Posts Tagged ‘American Recovery and Reinvestment Act’
As a result of the health care reform Individual health premiums are going up. As of Sept. 23rd we will see rate increases from anywhere of 20%-54%. This is a direct result of Health Care Reform.
Under health care reform all policy will have to cover “Essential Benefits”. The Essential Benefits will have no annual max which means they are unlimited. So for an example bariatric medicine would be covered with no limitation. This sounds great if you are one that needs those services but the problem is everyone is going to have to pay for that benefit.
For new Individual policies the price is going to up. If you are on a policy that was in place prior to 3-23-10 you will be grandfathered in. Being grandfathered in might help you save a significant amount form the rate increase that is coming. If you are not grandfathered in your policy will include all of the new coverages and then you will see the rate increase at your renewal. Some carriers might give the rate increase immediately while other will wait for the renewal date.
As of Sept. 23 there will be an open enrollment period for children’s under 19. This open enrollment period will be a time where children can not be declined coverage. We expect the premium amount for a stand alone child policy to be in the ball park of $400 a month. Outside of that open enrollment children will have to go through underwriting to get a policy. If a child is approved for the policy they cannot be pre x. Right now we do not have an estimate of what that policy cost could look like.
With this health care reform we are about to see health insurance premiums at an all time high.
Please check back with us as more details become available.
Governor Tim Pawlenty gave an executive order barring state agencies from participation in the health reform law.
The executive order directs state agencies to decline all discretionary participation in the new law. As a result, none of Minnesota’s executive branch departments and agencies can submit applications for grants or demonstration projects unless required by the new law or approved by the governor’s office.
“Obamacare is an intrusion by the federal government into personal healthcare matters and it’s an explosion of federal spending that does nothing to make healthcare more affordable,” Pawlenty said in a statement. “To the fullest extent possible, we need to keep Obamacare out of Minnesota. This executive order will stop Minnesota’s participation in projects that are laying the groundwork for a federally-controlled healthcare system.”
The Kaiser Family Foundation has calculated that about 250,000 Minnesotans would join the Medicaid rolls under the expansion. Pawlenty has said it would cost the state $430 million in the first three years.
Pawlenty turned down an $850,000 sex-education grant on Monday, and Minnesota was one of five states — along with Alaska, Georgia, Iowa and Wyoming — not to apply for a $1 million healthcare reform grant to strengthen its health insurance rate review process. But the state already has one of the strictest rate review requirements in the country and may not have seen a need for the grants
The think tanks have already started to come up with strategies to stop Obamacare. With Sept 23rd just a few weeks a way we are already seeing issues with health care reform that are leading people to think repeal. Below are a few ways for the Republicans to fight the health care reform.
Here are six key strategies that a Republican Congress could employ to either repeal health care reform or delay it.
1. Defund it. House Republican Leader John Boehner of Ohio has vowed to choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the “army of new IRS agents” needed to police compliance.
While Republicans could target the most damaging provisions of the legislation and tie their defunding measures to appropriations legislation that the president wants and needs to sign, they’d better be ready for battles. When former House Speaker Newt Gingrich lost a stand-down with President Clinton over closing down the government in 1996, it was widely seen as a setback for GOP efforts to scale back big government.
2. Dismantle it. To focus committee action and floor votes, Republicans can look for provisions in the law that Democrats are on record as opposing. For example, Senate Budget Committee Chairman Kent Conrad (D., N.D.) has said that the new federal program to fund long-term care—the Community Living Assistance Services and Supports Act, or CLASS Act—is “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.” Mr. Conrad and five of his Democratic colleagues sent a letter to Senate Majority Leader Harry Reid (D., Nev.) before the legislation passed opposing the program and expressing “grave concerns” about its fiscal sustainability.
Other highly unpopular provisions include the requirement that all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. This is designed to raise about $17 billion over 10 years from tax cheats. Rep. Dan Lungren (R., Calif.) was the first to introduce legislation to repeal this gigantic paperwork burden. Many Democrats in vulnerable districts who voted for the health law are also anxious to repeal this provision, which the National Federation of Independent Business says will impact 40 million businesses.
3. Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law. Mr. Obama wouldn’t likely sign such legislation, but the debate would shine a light on problems that haven’t received nearly enough attention.
4. Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off. But proposing a resolution of disapproval under the CRA gives Republicans a platform to express strong disagreement and bring attention to especially egregious rules.
The current congressional majority wants to gut the CRA, and the House passed a bill that would eliminate the requirement that federal agencies submit their rules to Congress before they can take effect. The Senate has not yet acted, but this measure should be on the Republicans’ watch list for the rest of the year.
5. Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial—even before they have been issued. Businesses are also aghast at the narrow openings they have to protect their current health plans from onerous federal regulation. Republicans could summon many witnesses to testify about the impact of this regulatory straightjacket.
Congress also must keep a careful eye on the evolving cost estimates and deficits. Former Congressional Budget Office Director Douglas Holtz-Eakin estimates that the cost of the subsidies for private insurance could rise to $1.4 trillion —triple the $450 billion assumed by the current CBO. This is because the legislation creates strong incentives for businesses to drop coverage and dump their employees into federally subsidized insurance. Congress has a responsibility to protect taxpayers from what surely will be exploding costs.
Republicans also will want to call Donald Berwick, head of the powerful Centers for Medicare and Medicaid Services, to testify before Congress and detail his regulatory agenda for implementing the health-care law. He escaped that duty earlier this year when the White House avoided his Senate confirmation by giving him a controversial recess appointment.
6. Delegate to the states. Congress should encourage states to press forward with their own innovative programs. For example, Gov. Mitch Daniels’s popular and fiscally responsible Healthy Indiana Plan expands coverage to the uninsured using a health savings account model. And the lightly regulated Utah Health Exchange provides a marketplace for individuals and small businesses to purchase affordable, portable health insurance. Both are threatened by ObamaCare. The more that states are marching forward with reform that suits the needs and pocketbooks of their citizens, the easier it will be for Congress to repeal ObamaCare and start over.
Americans intuitively understand that government can’t pay for huge new entitlement programs and the expansion of Medicaid with imagined cuts to Medicare, while still improving Medicare’s long-term solvency. They also know that job creation is flat and that employers’ fear of ever-rising health benefit costs is part of the problem. They need to hear the evidence that their fears are valid.
The real wallop of ObamaCare will come in 2014, when most of the spending begins and businesses and individuals are hit with intrusive and expensive mandates. The main job of Republicans, should they capture Congress, will be to slow down implementation of the law and explain to the American people the damage it will do—and already is doing—to our economy. If the White House changes hands in 2012, they can be ready to start with a clean slate and begin a step-by-step approach to sensible reform.
I just spent 10 days in Canada and had the opportunity to listen to stories from multiple Canadians about there health care experiences.
I was able to speak to 3 different people about their health conditions and what kind of treatment they received. It was very interesting because as they told me their stories I thought how those conditions would have been treated here in United States.
The first situation was a gentlemen that need a double knee surgery. He needed both knees to be essential rebuilt. He had multiple tears in both knees and really had problems walking. When he would walk down the stairs he had to walk step side ways. He has been on a waiting list for over 5 years. He lived in Toronto which is a major metropolitan city. I was amazed that it had really been 5 years. Here in the US he might have waited 5 weeks. Now if was on a private health plan here he might have had to pay his out of pocket max for that surgery. If he was on a subsidized plan like Medicaid he would have paid very little out of pocket.
The next case was a women that suffered from Gall Stones. She had been in extreme pain and unable to eat. It took the Canadian health care system well over a year to figure out what was wrong with her. The big problem they had was access to diagnostic imaging to detect the stones. She started the treatment in a rural hospital that had very little resources. They decided to move her treatment to Toronto. At that point she had no relationship with any of the doctors. She stated to me that in the Canadian system its very important to have your primary car physicianact as a gate keeper to all of your care. Once she lost that gate keeper none of the health care providers really show any case of urgency even though she was losing weight. After 8 months she was finally able to get diagnostic services to detect the stone. Once the stone was it took about 6 months and 3 outpatient surgeries to remove it. There was problems removing the stones because of a lack of having the correct instruments for the surgery. On the 3rd procedure they were finally able to remove the stones. It was indicated to the patient that the gall bladder was close to dieing because of a lack of blood. The patient lost almost 50 lbs and was on her death bed. Her husband though that she had a couple of weeks left had the 3rd surgery not worked. Here in the US this condition could have been corrected in just a couple of months tops. There would have been immediate access to diagnostic imagining. With our technology the removal of the gall stone would have had a much higher probability of being success on the 1st surgery. There is absolutely no reason a person should come close to death because of a gall stone.
The 3rd person had a much different story. She was diagnosed with a very rare kind of cancer. So rare that her life expectancy was months if not treated. She was treated and the cancer went into remission in just a couple of months. When she told me this I asked how she was able to get such fast treatment. She told me that it was her doctor that saved her. The doctor put her on a list of need treatment immediately. I did not understand. I asked if there was a panel of people that make these type of decision and she said no just the treating d0ctor. So in this situation it sound like she a doctor that saved her life. I think had she received treatment here for the condition the treatment level would have been about the same with her sharing a small fraction of the total cost.
With our current system all three situations would have be treated quickly with less suffering for at least 2 of the 3 cases. The trade off would have been the patients would have had to pays a small portion of the overall treatment.
With the new health care reform pushing Universal Care through an Employer Based plan I fear we are going down the socialized medicine route. The route is going to ration health care on a very large scale if you are insured through a subsidized health plan. Will US citizens have to wait 8 months for diagnostic imaging? Will it take 3 out patient surgeries to correct a condition? If your condition is not life threatening will you wait indefinitely?
After 2014 we could see to market of health care in this country. Subsidized plans like welfare and medicaid could have a huge drop off of quality of care and rationing. While the private health insurance market will dictate that you get immediate treatment and the quality of that care is the best.
Only time will tell.
A new group, the States Alliance for Balanced Insurance Regulation, will represent small and midsize insurance-related businesses in the looming battle over the role of federal regulators. With health care reform we have seen the Office of Consumer Information and Insurance Oversight created by the Federal Goverment and SABIR is being created to in protecting the interests of small and mid-sized businesses within and related to the insurance industry.
David Bass will be the executive director of SABIR, and former Congressman Barry Goldwater Jr. will be the president.
“SABIR will be fundamentally different from other major insurance associations in that we won’t be inclined to support federal regulation,” Bass says. “We were born of the sentiments and frustration from insurers across the nation. They have always operated under state regulation, and the intrusive federal government threatens not only their way of business but their existence as a whole…. SABIR aims to be the collective organ for the protection and promotion of balanced regulation of insurance.”
With Sept. 23rd right around the corner health plans are ordered by law to cover certain aspect of reform.
There is real uncertainty in the carrier market. We have already seen an exodus of stand alone children policies being offered. The only carrier offer standalone children’s plan is Anthem. There is a chance that they too could pull out of that market. The problem the carriers are having is as Sept 23rd any child under 19 year age is guaranteed issue which means they can not be declined or pre x for any kind of health coverage. This could lead to major premium increases if the policies are even available. The government has agreed to allow the carriers to have an open enrollment period for these type of plans which will help.
The other uncertainty right now is the preventive care coverage that is being mandated under the health care reform. The individual carriers are looking to the government to give clarification on these rules. The problem then occurs is designing a plan that is compliant with health care reform and then getting the new plan design approved with the department of insurance in each state.
With these current issues we could see a black out of indiviudal coverage for new policies. So on Sept. 23rd you might not be able to get a new individual policy. If you are in the market for a policy you need to act fast because who knows how long it could take before carriers clear up these issues with both the Federal Gov. and local Gov. On a positive note they could get all this resolved before Sept. 23rd.
Current estimates on possible price increase for individualplans for this aspect of health care reform is anywhere from 4%-8%. There are no available estimates on the price increases for a stand alone child’s policy.
Rep. Wally Herger (R-Calif.) filed a discharge petition Tuesday that would get rid of the Democrats’ health care reform and replace it with a Republican alternative.
His push follows Rep. Steve King’s (R-Iowa) petition to simply repeal the reform without replacing it with new legislation. King’s petition currently has 170 supporters, while Herger’s got 28 in its first day.
I think the Repeal process is going to continue. The Republican party realizes the negative impact that the health care reform is going to have. We are starting to see some estimates of the cost of the health insurance exchange and its very high. The burden to small business that this health care reform is going to have is very high. The cost to the states with the expansion of medicaid is extremely high. The high probability of small group health carriers dropping out of the market is likely because of the reform. The Medical Loss Ratio impact on all health insurance providers could force carriers to exit certain regions. The medical review panel for Medicare could be seen as the death panel because they will decide what is covered. The tax penalty for not carrying insurance can be seen as unconstitutional. This is just a few bullet points as you did into the bill from actuarialstandpoint the reform could collapse the entire health care system.
This is why we will contiune to see a push to Repeal this law. We will also see the conservative party go after funding for this law.
As the health care reform becomes more and more clear we are starting to see the debate to repeal certain aspects. This recent legislation to repeal makes a lot of sense. The entire purpose of the Health Savings Accounts and Flexible Spending Accounts is to make consumers more engaged in their health care spending. With these plans there is tax free dollars that can be used for the purchases of health care. One of the big issues is over the counter drugs (OTC). From a consumer standpoint if your acid reflux drug can be purchased OTC for $7 for a 90 day supply compared with a brand name drug that is $89 for 30 days supply that is a huge cost savings. If the OTC treats the conditions effectively and your Doctor agree it just makes sense. With the HSA and FSP account you can use pre tax money to buy the OTC drug thus creating consumerism. The new health care law take away the tax incentives of using your money for OTC drugs.
Senator Kay Bailey Hutchison’s (R-TX) recently-introduced Patients’ Freedom to Choose Act, legislation that repeals two provisions included in the Patient Protection and Affordable Care Act.
Under current law, starting in 2011, the PPACA will prohibit individuals from using either their Health Savings Account (HSA) or Flexible Spending Account (FSA) funds to purchase over-the-counter medication unless they have a prescription from their doctor. And, starting in 2013, the PPACA institutes an annual FSA contribution cap of $2,500.
The Patients’ Freedom to Choose Act strikes these arbitrary provisions from the law. Many individuals and employers will benefit from this important legislation. Over 80% of all large employers that offer an FSA to their employees include a limit that is over this $2,500 threshold. According to a report issued by America’s Health Insurance Plan, over ten million Americans are insured with an HSA-compatible plan.
New Consumer Protections Start This Fall
The new Patients’ Bill of Rights regulations detail a set of protections that apply to health coverage starting on or after September 23, 2010. They are:
No Pre-Existing Condition Exclusions for Children Under Age 19. The new regulations will prohibit insurance plans from denying coverage to children based on pre-existing conditions. This ban includes both benefit limitations (e.g., an insurer or employer health plan refusing to pay for chemotherapy for a child with cancer because the child had the cancer before getting insurance) and outright coverage denials (e.g., when the insurer refuses to offer a policy for the child because of the child’s pre-existing medical condition). These protections will apply to all types of insurance except for individual policies that are “grandfathered,” and will be extended to Americans of all ages starting in 2014.
No Arbitrary Rescissions of Insurance Coverage. Right now, insurance companies are able to retroactively cancel your policy when you become sick, or if you or your employer made an unintentional mistake on your paperwork.
Under the regulations, insurers and plans will be prohibited from rescinding coverage – for individuals or groups of people – except in cases involving fraud or an intentional misrepresentation of material facts. Insurers and plans seeking to rescind coverage must provide at least 30 days advance notice to give people time to appeal. There are no exceptions to this policy.
No Lifetime Limits on Coverage. Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. The regulation prohibits the use of lifetime limits in all health plans and insurance policies issued or renewed on or after September 23, 2010.
Restricted Annual Dollar Limits on Coverage. Annual dollar limits on what an insurance company will pay for health care will phase out over the next three years until 2014, when the Affordable Care Act bans them for most plans. However, employers who demonstrate that current annual limits are necessary to prevent a significant loss of coverage or increase in premiums will be allowed to delay complying with these rules. Limited benefit insurance plans – which are often used by employers to provide benefits to part-time workers — are examples of insurers that might seek this kind of delay. These restricted annual dollar limits apply to all insurance plans except for individual market plans that are grandfathered.
Protecting Your Choice of Doctors. Being able to choose and keep your doctor is a key principle of the Affordable Care Act. The new rules make clear that health plan members are free to designate any available participating physician as their primary care provider. The rules allow parents to choose any available participating pediatrician to be their children’s primary care provider. These policies apply to all individual market and group health insurance plans except those that are grandfathered.
Removing Insurance Company Barriers to Emergency Department Services. Some insurers will only pay for health care provided by a limited number or network of providers – including emergency health care. Others require prior approval before receiving emergency care at hospitals outside of their networks. The new rules make emergency services more accessible to consumers and limit the amount of cost-sharing for emergency services received out of network.
The rules also set requirements on how health plans should reimburse out-of-network providers. This policy applies to all individual market and group health plans except those that are grandfathered.
Under the Patient Protection and Affordable Care Act, a non-grandfathered group health plan must adopt an improved internal claims and appeal process and follow minimum requirements for external review. On July 23, 2010, interim final regulations were issued implementing these requirements (the Interim Final Rule). The appeals process rules are effective for plan years beginning on or after September 23, 2010. Comments on the Interim Final Rule are being accepted until September 21, 2010.
Key provisions of the Interim Final Rule include information on:
- How to comply with updated internal claims and appeals processes;
- Determining whether a state or federal external review process applies for appeals, along with guidance for each process; and
- Requirements for notices in connection with the appeals process.
This Legislative Brief summarizes the new Interim Final Rule. Please read below for more detailed information. For a copy of the regulations, see www.federalregister.gov/a/2010-18043.
SUMMARY OF THE INTERIM FINAL RULE
Internal Claims and Appeals Process for Group Health Plans
Health care reform requires group health plans to implement an effective internal claims and appeals process. These plans, as well as health insurance issuers providing their health insurance coverage, must follow the Department of Labor’s claims procedure rules for group health plans.[1]
In addition to the existing DOL claims procedure regulations, group health plans must follow a number of new requirements:
- New Definition of “Adverse Benefit Determination.” The definition of the term adverse benefit determination is found in the claims procedure regulations. It includes a denial, reduction, termination of, or failure to pay for (in whole or in part), a benefit under the plan. It includes decisions based on an individual’s eligibility to participate in the plan, a benefit not being a covered benefit, imposition of an exclusion, or a benefit being experimental or not medically necessary. Denials can include both pre- and post-service claims.
The Interim Final Rule adds rescissions of coverage to the definition of the term adverse benefit determination. A rescission is a cancellation or discontinuation of coverage that has a retroactive effect. A cancellation because of a failure to timely pay premiums for coverage is not considered a rescission.
- Expedited Notice for Urgent Care Claims. Under the Interim Final Rule, group health plans must notify claimants of a benefit determination involving an urgent care claim more quickly. The new deadline is as soon as possible, taking into account the medical circumstances, but not later than 24 hours after the plan gets the claim. There is an exception to the deadline if the claimant does not provide enough information to the plan. The prior rule required the notice to be given within 72 hours. The change is attributable to faster decision-making capabilities, due to electronic communication.
- Full and Fair Review. In addition to complying with the claims procedure regulations’ existing requirements, group health plans must follow additional rules to make sure claimants receive a full and fair review. Specifically, the plan must give the claimant any new evidence related to the claim or new rationale for a decision, free of charge. It must be provided as soon as possible and early enough before the appeal deadline to let the claimant respond.
- Avoiding Conflicts of Interest. Group health plans must make sure that all claims and appeals are decided in a way that avoids conflicts of interest. The decision method must be designed to ensure the independence and impartiality of the decision-makers. The decision to hire a person involved in deciding claims or appeals must not be made based on the likelihood that they will support a denial of benefits. For example, a plan cannot provide bonuses based on the number of denials made by a claims adjudicator. Also, a plan cannot hire a medical expert based on his or her reputation for outcomes in contested cases, rather than his or her professional qualifications.
- Notice. The Interim Final Rule provides new standards regarding notice to enrollees. Group health plans must provide notices required by the claims procedure regulations in a culturally and linguistically appropriate manner. See the section entitled “Required Notices” below for a discussion of the culturally and linguistically appropriate standards. The notices must also include the following additional content:
- Information sufficient to identify the claim involved, including the date of service, the health care provider, the claim amount, the diagnosis code and its meaning, and the treatment code and its meaning;
- The reason for the denial must include the denial code and its meaning, as well as any standard used in denying the claim;
- A description of available internal appeals and external review processes, including information about how to initiate an appeal; and
- Contact information for any applicable office of health insurance consumer assistance to assist individuals with the internal claims and appeal and external review processes.
- Deemed Exhaustion of Internal Claims and Appeals Processes. If a plan fails to comply with these rules, the claimant will be deemed to have exhausted the plan’s internal claims and appeals process, even if the plan claims that it substantially complied with the requirements. That means that the claimant is free to pursue other remedies, such as external review or a lawsuit.
- Continued Coverage Pending Outcome of Internal Appeals. Under the new rules, a plan must continue to provide coverage to the claimant until an internal appeal is resolved. Generally, this means that plans may not reduce or terminate an ongoing course of treatment without advance notice and an opportunity for advance review. Also, anyone in an urgent care situation or receiving an ongoing course of treatment may be allowed to proceed with an expedited external review at the same time as the internal appeal.
External Review Standards
Group health plans must comply with either a state external review process or the federal external review process. The Interim Final Rule provides guidance on which process must be followed.
State Standards for External Review
If a state external review process that applies to and is binding on an insurance issuer includes the consumer protections in the NAIC Uniform Model Act in place on July 23, 2010, then the issuer must comply with that state external review process. In that case, where benefits under a group health plan are provided through health insurance coverage, the issuer must provide the external review process and the group health plan itself is not obligated to do so. Some self-insured group health plans may be subject to the state external review process if they are not subject to ERISA preemption.
Any plan or issuer that is not subject to a state external review process must comply with the federal external review process. A plan or issuer will be subject to the federal process if there is not state external review process or if the state external review process does not meet the minimum requirements of the NAIC Uniform Model Act.
The Department of Health and Human Services will determine whether a state external review process meets the minimum requirements. HHS will also provide a transition period for plan years beginning before July 1, 2011, where existing state external review processes will be treated as meeting the minimum requirements. This transition period will give states the opportunity to review and amend their processes. For plan years beginning on or after July 1, 2011, the federal external review process will apply unless HHS determines that the state process meets the minimum standards.
Federal External Review Process
The health care reform law requires a federal external review process to be established. The Interim Final Rule does not establish that process, but it does describe the standards that will be included. Plans or issuers that are not subject to a state external review process will have to follow the federal process. For an insured group health plan, if either the issuer or the plan complies with the federal process, then the obligation is satisfied for both the plan and the issuer.
The federal external review process will apply to most adverse benefit determinations or final internal adverse benefit determinations, including rescissions. However, it will not apply to denials based on a participant or beneficiary’s ineligibility for the plan.
The standards to be issued for the federal external review process will include procedures for initiating and conducting the review, an expedited external review process for certain claims, additional consumer protections for claims involving experimental or investigational treatment, and additional notices and disclosures to claimants.
Required Notices
Notices of available internal claims and appeals and external review processes must be provided in a culturally and linguistically appropriate manner. This means providing notices in a non-English language if certain thresholds are met for the number of people who are literate in the same non-English language.
For a group health plan that covers fewer than 100 participants at the beginning of the plan year, the threshold is 25 percent of all plan participants being literate in only the same non-English language. For a plan that covers 100 or more participants, it is the lesser of (a) 500 participants, or (b) 10 percent of all plan participants.
If an applicable threshold is met, the notice must be provided in the non-English language upon request. In addition, the plan or issuer must include a statement in the English version of all notices offering the notice in the non-English language. The statement must be prominently displayed in the non-English language. Once a request has been made by a claimant, all future notices to that claimant must be provided in the non-English language. Also, if the plan or issuer has a customer assistance process that answers questions or gives assistance with filing claims and appeals (such as a telephone hotline), the assistance must be provided in the non-English language.
