Office for Civil Rights
HHS News
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE FOR CIVIL RIGHTS
FOR IMMEDIATE RELEASE
Wednesday, Aug. 30, 2000
Contact: Kathleen O=Brien (OCR)
(202) 619-0403
HHS Provides Written Guidance for Health and Human Services Providers
To Ensure Language Assistance for Persons with Limited English Skills
The U.S. Department of Health and Human Services today issued
written policy guidance to assist health and social services
providers in ensuring that persons with limited English skills can
effectively access critical health and social services.
The guidance, published in the Federal Register by
the HHS Office for Civil Rights (OCR), lays out and explains more
fully OCR's existing policies. It outlines the legal
responsibilities of providers who receive Federal financial
assistance from HHS - such as hospitals, HMOs and human service
agencies - to assist people with limited English skills. It also
provides a flexible road map to the range of options available to
providers in meeting the language needs of the nation's
increasingly diverse populations.
Publication of the guidance makes HHS the first federal agency to
publish guidance since the issuance of Executive Order 13166 on
serving persons with limited English skills, signed by President
Clinton on August 11, 2000. The executive order requires each
federal agency to have written policies on providing effective
service to those with limited English proficiency who are served by
federally-funded programs.
Title VI of the Civil Rights Act of 1964 prohibits discrimination
on the basis of race, color, or national origin by any entity that
receives federal financial assistance. Under Title VI of the law,
hospitals, HMOs, social service agencies and other entities that
receive Federal financial assistance from HHS are required to take
the steps necessary to ensure that individuals with limited English
proficiency (LEP) can meaningfully access the programs and
services. The requirements apply to state-administered as well as
private and non-profit facilities and programs that benefit from
HHS assistance. OCR is responsible for compliance with the law as
it applies to HHS assisted programs.
In a letter to governors announcing publication of the written
guidance, HHS Secretary Donna E. Shalala said, "This guidance
enhances our ability to reach our national goal of eliminating
racial and ethnic disparities in health, and will assist in
increasing opportunities for persons with limited English
proficiency to improve their socioeconomic status."
Some of the state-administered programs where access for persons
with limited English proficiency may be especially important
include the State Children's Health Insurance Program (SCHIP),
Medicaid and Temporary Assistance to Needy Families (TANF).
Effective communication is the key to meaningful access, whether
it is a hospital, a clinic or a benefits program," said OCR
Director Thomas Perez. "Failure to communicate effectively can have
serious consequences for millions of Americans."
The guidance emphasizes that providers have flexibility in
designing effective programs. The types of language assistance a
provider must have in place to ensure meaningful access depend on a
variety of factors, including the size of the facility or covered
entity, the size of the eligible LEP population it serves, the
nature of the program or service, the objective of the program, the
resources available to the facility or covered entity, and the
frequency with which LEP persons come into contact with the
program. Small practitioners and providers have considerable
flexibility in determining how to fulfill their obligations to
ensure meaningful access for persons with limited English
proficiency.
"OCR has a history of working cooperatively with health and social
services providers to help them comply with the law and serve their
limited English populations effectively without causing undue
burden," said Perez. "We have found widespread willingness to
improve language assistance services, especially when providers
learn that solutions can be tailored to fit individual situations,
and services can be provided cost-effectively."
"With our requirements and flexible policies now in writing, we
expect to make even greater progress in cooperation with health and
social service providers in making services truly accessible to
those with limited English skills. OCR will continue to be
available to provide technical assistance to any covered entity
seeking to ensure the operation of an effective language assistance
program," Perez said.
Depending on the need and the circumstances of the individual
facility, options for providing oral language assistance range from
hiring bilingual staff or hiring on-staff interpreters to
contracting for interpreter services as needed, engaging community
volunteers, or contracting with a telephone interpreter service.
Examples of problem practices that have been found by OCR include:
providing services to LEP persons which are more limited in scope
or lower in quality than those provided to other persons;
subjecting LEP persons to unreasonable delays; limiting
participation in a program or activity on the basis of English
proficiency; providing services to LEP persons that are not as
effective as those provided to persons proficient in English; and
failing to inform LEP persons of the right to receive free
interpreter services or requiring them to provide their own
interpreter.
As outlined in the guidance, satisfactory service to LEP clients
should include:
- Having polices and procedures in place for identifying
and assessing the language needs of the individual provider and
its client population;
- A range of oral language assistance options,
appropriate to each facility's circumstances;
- Notice to LEP persons of the right to free language
assistance;
- Staff training and program monitoring; and
- A plan for providing written materials in languages
other than English where a significant number or percentage of
the affected population needs services or information in a
language other than English to communicate effectively.
"The purpose of putting these policies into writing is to help
make the requirements of the law both clear and widely-known, among
providers and potential LEP clients as well," Perez said. "We
believe that by making these policies known, and making clear the
flexibility we provide on a facility-by-facility basis, providers
will be more likely to review and improve their language assistance
services, and individuals with limited English skills will be
better able to access the services they need."
The written guidance, "Title VI Prohibition Against National
Origin Discrimination as it Affects Persons with Limited English
Proficiency," is available in the Federal Register,
through OCR's 10 Regional Offices, or on the Internet at http://www.hhs.gov/ocr
Last revised: August 29, 2000
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