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**The material herein on ACA Section 1557 compliance is educational and informational only. No legal advice is provided.**

New regulation continues to increase the importance of hospital language services. CMS’s rollout of their five-star rating results highlighted how language access may impact patient satisfaction and readmission rates. Now, the final section of the Affordable Care Act has added a new layer of complexity to language services, increasing the requirements for healthcare interpreters and giving LEP patients new rights.

 So, whether or not they have a great language services program or are just getting started, CyraCom believes providers need to be aware of the new rules and regulations:


Section 1557 of the ACA tightens qualifications for both on-site and remote interpreters in healthcare. The ruling also contains some specific prohibitions regarding who may not interpret in medical scenarios. Providers seeking to achieve 1557 compliance will ensure that their LEP patients do not receive interpretation from:

A Patient’s Minor Children

HHS specifically states that a patient’s minor children may not act as interpreters during care, except in an emergency scenario where “an imminent threat to the safety or welfare of an individual or the public where no qualified interpreter is immediately available.”

Hospitals with leading language services programs have long avoided this practice. While children who attend appointments with their patient parents may seem a convenient source of interpretation, they lack the training (and, depending on age, vocabulary and articulation) to accurately convey a message to their parent’s doctor and back. Leading providers also consider it unfair and potentially damaging to ask children to pass along a loved one’s medical information, particularly when the message contains news like a difficult diagnosis.

Family and Friends Attending the Appointment

The rule also prohibits adult family and friends from interpreting except in emergencies or when an LEP patient “specifically requests that the accompanying adult interpret or facilitate communication and the accompanying adult agrees to provide such assistance.” In this case, providers must still use a qualified interpreter as needed to ensure clear communication.

Medical facilities may not require LEP patients to bring someone with them to interpret or assume that an English-speaking friend or partner is there for that purpose. Conversely, the medical provider is not absolved of the duty to use an interpreter simply because their LEP patient insists on using adult friends and family instead. Doctors and nurses are responsible for ensuring they understand the patient, and they’re required to use the resources needed to do so.

 A Hospital’s Own Bilingual Staff

HHS draws a distinction between “qualified bilingual/multilingual staff” and untrained bilingual/ multilingual staff, explaining that to act as an interpreter, a staff member must have demonstrated that he or she is proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology, and:

1. is proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology, andis

2. is able to effectively, accurately, and impartially communicate directly with individuals with limited English proficiency in their primary languages.

1557 also mandates that healthcare staff who will provide interpretation must be “designated by the covered entity to provide oral language assistance as part of the individual’s current, assigned job responsibilities.”

Now that you understand who shouldn’t interpret in healthcare for Section 1557 Compliance, DOWNLOAD OUR GUIDE to learn more about making sure your organization is in compliance with the new law.

Section 1557 Guide Compliance


Graham Newnum

Graham Newnum

Digital Marketing Specialist experienced in researching and writing about language access-related topics for healthcare, business, and government.