such as 30 capitation payments or shared-risk arrangements, that are not 31 tied to specific medical decisions involving specific 32 enrollees or groups of enrollees with similar medical 33 conditions. The payments rendered or to be rendered to 34 health care provider under these arrangements shall be deemed -9- LRB9011442JSmg 1 confidential information. 2 (f) No managed care plan shall by contract, written 3 policy or procedure, or informal policy or procedure permit, 4 allow, or encourage an individual or entity to dispense a 5 different drug in place of the drug or brand of drug ordered 6 or prescribed without the express permission of the person 7 ordering or prescribing, except this prohibition does not 8 prohibit the interchange of different brands of the same 9 generically equivalent drug product, as provided under 10 Section 3.14 of the Illinois Food, Drug and Cosmetic Act. 11 (g) Any contract provision, written policy or 12 procedure, or informal policy or procedure in violation of 13 this Section violates the public policy of the State of 14 Illinois and is void and unenforceable. 15 Section 20. Network of providers. 16 (a) At least once every 3 years, and upon application 17 for expansion of service area, a managed care plan shall 18 obtain certification from the Director of Public Health that 19 the managed care plan maintains a network of health care 20 providers and facilities adequate to meet the comprehensive 21 health needs of its enrollees and to provide an appropriate 22 choice of providers sufficient to provide the services 23 covered under its enrollee's contracts by determining that: 24 (1) there are a sufficient number of geographically 25 accessible participating providers and facilities; 26 (2) there are opportunities to select from at least 27 3 primary care providers pursuant to travel and 28 distance time standards, providing that these standards 29 account for the conditions of accessing providers in 30 rural areas; and 31 (3) there are sufficient providers in all covered 32 areas of specialty practice to meet the needs of the 33 enrollment population. -10- LRB9011442JSmg 1 (b) The following criteria shall be considered by the 2 Director of Public Health at the time of a review: 3 (1) provider-enrollee ratios by specialty; 4 (2) primary care provider-enrollee ratios; 5 (3) safe and adequate staffing of health care 6 providers in all participating facilities based on: 7 (A) severity of patient illness and functional 8 capacity; 9 (B) factors affecting the period and quality 10 of patient recovery; and 11 (C) any other factor substantially related to 12 the condition and health care needs of patients; 13 (4) geographic accessibility; 14 (5) the number of grievances filed by enrollees 15 relating to waiting times for appointments, 16 appropriateness of referrals, and other indicators of a 17 managed care plan's capacity; 18 (6) hours of operation; 19 (7) the managed care plan's ability to provide 20 culturally and linguistically competent care to meet the 21 needs of its enrollee population; and 22 (8) the volume of technological and speciality 23 services available to serve the needs of enrollees 24 requiring technologically advanced or specialty care. 25 (c) A managed care plan shall report on an annual basis 26 the number of enrollees and the number of participating 27 providers in the managed care plan. 28 (d) If a managed care plan determines that it does not 29 have a health care provider with appropriate training and 30 experience in its panel or network to meet the particular 31 health care needs of an enrollee, the managed care plan 32 shall make a referral to an appropriate provider, pursuant to 33 a treatment plan approved by the primary care provider, in 34 consultation with the managed care plan, the -11- LRB9011442JSmg 1 non-participating provider, and the enrollee or enrollee's 2 designee, at no additional cost to the enrollee beyond what 3 the enrollee would otherwise pay for services received within 4 the network. 5 (e) A managed care plan shall have a procedure by which 6 an enrollee who needs ongoing health care services, 7 provided or coordinated by a specialist focused on a specific 8 organ system, disease or condition, shall receive a referral 9 to the specialist. If the primary care provider, after 10 consultation with the medical director or other 11 contractually authorized representative of the managed care 12 plan, determines that a referral is appropriate, the primary 13 care provider shall make such a referral to a specialist. In 14 no event shall a managed care plan be required to permit 15 an enrollee to elect to have a non-participating 16 specialist, except pursuant to the provisions of subsection 17 (d). The referral made under this subsection shall be 18 pursuant to a treatment plan approved by the enrollee or 19 enrollee's designee, the primary care provider, and the 20 specialist in consultation with the managed care plan. The 21 treatment plan shall authorize the specialist to treat the 22 ongoing injury, disease, or condition. It also may limit the 23 number of visits or the period during which visits are 24 authorized and may require the specialists to provide the 25 primary care provider with regular updates on the specialty 26 care provided, as well as all necessary medical information. 27 (f) A managed care plan shall have a procedure by which 28 a new enrollee, upon enrollment, or an enrollee, upon 29 diagnosis, with (i) a life-threatening condition or disease 30 or (ii) a degenerative or disabling condition or disease, 31 either of which requires specialized medical care over a 32 prolonged period of time shall receive a standing referral to 33 a specialist with expertise in treating the life-threatening 34 condition or disease or degenerative or disabling condition -12- LRB9011442JSmg 1 or disease who shall be responsible for and capable of 2 providing and coordinating the enrollee's primary and 3 specialty care. If the primary care provider, after 4 consultation with the enrollee or enrollee's designee and 5 medical director or other contractually authorized 6 representative of the managed care plan, determines that the 7 enrollee's care would most appropriately be coordinated 8 by a specialist, the primary care provider shall refer, on a 9 standing basis, the enrollee to a specialist. In no event 10 shall a managed care plan be required to permit an enrollee 11 to elect to have a non-participating specialist, except 12 pursuant to the provisions of subsection (d). The 13 specialist shall be permitted to treat the enrollee 14 without a referral from the enrollee's primary care 15 provider and shall be authorized to make such referrals, 16 procedures, tests, and other medical services as the 17 enrollee's primary care provider would otherwise be 18 permitted to provide or authorize including, if 19 appropriate, referral to a specialty care center. If a 20 primary care provider refers an enrollee to a 21 non-participating provider pursuant to the provisions of 22 subsection (d), the standing referral shall be pursuant to a 23 treatment plan approved by the enrollee or enrollee's 24 designee and specialist, in consultation with the managed 25 care plan. Services provided pursuant to the approved 26 treatment plan shall be provided at no additional cost to 27 the enrollee beyond what the enrollee would otherwise pay 28 for services received within the network. 29 (g) If an enrollee's health care provider leaves the 30 managed care plan's network of providers for reasons other 31 than those for which the provider would not be eligible to 32 receive a pre-termination hearing pursuant to subsection (f) 33 of Section 10, the managed care plan shall permit the 34 enrollee to continue an ongoing course of treatment -13- LRB9011442JSmg 1 with the enrollee's current health care provider during a 2 transitional period of: 3 (1) up to 90 days from the date of notice to the 4 enrollee of the provider's disaffiliation from the 5 managed care plan's network; or 6 (2) if the enrollee has entered the second trimester 7 of pregnancy at the time of the provider's 8 disaffiliation, for a transitional period that 9 includes the provision of post-partum care directly 10 related to the delivery. 11 Transitional care, however, shall be authorized by the 12 managed care plan during the transitional period only if the 13 health care provider agrees (i) to continue to accept 14 reimbursement from the managed care plan at the rates 15 applicable prior to the start of the transitional period 16 as payment in full, (ii) to adhere to the managed care plan's 17 quality assurance requirements and to provide to the managed 18 care plan necessary medical information related to the care, 19 (iii) to otherwise adhere to the managed care plan's 20 policies and procedures including, but not limited to, 21 procedures regarding referrals and obtaining 22 pre-authorization and a treatment plan approved by the 23 primary care provider or specialist in consultation with the 24 managed care plan, and (iv) if the enrollee is a recipient of 25 services under Article V of the Illinois Public Aid Code, the 26 health care provider has not been subject to a final 27 disciplinary action by a state or federal agency for 28 violations of the Medicaid or Medicare program. 29 (h) If a new enrollee whose health care provider is not 30 a member of the managed care plan's provider network enrolls 31 in the managed care plan, the managed care plan shall permit 32 the enrollee to continue an ongoing course of treatment with 33 the enrollee's current health care provider during a 34 transitional period of up to 90 days from the effective -14- LRB9011442JSmg 1 date of enrollment, if (i) the enrollee has a 2 life-threatening disease or condition or a degenerative or 3 disabling disease or condition or (ii) the enrollee has 4 entered the second trimester of pregnancy at the effective 5 date of enrollment, in which case the transitional period 6 shall include the provision of post-partum care directly 7 related to the delivery. If an enrollee elects to continue 8 to receive payment for care from a health care provider 9 pursuant to this subsection, the care shall be authorized by 10 the managed care plan for the transitional period only if 11 the health care provider agrees (i) to accept reimbursement 12 from the managed care plan at rates established by the 13 managed care plan as payment in full, which rates shall be no 14 more than the level of reimbursement applicable to similar 15 providers within the managed care plan's network for 16 those services, (ii) to adhere to the managed care plan's 17 quality assurance requirements and agrees to provide to the 18 managed care plan necessary medical information related to 19 the care, (iii) to otherwise adhere to the managed care 20 plan's policies and procedures including, but not limited 21 to, procedures regarding referrals and obtaining 22 pre-authorization and a treatment plan approved by the 23 primary care provider or specialist, in consultation with the 24 managed care plan, and (iv) if the enrollee is a recipient of 25 services under Article V of the Illinois Public Aid Code, the 26 health care provider has not been subject to a final 27 disciplinary action by a state or federal agency for 28 violations of the Medicaid or Medicare program. In no 29 event shall this subsection be construed to require a managed 30 care plan to provide coverage for benefits not otherwise 31 covered or to diminish or impair pre-existing condition 32 limitations contained within the enrollee's contract. 33 Section 25. Duty to report. -15- LRB9011442JSmg 1 (a) A managed care plan shall report to the 2 appropriate professional disciplinary agency, after 3 compliance and in accordance with the provisions of this 4 Section: 5 (1) termination of a health care provider contract 6 for commission of an act or acts that may directly 7 threaten patient care, and not of an administrative 8 nature, or that a person may be mentally or physically 9 disabled in such a manner as to endanger a patient under 10 that person's care; 11 (2) voluntary or involuntary termination of a 12 contract or employment or other affiliation with the 13 managed care plan to avoid the imposition of disciplinary 14 measures. 15 The managed care plan shall only make the report after it 16 has provided the health care professional with a hearing on 17 the matter. (This hearing shall not impair or limit the 18 managed care plan's ability to terminate the professional. 19 Its purpose is solely to ensure that a sufficient basis 20 exists for making the report.) The hearing shall be held 21 before a panel appointed by the managed care plan. The 22 hearing panel shall be composed of 5 persons appointed by the 23 plan, the majority of whom shall be clinical peer reviewers, 24 to the extent possible, in the same discipline and the same 25 specialty as the health care professional under review. The 26 hearing panel shall determine whether the proposed basis for 27 the report is supported by a preponderance of the evidence. 28 The panel shall render its determination within 14 days. If 29 a majority of the panel finds the proposed basis for the 30 report is supported by a preponderance of the evidence, the 31 managed care plan shall make the required report within 21 32 days. 33 Any hearing under this Section shall provide the health 34 care professional in question with the right to examine -16- LRB9011442JSmg 1 pertinent information, to present witnesses, and to ask 2 questions of an authorized representative of the plan. 3 If a hearing has been held pursuant to subsection (f) of 4 Section 10 and the hearing panel sustained a plan's 5 termination of a health care professional, no additional 6 hearing is required, and the plan shall make the report 7 required under this Section. 8 (b) Reports made pursuant to this Section shall be made 9 in writing to the appropriate professional disciplinary 10 agency. Written reports shall include the name, address, 11 profession, and license number of the individual and a 12 description of the action taken by the managed care plan, 13 including the reason for the action and the date thereof, or 14 the nature of the action or conduct that led to the 15 resignation, termination of contract, or withdrawal, and the 16 date thereof. 17 For any hearing under this Section, because the candid 18 and conscientious evaluation of clinical practices is 19 essential to the provision of health care, it is the policy 20 of this State to encourage peer review by health care 21 professionals. Therefore, no managed care plan and no 22 individual who participates in a hearing or who is a member, 23 agent, or employee of a managed care plan shall be liable for 24 criminal or civil damages or professional discipline as a 25 result of the acts, omissions, decisions, or any other 26 conduct, direct or indirect, associated with a hearing panel, 27 except for wilful and wanton misconduct. Nothing in this 28 Section shall relieve any person, health care provider, 29 health care professional, facility, organization, or 30 corporation from liability for his, her, or its own 31 negligence in the performance of his, her, or its duties or 32 arising from treatment of a patient. The hearing panel 33 information shall not be subject to inspection or disclosure 34 except upon formal written request by an authorized -17- LRB9011442JSmg 1 representative of a duly authorized State agency or pursuant 2 to a court order issued in a pending action or proceeding. 3 Section 30. Disclosure of information. 4 (a) A health care professional affiliated with a 5 managed care plan shall make available, in written form at 6 his or her office, to his or her patients or prospective 7 patients the following: 8 (1) information related to the health care 9 professional's educational background, experience, 10 training, specialty and board certification, if 11 applicable, number of years in practice, and hospitals 12 where he or she has privileges; 13 (2) information regarding the health care 14 professional's participation in continuing education 15 programs and compliance with any licensure, 16 certification, or registration requirements, if 17 applicable; 18 (3) information regarding the health care 19 professional's participation in clinical performance 20 reviews conducted by the Department, where applicable and 21 available; and 22 (4) the location of the health care professional's 23 primary practice setting and the identification of any 24 translation services available.
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