Language Resources

Language Needs Assessments of Virginia's Health Districts

WHAT IS REQUIRED OF HEALTH CARE PROVIDERS BY LAW?

Title VI of the Civil Rights Act of 1964 prohibits recipients of federal funds from discriminating against individuals on the basis of race, color, or national origin. The courts have applied this statute to protect national origin minorities who are Limited English Proficient (LEP).

Executive Order 13166 issued on August 11, 2000, requires every federal agency that provides financial assistance to non-federal entities to publish guidance on how their recipients can provide meaningful access to LEP persons and thus comply with Title VI regulations.

Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons

• Requires all recipients of federal financial assistance (including grants, loans and reimbursements like Medicaid and Medicare) to take reasonable steps to provide meaningful access to LEP persons, and at no additional cost to the patient. The Guidance explains that the obligation to provide meaningful access is fact-dependent and starts with an individualized assessment that balances four factors:
• (1) the number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee;
• (2) the frequency with which LEP individuals come into contact with the program;
• (3) the nature and importance of the program, activity or service provided by the recipient to its beneficiaries; and
• (4) the resources available to the grantee/recipient and the costs of interpretation/translation services.
• There is no "one size fits all" solution for Title VI compliance with respect to LEP persons, and what constitutes "reasonable steps" for large providers may not be reasonable where small providers are concerned. However, the Guidance states specifically that recipients cannot require LEP persons to bring their own interpreters or use family members or friends as interpreters.
• Identifies the following as “safe harbors” for compliance with meaningful access to translated written documents. The following actions will be considered as “strong evidence” that an agency/organization has complied with its written translation requirements:
• Written translations of vital documents are provided for each eligible LEP language group that constitutes 5% or 1,000, whichever is less, of the population of persons eligible to be served or likely to be affected or encountered. Oral translation of other non-vital documents is permitted.
• If there are fewer than 50 persons in a language group that reaches the 5% trigger, the practice may, as an alternative to translating vital written materials, provide written notice in the primary language of the LEP language group of the right to receive competent oral interpretation of the written materials without cost.

Vital documents could include:

• consent and complaint forms
• notices advising LEP persons of free language assistance
• intake forms with potential for important health consequences
• written tests that do not assess English language competency, but test competency for a particular license, job or skill for which knowing English is not required
• written notices of eligibility criteria, rights, denial, loss, or decreases in benefits or services
• applications to participate in a recipient's program or activity or to receive recipient benefits or services.
• actions affecting parental custody or child support, and other hearings

National Standards for Culturally and Linguistically Appropriate Services in Health Care
Additionally, the DHHS Office of Minority Health (OMH) issued National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care in December 2000. There are 14 standards. Four of the standards relate to language access services and are mandated for recipients of federal funds. These include:

Standard 4: Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact in a timely manner during all hours of operation.

Standard 5: Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

Standard 6: Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (unless requested by the patient/consumer).

Standard 7: Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered group and/or groups represented in the service area.

Legal requirements notwithstanding, health care quality research* shows that providing meaningful language access can and does:

• Improve health outcomes
• Increase patient compliance
• Be more cost effective
• Increase patient satisfaction
• Increase access to health care

*Supporting research can be found at CLAS-Act Virginia