Help Prevent the Roll Back of LEP Healthcare Rights – Comment by August 13th
By Stratus Video President, David Fetterolf
Section 1557 is the nondiscrimination provision of the Affordable Care Act. The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. 1557 applies to any health program or activity of which received funding from the Department of Health and Human Services (HHS) or that HHS itself administers. Current administration recently proposed significant changes to the rule, some of which will greatly impact the provision of language services for limited English proficient (LEP), Deaf and Hard of Hearing (HoH) patients. HHS is accepting comments on the proposed rule through August 13th.
How the Current Rule Protects LEP Patients
Section 1557 is significant for LEP, Deaf and HoH patients, as it requires hospitals to provide meaningful access to healthcare information.
Meaningful access signifies understanding of healthcare information, including any new diagnoses, care plans and discharge instructions: all essential components of quality care delivery and patient outcome.
In regards to language access for LEP patients, Section 1557 requires federally funded healthcare facilities to:
- Publish taglines, in the top 15 languages other than English, and post in prominent locations to notify LEP patients about the availability of no-cost language assistance services.
- Offer a qualified interpreter when oral interpretation is a reasonable step to provide an individual with meaningful access.
- Refrain from using an ad-hoc or untrained interpreter, barring extreme circumstances.
- Provide language services free of charge and in a timely manner.
- Adhere to certain quality standards in delivering language assistance services.
A Quick Overview of the LEP population
There are more than 25 million people living in the United States today who are considered limited English proficient (LEP), according to the Migration Policy Institute. Limited English proficiency refers to anyone above the age of five who reported speaking English less than “very well,” as classified by the U.S. Census Bureau. Though most LEP individuals are immigrants, nearly 19 percent (4.7 million) were born in the United States, most to immigrant parents. The LEP population represents nine percent of the total U.S. population ages five and up.
As a result, hospitals are encountering a significantly higher number of patients in need of language services, even in areas historically known to have minimal language diversity. A national survey conducted by the Health Research & Educational Trust and National Health Law Program revealed over 60 percent of hospitals encounter LEP patients either on a daily or weekly basis.
When a patient does not speak the same language as the healthcare provider, communication is hindered, compromising the provider’s ability to cultivate trust with the LEP patient and the patient’s ability to adhere to care plans. Effective communication is an essential aspect of care. For LEP patients, this requires the use of a qualified medical interpreter.
How the Proposed Rule Will Impact LEP Patients
In addition to requiring the provision of language services for LEP patients, Section 1557 expressly prohibits the use of family members, untrained bilingual staff and other ad-hoc interpreters. Without this requirement in place, patient outcome is at risk.
Research shows a higher number of errors occur resulting in adverse effect when an untrained interpreter is used versus a qualified medical interpreter to facilitate communication with LEP patients. Patient satisfaction has also been shown to rise significantly when a qualified interpreter is used versus a family member or untrained bilingual staff member.
A study conducted by researchers at the University of Toronto found that the length of stay was significantly longer for LEP patients than English speaking patients, in some cases up to six days. In addition to a longer stay, findings at the University of Massachusetts Medical School illustrate LEP patients who are not provided with a professional medical interpreter at check-in and discharge are also at higher risk of readmission.
The proposed rule appeals Section 1557 provisions on taglines, the use of language access plans, and notices of non-discrimination. Without signage in place, it will be more difficult for LEP patients to express their need for language services and for providers to identify the patient’s language preference.
The proposed rule also proposes the replacement of VRI technical requirements, “with comparably effective requirements with respect to audio-based services”. Current requirements ensure VRI is compatible with The Americans with Disabilities Act and Rehabilitation Act of 1973, both of which require hospitals and medical providers to ensure effective communication with people who are Deaf or HoH. The National Association of the Deaf (NAD) has also established stringent minimum technical requirements for VRI. Any changes to VRI technical requirements by the current administration in Section 1557 could potentially impact the utilization of VRI services by Deaf and HoH patients as well as the NAD’s position on the use of such services.
How to Comment
HHS is accepting comments on the proposed rule through August 13th. The proposed rule states HHS will review comments submitted by any of the following methods:
- Federal eRulemaking Portal: Visit http://www.regulations.gov & search for the Docket ID number HHS-OCR-2019-0007. Instructions for this method also found here: http://www.regulations.gov
- Regular, Express, or Overnight Mail: Mail comments to U.S. Department of Health and Human Services, Office for Civil Rights, Attention: Section 1557 NPRM, RIN 0945-AA11, Hubert H. Humphrey Building, Room 509F, 200 Independence Avenue SW, Washington, DC 20201.
- Hand Delivery/Courier: Comments can be hand delivered to the U.S. Department of Health and Human Services, Office for Civil Rights, Attention: Section 1557 NPRM, RIN 0945-AA11, Hubert H. Humphrey Building, Room 509F, 200 Independence Avenue SW, Washington, DC 20201.
We urge everyone to comment in order to help preserve limited English proficiency rights.
Stratus Video is a language services company that is changing the way limited English proficiency patients communicate with their healthcare providers. Learn more about our interpreter qualifications and commitment to improving care for LEP patients here.