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Language Service Notices Required

Monday, November 7, 2016   (0 Comments)
Posted by: Rob French
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New Office Notices Required:  Language Services for Patients with Limited English Proficiency 


Most of us understand “nondiscrimination in health care” to refer to Section 2706 of the Affordable Care Act (PPACA), which requires health plans not to discriminate against health care providers.  But did you know the Affordable Care Act (PPACA) also contains a provision that prohibits discrimination against patients?  Section 1557 of the PPACA prohibits health care discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. 

Section 1557 has actually been in effect since the enactment of the PPACA in 2010, and the U.S. Department of Health and Human Services (HHS) Office for Civil Rights has been enforcing patient nondiscrimination since 2010.  However, HHS has now adopted rules to further interpret and enforce section 1557.   Health care providers who are covered by the rule will be required to refrain from all types of discrimination, including discrimination based on national origin.  HHS interprets provision as requiring health care providers to post notices and provide translation assistance to patients with limited English proficiency (LEP).

What Providers are Covered by the Rule?
The rule states that providers, including chiropractic physicians, who receive “federal funding,” must comply with the rule.  “Federal funding” does not include Medicare Part B, but does include receipt of incentive payments for meaningful use of EHR and Medicaid payments. Therefore, any chiropractic physician who received “meaningful use” payments or Medicaid payments must comply with the rule. (This article will refer to such providers as “covered providers.”)

What Steps Must I Take?
Covered providers have new obligations in two major categories – notices and language assistance services:  

  • Notices
    • Providers must post (in their waiting rooms and on their websites) a Notice of Nondiscrimination;
    • Providers must post (in their waiting rooms and on their websites) “taglines” in the top 15 languages spoken in the provider’s state, notifying patients with limited English proficiency of the availability of language assistance services;
    • In any significant marketing communication or publication (e.g., newsletters), providers must include the Notice of Nondiscrimination, together with the tagline in the top 15 languages spoken in the provider’s state; and
    • In any smaller publication issued by the practice (e.g., postcards or fliers), the provider must include a two-line statement regarding nondiscrimination, together with a tagline in the top 2 languages spoken in the provider’s state.
  • Providers must provide language assistance services, the extent of which depends on the size and nature of the practice.

Regarding notices, the HHS Office of Civil Rights has published a model form for the Notice of Nondiscrimination, the taglines and the two line statement for smaller publications at: HHS: Translated Resources for Covered Entities

The OCR website also makes available a list of the top 15 languages spoken in the 50 states at HHS: Estimates of the Top 15 Languages.

The definition and extent of required “language assistance services” is very fact dependent and varies based on the size and type of practice. Covered providers are required to take “reasonable steps” to ensure “meaningful access” to their services by LEP persons.  In some, but not all cases, the provider may need to provide an interpreter.  For a more detailed discussion of how to assess the steps a covered provider should take to provide “meaningful access,” see HHS: Guidance.

As always, the ICS will continue to monitor this rule and will provide updates as the regulation may become clarified through administrative proceedings, case law or additional rule filings.



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