Each time we pick up a prescription at the local pharmacy, visit a family member in a nursing home, make an unexpected trip to the emergency room, apply for a health insurance plan, or visit a doctor or dentist, we are very likely seeking health services that receive federal financial assistance from HHS or are covered by civil rights authorities enforced by HHS. Our mission at the HHS Office for Civil Rights (OCR) is to ensure that people have equal access and opportunity to participate in HHS-funded health care and human services programs as well as participate in health programs and activities administered by HHS.
Part of our work is focused on reducing the barriers for individuals with limited English proficiency (LEP) and helping covered entities to understand and comply with their language assistance obligations. Accordingly, two federal laws require recipients to provide language access services (LAS) free of charge whenever such services are reasonable steps necessary to ensure meaningful access to their programs:
- Title VI of the Civil Rights Act of 1964 (Title VI) implementing regulations
- Section 1557 of the Affordable Care Act (Section 1557) and implementing regulations
Title VI applies to any program or any part of a program that receives federal financial assistance, and Section 1557 applies to any HHS funded health program or activity, and any program or activity that HHS administers under Title I of the Patient Protection and Affordable Care Act, such as the health insurance Marketplaces and plans offered in the Marketplaces.
Title VI and Section 1557 specifically prohibit recipients of FFA from utilizing criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishment of the objective of the program as respect to individuals of a particular race, color, or national origin. In other words, if a hospital only provides information about its services or benefits in English, and that practice results in a denial, termination, or significant delay in services to persons who are LEP, the hospital could be operating in violation of Title VI and Section 1557.
Although the law does not require translation of every document, there are many best practices that could constitute reasonable steps that recipients can take to ensure meaningful access that are cost effective, reduce legal liability, and improve health outcomes. For example, a doctor might contract for a qualified telephonic interpreter services to communicate with a patient who is LEP, a hospital might post notices of the availability of language access services in multiple languages, a pharmacy could post grievance procedures in multiple languages to ensure customers who are LEP can seek relief if they are denied language assistance services, or a health plan may send benefit notices in English but also include notices in 15 languages that instruct persons who are LEP how to obtain a language interpreter at no cost who can explain the notice to them in their preferred language. Because access to health care is of primary importance and it is common for health care providers to encounter persons who are LEP, OCR recommends that all entities covered by Title VI and Section 1557, as a best practice, should develop written language access plans that include budgets for providing language access services to their patients and customers.
HHS has also taken steps to improve access to programs it administers. For example, in 2014, OCR worked with the Centers for Medicare and Medicaid Services (CMS) to improve accessibility for individuals with LEP who apply to participate in the Federally-facilitated Marketplace (FFM). Some individuals must verify their identity by accessing the Help Desk before they can get health care coverage through the FFM. Unfortunately, the contracting firm who initially operated the Help Desk only provided telephonic interpretation services in Spanish, which made it difficult for many individuals with LEP to communicate with the Help Desk and secure health care coverage. OCR's collaborated with CMS resulted in the Help Desk providing telephonic interpretation services to individuals with LEP in more than 200 languages since November 2014.
Collectively, HHS language access activities tackle issues relevant to more than 25 million persons with LEP and nearly 61 million people who speak a language other than English at home. For example, HHS received a complaint about a mental health clinic that refused to accept a patient with LEP for services despite the fact that interpreter assistance was available. Through further investigation, OCR found that the clinic had a practice of not accepting patients that needed interpreters because they believed having an interpreter limited the therapeutic process. Through its enforcement of Title VI of the Civil Rights Act of 1964, OCR was able to help the mental health clinic develop strategies to ensure its patients with LEP have meaningful access to its programs. As a result, the clinic voluntarily implemented a comprehensive policy for providing free language assistance services to patients with LEP at all of its facilities; conducted a language needs assessment and identified its five most frequently encountered non-English languages; instituted a comprehensive training course for its staff; and performed other corrective actions. This case is only one example of the many success stories where OCR significantly expanded language assistance services for individuals with LEP.
Because Section 1557 applies the enforcement mechanisms of Title VI to LEP cases, covered entities can use the HHS LEP Guidance To Recipients of Federal Financial Assistance to assess their programs and determine the type or types of language assistance services they should provide, when necessary to ensure that they are taking reasonable steps to ensure meaningful access to their programs by persons who are LEP. For more information on language access services, visit DOJ's website at: www.lep.gov, and for more information on Section 1557, please visit OCR's website at: https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html. Also feel free to refer inquiries directly to OCR at: https://www.hhs.gov/ocr/about-us/contact-us/index.html. It is our priority that individuals who are LEP, along with all other persons interacting with the health care and service provider community, are not improperly delayed or denied access to health programs and activities because they are LEP.
In addition, the Department established the HHS Language Access Steering Committee to update the HHS Language Access Plan and lead Departmental efforts to improve access by persons with LEP to programs and activities administered by HHS. The Steering Committee helped every HHS granting agency include civil rights language in grant and funding opportunity announcements, including links to technical assistance and contact information for OCR's Regional Offices. This ensured that entities that apply for HHS funds understand their civil rights obligations and know how to get OCR's help to ensure their programs are accessible to individuals with LEP.
OCR is committed to ensuring that covered entities comply with the obligations under Section 1557 and Title VI and to protecting the rights of all persons, including persons who are LEP. Because it has become quite common for health programs to receive patients and customers who are LEP, OCR encourages covered entities, even those that serve communities with relatively low LEP populations, have interpretation services readily available or to include multi-language notices with important documents in order that they are taking reasonable steps to ensure meaningful access to their programs by individuals with limited English proficiency.