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The Legal History Of Language Access Services

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There’s no federal oversight to make sure healthcare organizations implement interpretation services, even though it’s required. Researcher Melody Schiaffino graded hospitals on how well they’re doing.";s:3:

Hospitals and clinics are federally required to provide language assistance services for individuals who speak or understand limited English. However, a study on health disparities found that nearly one-third of hospitals in the country do not provide interpretation services. Our bilingual reporter Jazmin Orozco-Rodriguez helps us understand these laws and what they mean for individuals.

The legal foundation for language access, which lies in Title VI of the Civil Rights Act of 1964, established that federally-funded institutions, like hospitals, couldn’t discriminate based on race or national origin. In 2000, President Clinton signed an Executive Order that specifically focused on improving access to services for individuals who struggle to understand or speak English. The purpose was to ensure that these individuals would have access to federally-funded services, programs, and activities.

A provision was also added to the Affordable Care Act that clearly outlined expectations for institutions. It requires notices to be posted to inform individuals about their rights to language assistance services. Right now, the Department of Health and Human Services is proposing a revision to that requirement because it says that the cost of mailing out the notices is too high and that the notices have not reached the right people.

The ACA also prohibits healthcare organizations from relying on low-quality video or telephone interpretation services along with unqualified staff or translators to interpret. Additionally, it requires entities to develop a language access plan to ensure that they can provide meaningful language access to people who would need it.

The entities specifically addressed by the law are any health program or activity that receives funding from the Department of Health and Human Services. This includes hospitals, clinics, and doctors that accept health insurance, the Health Insurance Marketplaces and its participating issuers, and finally, any program administered by the HHS.

Individuals who need these services and do not receive them can file a complaint with the Office of Civil Rights within the Health and Human Services Department. There is limited federal oversight and hospitals are required to hold themselves accountable.

Researcher and Assistant Professor Melody Schiaffino from San Diego State University studies disparities in how healthcare is delivered. She conducted a study in which she researched how well hospitals are doing.

“That really was my emphasis, to look at this and see exactly how good of a job hospitals were doing policing themselves. They get about a C-. They're up to a C, I guess,"  Schiaffino said.

A big takeaway from the study is that there are areas in the country with language needs and no hospitals that offer those services.

The law is an unfunded mandate. Hospitals or healthcare organizations do not receive any funding or reimbursement from the government to provide language access services.

While it costs organizations money to fund language services, it could also be more expensive not to provide them.

Schiaffino explained that treating a patient with a limited proficiency in English leads to these individuals being subjected to more invasive diagnostic procedures and more procedures in general, increasing the cost of care for both the hospital and the patient. There’s also the risk of costly lawsuits.

This story was produced in partnership with Noticiero Móvil, a bilingual multimedia outlet run by the Reynolds School of Journalism.

Jazmin Orozco Rodriguez is a reporter for KHN’s rural health desk based in Elko, Nevada.
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