The U.S. Department of Health and Human Services issued written policy guidance to assist health and social services providers in ensuring that persons with limited English skills can effectively access critical health and social services.
The guidance, published in the Federal Register by the HHS Office for Civil Rights (OCR), lays out and explains more fully OCR's existing policies. It outlines the legal responsibilities of providers who receive federal financial assistance from HHS -- such as hospitals, HMOs and human service agencies -- to assist people with limited English skills. It also provides a flexible road map to the range of options available to providers in meeting the language needs of the nation's increasingly diverse populations.
Publication of the guidance makes HHS the first federal agency to publish guidance since the issuance of Executive Order 13166 on serving persons with limited English skills, signed by President Clinton on Aug. 11, 2000. The executive order requires each federal agency to have written policies on providing effective service to those with limited English proficiency who are served by federally funded programs.
Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, or national origin by any entity that receives federal financial assistance. Under that law, hospitals, HMOs, social service agencies and other entities that receive federal financial assistance from HHS are required to take the steps necessary to ensure that individuals with limited English proficiency (LEP) can meaningfully access the programs and services. The requirements apply to state-administered as well as private and non-profit facilities and programs that benefit from HHS assistance. OCR is responsible for compliance with the law as it applies to HHS funded programs.
In a letter to governors announcing publication of the written guidance, HHS Secretary
Donna E. Shalala said, "This guidance enhances our ability to reach our national goal of eliminating racial and ethnic disparities in health, and will assist in increasing opportunities for persons with limited English proficiency to improve their socioeconomic status."
Some of the state-administered programs where access for persons with limited English proficiency may be especially important include the State Children's Health Insurance Program (SCHIP), Medicaid and Temporary Assistance to Needy Families (TANF).
"Effective communication is the key to meaningful access, whether it is a hospital, a clinic or a benefits program," said OCR Director Thomas Perez. "Failure to communicate effectively can have serious consequences for millions of Americans."
The guidance emphasizes that providers have flexibility in designing effective programs. The types of language assistance a provider must have in place to ensure meaningful access depend on a variety of factors, including the size of the facility or covered entity, the size of the eligible LEP population it serves, the nature of the program or service, the objective of the program, the resources available to the facility or covered entity, and the frequency with which LEP persons come into contact with the program. Small practitioners and providers have considerable flexibility in determining how to fulfill their obligations to ensure meaningful access for persons with limited English proficiency.
"OCR has a history of working cooperatively with health and social services providers to help them comply with the law and serve their limited English populations effectively without causing undue burden," said Perez. "We have found widespread willingness to improve language access services, especially when providers learn that solutions can be tailored to fit individual situations, and services can be provided cost-effectively."
"With our requirements and flexible policies now in writing, we expect to make even greater progress in cooperation with health and social service providers in making services truly accessible to those with limited English skills. OCR will continue to be available to provide technical assistance to any covered entity seeking to ensure the operation of an effective language assistance program," Perez said.
Depending on the need and the circumstances of the individual facility, options for providing oral language assistance range from hiring bilingual staff or hiring on-staff interpreters to contracting for interpreter services as needed, engaging community volunteers, or contracting with a telephone interpreter service.
Examples of problem practices that have been found by OCR include: providing services to LEP persons which are more limited in scope or lower in quality than those provided to other persons; subjecting LEP persons to unreasonable delays; limiting participation in a program or activity on the basis of English proficiency; providing services to LEP persons that are not as effective as those provided to persons proficient in English; and failing to inform LEP persons of the right to receive free interpreter services or requiring them to provide their own interpreter.
As outlined in the guidance, satisfactory service to LEP clients should include:
'The purpose of putting these policies into writing is to help make the requirements of the law both clear and widely-known, among providers and potential LEP clients as well," Perez said. "We believe that by making these policies known, and making clear the flexibility we provide on a facility-by-facility basis, providers will be more likely to review and improve their language assistance services, and individuals with limited English skills will be better able to access the services they need."
- having polices and procedures in place for identifying and assessing the language needs of the individual provider and its client population;
- a range of oral language assistance options, appropriate to each facility's circumstances;
- notice to LEP persons of the right to free language assistance;
- staff training and program monitoring; and
- a plan for providing written materials in languages other than English where a significant number or percentage of the affected population needs services or information in a language other than English to communicate effectively.
The written guidance, "Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency," is available in the Federal Register, through OCR's 10 regional offices, or on the Internet at http://www.hhs.gov/ocr.