Understand the Limited English Proficiency rule.

If your medical practice receives any federal funds, it must comply with the Limited English Proficiency (LEP) rule. This rule falls under Section 1557 of the Affordable Care Act (ACA), which aims to enhance equality within health care, and is enforced by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR).¹

Under the rule, covered entities must provide meaningful access to any patient with LEP who may seek health-care services. LEP is defined as “a person whose primary language for communication is not English and who has a limited ability to read, write, speak, or understand English.”² Practices are required to provide language assistance services to these patients.

Here is some advice on how to comply.

Provide free, timely interpretation services

Have a qualified interpreter available. This is someone who:

1. Adheres to generally accepted interpreter ethics principles, including client confidentiality;
2. Has demonstrated proficiency in speaking and understanding both spoken English and at least one other spoken language; and
3. Can interpret effectively, accurately, and impartially, both receptively and expressly, to and from such language(s) and English, using any necessary specialized vocabulary, terminology, and phraseology.³

Refrain from using remote, low-quality video interpreting services and/or unqualified staff. Many vendors offer certified medical interpreter services available for use with varying logistics to consider.

Post required notices

For your convenience, the OCR has translated the required notices, statements, and taglines into 64 languages (bit.ly/3JX76jM ). If your practice needs a copy of the regulation in large print, Braille, or some other alternative format, contact the OCR.

Post nondiscrimination notices/statements alerting patients of available language assistance services. The nondiscrimination notice in English, along with the 15 other taglines, should be in a conspicuous place on your website such as the homepage. Posting these written statements in English is sufficient to meet the rule; however, the OCR encourages covered entities to produce the information in one or more of the most common non-English languages frequently encountered in the practice’s geographic area.

In addition, display taglines (examples below) in the top 15 non-English languages spoken in the state where you do business. If you have offices in more than one state, an aggregate table of the languages spoken is available (go.cms.gov/3LAPhqW ).

Below are the English and Spanish taglines from the OCR website:

• ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-xxx-xxx-xxxx.
• ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx).

Practice size requirements

If your facility has 15 or more employees, a grievance procedure must be in place to address patient complaints related to the above requirements.

If you have fewer than 15 employees, your active compliance plan and officer sufficiently meet the grievance requirement. Further, per the OCR, small practice practitioners have considerable flexibility in determining precisely how to fulfill their obligations in taking reasonable steps to ensure meaningful access for LEP persons.⁴

Provide training

Based on these requirements, create protocols for accessing and utilizing the resources outlined above for LEP patient encounters. Make contact information and instructions for the translation vendors you choose readily available to staff for efficient patient care (i.e., appointments may need to made with translators in advance). Afterward, train staff on those protocols to ensure compliance.

Stay in the know

HHS has proposed future changes to Section 1557 to reduce the administrative burden on providers. Set aside time each year to do a compliance check on the status of LEP requirements on the OCR website. OP

REFERENCES:

1. Summary: Final Rule Implementing Section 1557 of the Affordable Care Act. U.S. Department of Health & Human Services. https://www.hhs.gov/civil-rights/for-individuals/section-1557/summary-of-final-rule/index.html . Accessed March 30, 2022.
2. Section 1557: Ensuring Meaningful Access for Individuals with Limited English Proficiency. U.S. Department of Health & Human Services. https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf . Accessed March 30, 2022.
3. Jacobs B, Ryan AM, Henrichs KS, Weiss BD. Medical Interpreters in Outpatient Practice. Ann Fam Med. 2018;16(1):70-76.
4. Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons U.S. Department of Health & Human Services. https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-vi/index.html . Accessed March 30, 2022.