Health Care Services

There are many resources below describing the obligations of health care facilities and the importance of language services and assuring cultural competency when providing health services. Click Here

Federal Health Protections                                                    

In January 1998, the Department of Health of Human Services (HHS) Office of Civil Rights (OCR) issued a memorandum entitled "Title VI Prohibition Against National Origin Discrimination, Persons with Limited-English Proficiency" to ensure consistent application of Title VI of the Civil Rights Act of 1964 to health and social services programs funded by HHS.

"The import of the memorandum is that it addresses language assistance that may be required for effective communication between health and social service providers and persons of Limited English Proficiency (LEP)." A copy of the memorandum is available here.

HHS federal regulations, 45 CFR 80.3(b)(2), also requires all recipients of federal financial assistance from HHS to provide meaningful access to LEP persons. Federal financial assistance includes grants, training, use of equipment, donations of surplus property, and other assistance. Recipients of HHS assistance may include, for example:

• Hospitals, nursing homes, home health agencies, and managed care organizations.
• Universities and other entities with health or social service research programs.
• State, county, and local health agencies.
• State Medicaid agencies.
• State, county and local welfare agencies.
• Programs for families, youth, and children.
• Head Start programs.
• Public and private contractors, subcontractors and vendors.
• Physicians and other providers who receive Federal financial assistance

The 2000 HHS LEP Guidance describes the obligations of programs that receive Federal financial assistance to provide language assistance services to LEP individuals. HHS issued their most recent LEP Guidance in 2003.  The Guidance discusses the use of interpreters, and determining qualified interpreters in health care settings. A copy of the HHS LEP Guidance is available here and the resources below.

Several interpreter guides for hospitals and patients are also provided below. HHS also has a procedure for individuals to submit a discrimination complaint. The HHS discrimination complaint forms are provided in the resources below.

New York State Department of Health Requirements             4

The New York State Department of Health (DOH) has implemented a new regulation in September 2006 that sets standards for hospitals' communication with limited-English-proficient individuals (LEP). A memo on the comparison of the new and old regulation can be found here and in the resources below.

This regulation makes it clear that every limited-English-proficient patient has a right to meaningful access to a hospital's services; requires every hospital to develop a language assistance program and designate a language assistance coordinator; requires hospitals to identify and document each patient's language of preference and the acceptance or refusal of language assistance services; sets clear limits on the use of friends, strangers, and family members as interpreters, including age restrictions; and so forth. A copy of the the new regulation can be found here and in the resources below

Federal Resources                                                                            

• HHS LEP Guidance
• HHS LEP Page
• HHS LEP Fact Sheet
• HHS Discrimination Complaint Form
• HHS Discrimination Complaint Form (Spanish)
• HHS OCR LEP Complaints and Compliance Reviews
• HHS Office of Civil Rights Found National Origin Discrimination by HRA, Nassau and Suffolk Counties
• HHS Regional Office Notice of Personal Information
• HHS Office of Civil Rights
• 4th Circuit Federal Court Discussion of the HHS Requirements
• HHS Settlement on LEP Issues in Pennsylvania
• HHS Office of Minority Health Standards for Cultural and Linguistic Competency, 2001 Final Report (Large PDF)

State Resources                                                                                 

• NY DOH Regulation on Interpreter Access Effective September 13, 2006 (Word Format) PDF Version
• NY DOH Press Release on 2006 Regulation
• Attorney General Resolution Agreements with New York Hospitals to Provide interpreters to LEP patients:
  • St. Luke Hospital in Utica, New York
  • St. Elizabeth Hospital in Utica, New York
• Latino Health Resource Directory, Monroe County Latino Alliance (Large PDF Document)

Other Resources                                                                                 

Obligation to Provide Language Services in Health Care Settings

• Language Access and the Law, LEP and Deaf and Hard of Hearing Individuals, The Joint Commission, January 2008 (PDF)
• The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond, Chen et al, JGIM, 2007 (PDF)
• Official Guide to LEP Patient Care, AMA, 2008 (PDF)
• Language Access Responsibilities under the Civil Rights Act and HHS, The Health Consumer Alliance, 2004 (PDF)
• Limited English Proficiency (LEP) Regulations: Implications and Guidance for U.S. Hospitals Serving Minority Populations, Habalmaos Juntos (PDF)
• Ensuring Linguistic Access in Health Care Settings: An Overview of Current Legal Rights and Responsibilities, 2003 Kaiser Foundation (Large PDF)
• A Health Interpreters Guide, National Council on Interpreting in Health Care, 2005 (PDF)

Language Services and Cultural Competency

• Language Understanding the Barriers and Challenges in Primary Care Settings, ACU and NHeLP, May 2008 (PDF)
• Patients Center Guide to Language Access in Health Care,  Office of Minority Health of HHS (Large PDF)
• Language Services Action Kit: Interpreter Services in Hospital Settings for People with LEP, Access Project & National Health Law Program 2004 (Large PDF)
• Interpreter Services in Health Care Settings for LEP Patients, National Health Law Program, 2004 (Large PDF)
• Models for the Provision of Language Access in Health Care Settings, The National Council on Interpreting in Health Care March 2002 (PDF)
• Language Services Resource Guide for Health Care Providers, National Health Law Program 2006 (Large PDF)
• Cultural and Linguistic Access to Health Care, National Health Law Program (PDF)
• Cultural & Linguistics Studies & Reports on Health Care, California Pan-Ethnic Health Network
• Cultural Competence Works: Using Cultural Competence to Improve the Quality of Health Care for Diverse Populations and Add Value to Managed Care Arrangements, 2001 HHS
• Communication and Culture: Strategies to Improve and Assess Hospital Care for Latino Children From LEP Homes, The Child and Adolescent Health Measurement Initiative, 2005 (PDF)

Other LEP Health Studies and Reports

• The Language Spoken at Home and Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children, Glenn Flores M.D., Pediatrics, 2008 (PDF)

• Medicare Prescription Drug Plans Fail Limited English Proficient Beneficiaries, The National Senior Citizens Law Center, 2007 (PDF)

• Language Barriers to Health Care in the United States, Glenn Flores M.D., 2006, New England Journal of Medicine (Web)

• Hospital Language Services for Patients with LEP: Results from a National Survey, National Health Law Program, 2006 (Large PDF)
• What a Difference an Interpreter Can Make, The Access Project 2002 (PDF)
• Hablamos Juntos: Literature, Reports and Data
• The Truth About Language Barriers: One Residency Program’s Experience, Pediatrics September 2006
• Cultural Effectiveness and Health Disparities, American Academy of Pediatrics

Last Updated: March 17, 2009 ● Empire Justice Center © 2009