It’s a common scene: The care team is ready, but the interpreter is running behind. Rather than waiting or calling an interpreting service, a team member volunteers to interpret. She’s bilingual, she’s interpreted for patients before, and she may even have a good grasp of specialized medical vocabulary. Satisfied, the care team begins to treat the patient, confident that they can communicate without being misunderstood. They trust their co-worker. Good enough, right?
In fact, the above scenario may put the healthcare organization out of compliance with Section 1557 of the Affordable Care Act. The rule took effect on July 18 of this year and requires compliance beginning Oct. 16, 2016. The rule applies to hospitals that receive federal funding, are administered by Health and Human Services (HHS) or participate in health insurance marketplaces – the majority of health care organizations in the U.S.
Section 1557 attempts to improve outcomes for limited-English proficient (LEP) patients by setting specific requirements on who can provide health care interpretation. According to the Agency for Healthcare Research and Quality, LEP and culturally diverse patients experience a disproportionate number of adverse events in health care. These include medication reconciliation errors, inadequate understanding of patient discharge instructions, uninformed consent, emergency department errors, and miscommunication regarding surgical procedures.
Before the Affordable Care Act (ACA) passed in 2010, federal law required health care interpreters to be “competent.” ACA Section 1557 specifically modified that requirement to mandate “qualified” interpreters, making informal interpretation noncompliant. The rule acknowledges that nonqualified individuals like friends, family members and nonqualified staff may lack the interpreting skills and cultural competency to communicate effectively.
Covered institutions must take “reasonable steps to provide meaningful access” to accommodate LEP patients who are served or likely to be served, and must abide by the following requirements:
1. Posting of non-discrimination notices and descriptions of language service availability for the top 15 non-English languages in a state (or area). Translated notices of non-discrimination are available for use by covered entities in a variety of languages on the U.S. Department of Health and Human Services website.
2. Use of qualified interpreters in health care scenarios. This update requires interpreters to meet concrete standards and have documented proof of testing that they are qualified to interpret in a health care setting. Testing standards include:
- Adherence to ethical principles, including confidentiality
- Proficiency in both English and another spoken language
- Ability to accurately and impartially deploy specialized medical terminology and phrasing as necessary
Under this provision, a bilingual adult family member or friend of a patient may only interpret if explicitly requested by the patient. Staff members may not interpret ad-hoc, unless they are documented qualified interpreters and interpretation is a part of their job responsibilities. Minors may only interpret in emergency scenarios when no other interpreter is available.
3. Access to a qualified interpreter for patient’s spouse, family, and/or partner, even if the patient does not require an interpreter.
Institutions that fail to comply with Section 1557 could risk a lawsuit, as the final rule grants patients a private cause of action to sue for discrimination when language services are not provided. However, assessment of compliance is somewhat subjective, depending on the nature of health activity, importance of communication, and implementation of an effective language access plan.
With changing U.S. demographics, Section 1557’s final rule is written to better accommodate the needs of the current and future patient population: Of the nearly 300 million people reached by the U.S. census in 2015, just over 8 percent — 25 million — spoke a language other than English in the home, with Spanish being the most common. According to an advisory by The Joint Commission, half of newly insured people will be minorities and less likely to speak English as a primary language by 2021.
While changes may seem difficult for some institutions, there are a variety of interpretation services available in the health care marketplace that can help providers meet the new regulations, such as CyraCom’s language solutions. CyraCom supports interpretation and translation in more than 200 languages and dialects via phone, app, teleconference and more. Interpreters have 120 hours of training in the competencies required by the final rules in 1557, making compliance one step closer.
For help in understanding Section 1557 and how to achieve compliance, download CyraCom’s white paper, The New Law on Language Access: How Will Section 1557 of the ACA Impact Care for LEP Patients? CyraCom’s Interpretation & Translation Services have earned the exclusive endorsement of the American Hospital Association.
Figure 1. Top 10 LEP languages of U.S. Census participants in 2015, shown by percentage of LEP speakers claiming a language as their primary one. While 350 different languages are spoken at home in the United States, the majority of the U.S. LEP population speaks Spanish.