The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), and the Centers for Medicare & Medicaid Services (CMS) have joined forces, demonstrating their unwavering commitment to enhancing protections against discrimination in healthcare. Their collaborative effort has resulted in a final rule under Section 1557 of the Affordable Care Act (ACA), a testament to their dedication and thoroughness in eliminating discrimination based on race, color, national origin, sex, age, and disability.
Section 1557 is a beacon of hope, aiming to significantly reduce language access barriers, enhance physical and digital accessibility, and address bias in health technology, among other crucial improvements. You can view the full version of the HHS ruling here: HHS Language Access Plan
Part of this rule concerns the right of patients who speak no or limited English to an interpreter during their visit and written documentation available in their language at no cost to them.
HHS Language Action Plan Benchmarks
The revised regulations are a significant achievement for language access advocates, patients, and healthcare providers focused on equitable care. These new rules also have important implications for remote interpreting services, particularly regarding quality, technological accessibility, and the training and qualifications of remote interpreters.
They also ensure that individuals with limited English proficiency (LEP) have access to healthcare documentation, websites, literature, written diagnoses, and insurance benefits information during open enrollment periods in their native languages.
The Key Provisions of Section 1557
Notification of Language Access Rights
Healthcare entities must actively inform individuals with limited English proficiency (LEP) about their entitlement to free language assistance services and non-discrimination policies.
This notification must occur during the initial encounter and through prominently displayed notices in key locations within healthcare facilities. Additionally, to ensure comprehensive understanding, these notifications should be available in multiple languages commonly spoken by the patient population.
The notices should clearly articulate the availability of interpreters, translated materials, and other language assistance services at no cost.
These communications must be readily accessible and easy to understand, ensuring that LEP individuals are fully aware of their rights and resources. This proactive approach helps to eliminate barriers to care and supports a more inclusive and equitable healthcare environment.
Telehealth Accessibility to LEPs
Telehealth providers must ensure their services are accessible to individuals with limited English proficiency (LEP) and those with disabilities.
The new ruling mandates integrating interpreting services into telehealth platforms, addressing a critical need that has been underdeveloped until recently.
Telehealth platforms should incorporate robust language support features like real-time interpretation to facilitate effective communication between healthcare providers and LEP patients.
Additionally, these platforms must comply with accessibility standards for individuals with disabilities, including features like screen reader compatibility, captioning for video content, and user-friendly interfaces.
Language Support Across Healthcare
The revised regulations now extend their reach to include Medicare Part B (doctors’ offices), Medigap plans, telehealth providers, and companions accompanying patients with limited English proficiency (LEP).
That ensures that language support is comprehensively available across the entire healthcare field.
Under the updated regulations, doctors’ offices, outpatient clinics, and other smaller healthcare entities must now implement robust language access services for LEP patients and their companions.
That includes the availability of interpreters, translated materials, and other essential language assistance tools, ensuring that LEP individuals can make informed decisions about their healthcare coverage without facing language barriers.
Prohibition of Untrained Interpreters
Under the new rules, healthcare providers must prioritize using trained and qualified interpreters for all interactions with LEP patients. The regulations strictly limit the circumstances under which providers rely on untrained interpreters.
Patients with LEP can only utilize an untrained interpreter if they explicitly request one privately, with a professional interpreter to facilitate decision-making.
This measure ensures that patients are fully informed about the potential risks and limitations associated with using untrained interpreters.
In emergencies where immediate communication is critical, healthcare providers may temporarily rely on untrained interpreters while awaiting a qualified interpreter. However, this exception is strictly time-bound and only when necessary to prevent delays in urgent care.
Language Access and Artificial Intelligence
For the first time in federal policy, the revised regulations under Section 1557 address the role of artificial intelligence (AI) in providing language services.
Recognizing the increasing reliance on AI-driven communication tools, the new rules set clear guidelines to ensure that these technologies enhance, rather than compromise, the quality of care for individuals with limited English proficiency (LEP).
One key provision is that qualified human translators must review any critical communication involving LEP individuals conducted through machine translation.
This requirement ensures that essential medical information, such as diagnoses, treatment plans, consent forms, and discharge instructions, is conveyed accurately.
Final Rule Compliance Guide
The Final Rule contains numerous details and might appear overwhelming to implement. As your organization assesses compliance with the Final Rule, consider the following points:
assess your organization’s health programs
First, assess your organization’s health programs and activities under the relevant provisions. The Department of Health and Human Services (HHS) has provided more explicit guidelines.
One significant update is the inclusion of Medicare Part B as a form of Federal financial assistance. Suppose an organization predominantly provides or manages health insurance or health-related coverage and receives Federal financial assistance. In that case, all its operations must adhere to the Final Rule.
This clarification, brought about by the inclusion of Medicare Part B as a form of Federal financial assistance, is particularly beneficial for organizations that offer a diverse range of products. It removes much of the previous confusion, providing a clearer path for compliance.
determine who within your organization will oversee compliance
Thoughtfully determine who within your organization will oversee compliance with Section 1557. While the Department of Health and Human Services (HHS) does not specify an exact title for this role, they require that the appointed individual have overall oversight of all health programs and activities governed by Section 1557.
This person, often referred to as the Section 1557 Coordinator, is tasked with ensuring all related requirements are met. However, HHS also recognizes the need for flexibility and allows specific responsibilities to be delegated to others. They even suggest that this role can be combined with other positions, such as the Compliance Officer, empowering you to manage your responsibilities in a way that best suits your organization.
revise your organization’s existing policies and procedures
Evaluate and revise your organization’s existing policies and procedures. The Final Rule mandates essential updates for language access and reasonable modification protocols.
HHS allows consolidation of these policies and procedures, provided they adhere to the Final Rule’s requirements. This is an opportune moment to revisit and refresh any outdated documents you have in place. Ensure you review your policies periodically and address critical elements such as providing and procuring language services.
You should also outline training requirements for Section 1557 compliance and establish document retention standards that meet regulatory guidelines.
educate your staff on the essentials
Thoroughly educate your staff on the essentials. Employees must understand the available language access options and reasonable modifications, know how to quickly and efficiently provide these services upon request, offer non-discriminatory access, and navigate the organization’s grievance procedures.
Under the Final Rule, pertinent staff must receive training, so if your organization opts for minimal compliance, it’s necessary to establish a process for determining who needs this instruction. However, many organizations might find training all employees to ensure comprehensive readiness in meeting individuals’ needs beneficial.
collaborate with your marketing and facilities teams
Collaborate with your marketing and facilities teams to create and display the nondiscrimination and new availability notices.
The Department of Health and Human Services (HHS) has outlined specific requirements for these notices, including font size and type. Additionally, HHS mandates that the notices be placed where individuals seeking services are likely to see or hear them.
Your marketing team can assist in designing an appropriate and visually appealing format, while your facilities team can identify strategic locations throughout your premises to ensure compliance.
Remember, this obligation extends beyond physical postings; the notices must be accessible on your website and in written communications.
plan how your organization will distribute the necessary notices
Plan how your organization will distribute the necessary notices. New guidelines from HHS provide additional flexibility for delivering notices of availability. Individuals can now opt out of receiving these notices or request them in their preferred language and alternate format. Organizations may also merge the notice of nondiscrimination with the notice of availability.
If you allow opt-outs, establish a system to track and record these preferences accurately. Ensuring that this system helps you send the required notices annually to those who have yet to opt-out or whenever individuals request them is crucial.
If you decide to cater to language and format preferences, you must maintain records of these preferences and consistently provide materials that meet these specifications.
Additionally, it’s essential to coordinate with your vendors to guarantee they can support the chosen preferences. This will ensure smooth fulfillment and compliance with the new regulations.
identify who will deliver your organization’s interpreting and translation
Identify who will deliver your organization’s interpreting, translation, and alternate format services. To offer the necessary language assistance, readily available resources and reliable vendor partnerships are essential.
Ensure you have robust systems to provide these services at no cost to individuals. These measures must prevent reliance on companions or minors to fulfill these roles. Establish comprehensive protocols to guarantee that all individuals receive the required support promptly and professionally, aligning with the regulatory standards.
By proactively setting up these resources, your organization can ensure seamless communication and accessibility, enhancing overall service delivery and compliance.
TTG is Here to Assist You
On-Demand Telephone Interpreting
Transatlantic Translations Group offers an on-demand, 24/7 telephone interpreting service, allowing clients to access an interpreter in over 200 languages.
Setting up an account with us is free, and there’s no minimum monthly usage requirement. Plus, the service is available at a flat rate of $0.99 per minute for all languages, regardless of the day or time, making it a cost-effective and flexible solution.
Medical Document and Website Translations
In addition, Transatlantic Translations Group provides written translation to and from all languages. Given the sensitive nature of medical documentation, we do not use machine translation; instead, we use human translators to translate and review work before delivery to clients.
This ensures that patient information is not held on a server that could eventually be compromised.
Please get in touch with us to set up a meeting with one of our team members to discuss your requirements further and ensure your compliance with the Section 1557 ruling.