With the Senate regrouping to vote on repealing and replacing the Affordable Care Act (ACA), many aspects of US healthcare policy remain undecided. But Section 1557 and its language access requirements for providers treating limited-English proficient (LEP) patients seem certain to survive the vote.
The Human Rights Campaign recently reported that “the current versions of the House and Senate repeal bills would not roll back the Section 1557 protections.” Harvard Law School’s Center for Health Law & Policy Innovation also noted in a recent white paper that the reconciliation process Congress is using to review the ACA “can only be used for proposals relating to: 1) taxes and revenues, 2) spending, and 3) the federal debt limit” – categories that do not encompass Section 1557.
Finally, a recent Atlantic profile of Roger Severino, the Trump administration’s newly-appointed head of Health and Human Services (HHS) Office for Civil Rights, suggests that his personal history might drive him to defend Section 1557’s language access mandates from future legal challenges:
“Severino often translated for his mom in medical settings…once, when he wasn’t there, she misunderstood a diagnosis and incorrectly believed she was in serious danger because of a translation issue.
While Severino wouldn’t comment on whether this would continue being a priority under his leadership at OCR, ‘having seen the trauma that that caused my own family,’ he said, ‘I’m highly sensitive to the issue of language access for people who are limited English proficient.’”
Though the Senate has yet to put a final bill up for a vote, it appears Section 1557 will remain the law when treating LEP patients for the foreseeable future.
Five Key 1557 Requirements Hospitals and Healthcare Organizations Need to Know1. Section 1557 Covers Most Providers and Carries Specific Posting Mandates
HHS’s July 2016 ruling on Section 1557 explained that the new law applies to healthcare organizations and programs that:
- Receive federal funding (such as hospitals or doctors that accept Medicare/Medicaid). Excludes Medicare Part B.
- Are administered by the HHS itself (such as Medicare Part D).
- Participate in Health Insurance Marketplaces.
1557 requires covered providers to post a notice of nondiscrimination and taglines (short statements advising language services are available) in the state’s/hospital’s top 15 languages.
Find your top 15 languages by downloading Health and Human Services’ PDF. Then download HHS’s free translated taglines, available in 64 languages. CyraCom clients can contact their account manager or client services for access to customizable language notification posters with more than 100 languages and translations available.
2. Section 1557 Requires Staff to be Qualified Before Interpreting for Patients
Under 1557, bilingual staff must have interpreting listed as part of “the individual’s current, assigned job responsibilities” in order to act as interpreters. Staff members must also have demonstrated that they are:
- “Proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology.”
- “Able to effectively, accurately, and impartially communicate directly with individuals with limited-English proficiency in their primary languages.”
Demonstrating these skills may require interpreter training, testing, or certification. CyraCom offers staff testing and training for staff interpreters, as well as bilingual doctors and nurses who wish to interpret. We test both language proficiency and interpreter skills.
3. Section 1557 Prohibits Using the Patient’s Family or Friends as Interpreters
Family may seem like a convenient alternative to professional interpretation, but their emotional involvement and lack of formal interpreter training and certification may impact accuracy.
Section 1557 prohibits the use of:
- A patient’s minor children (except in emergencies to prevent imminent patient harm).
- Adult family and friends (unless the patient refuses an interpreter – provider may still utilize an interpreter if they determine the family member/friend cannot interpret adequately).
4. Section 1557 Sets Specific Quality Standards for Remote Interpretation Options
HHS’s ruling supports using qualified phone and video interpreters to help providers deliver timely language access to their LEP patients.
The ruling also establishes quality standards for video interpretation, linking it to standards set for ASL interpretation by the Americans with Disabilities Act, including:
- “Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication.
- A sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of his or her body position.
- A clear, audible transmission of voices.
- Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI.”
CyraCom’s unified phone and video interpretation solutions comply with all Section 1557 requirements.
5. Section 1557 Empowers Patients to Sue for Discrimination if Denied Language Access
Section 1557 enables LEP patients to claim disparate impact – that a provider’s failure to offer language access discriminates against non-English speakers on the basis of national origin. Under the new law, patients can file lawsuits against providers who do not “take reasonable steps to provide meaningful access.”
These provisions add to the enforcement mechanisms found in Title VI of the Civil Rights Act, which allow fines and Medicare/Medicaid cuts for non-compliant hospitals but do not enable individual patients to sue for discrimination. Staff should understand the potential consequences of noncompliance and be well-trained in accessing an interpreter quickly and efficiently.