The Affordable Care Act and Mandatory Language Services for Patients

Language barriers in health care significantly affect quality of care, patient safety, and overall health outcomes. When patients and providers do not share a common language, critical information about symptoms, medical history, and treatment plans can be misunderstood or inadequately conveyed, leading to misdiagnosis and inappropriate treatments. These communication challenges also affect patients’ ability to provide informed consent and adhere to treatment regimens, resulting in poorer health outcomes. Furthermore, language barriers can create feelings of alienation and distrust, hindering the patient-provider relationship and reducing patient satisfaction.

On July 25, 2022, the Department of Health and Human Services (HHS) issued a new proposed rule to significantly revise the agency’s prior interpretation of Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, national origin, sex, age, and disability in certain health programs and activities.¹ The final rule requires recipients of federal financial assistance, HHS-administered health programs and activities, and state and federally facilitated exchanges to inform patients that language assistance services and auxiliary aids are available free of cost if needed. The notice must be provided in English and in at least the 15 most common languages spoken by individuals with limited English proficiency (LEP) in the state(s) served.² Covered entities are required to provide these notices in prominent locations both physically and on their websites, make them available upon request, and include them with a specific list of communications.³ This ensures that language barriers do not impede access to medical care and that all patients can understand and participate in their health care decisions.

Under Section 1557, health care providers and organizations that receive federal funding must provide free language services, such as interpreters and translated materials, to individuals with LEP.⁴ This includes offering qualified interpreters for oral communication and translating vital documents, such as consent forms and discharge instructions, into the primary languages of commonly encountered populations with LEP. A covered entity must publish taglines, which are short statements in non-English languages, in significant publications and post in prominent locations and on its website to notify individuals about the availability of language assistance services.⁴ These measures are crucial for ensuring effective communication, improving patient outcomes, and upholding the rights of all patients to receive equitable and competent health care services.

A covered entity must comply with specific quality standards when providing language assistance services. It cannot require individuals to provide their own interpreter, rely on an individual younger than 18 years to interpret except in life-threatening emergencies, depend on the individual’s preferred interpreter if there are competency or confidentiality issues, use unqualified bilingual staff, or employ low-quality video remote interpreting services.⁴

In conclusion, language barriers in health care pose significant challenges that affect patient safety, quality of care, and overall health outcomes. The revisions to Section 1557 of the ACA proposed by HHS aim to address these challenges by requiring health care providers to offer language assistance services to individuals with LEP. By complying with these standards and providing free language services, including qualified interpreters and translated materials, pharmacies and other health care entities can ensure effective communication, improve patient outcomes, and uphold the rights of all patients to receive equitable and competent services.

REFERENCES

1. Keith K. HHS proposes revised ACA anti-discrimination rule. Health Affairs. July 27, 2022. Accessed August 1, 2024. https://www.healthaffairs.org/content/forefront/hhs-proposes-revised-aca-anti-discrimination-rule

2. Section 1557 final rule: frequently asked questions. US Department of Health and Human Services. Updated May 20, 2024. Accessed August 1, 2024. https://www.hhs.gov/civil-rights/for-individuals/section-1557/faqs/index.html

3. Strengthening nondiscrimination protections and advancing civil rights in health care through Section 1557 of the Affordable Care Act: fact sheet. US Department of Health and Human Services. Updated April 26, 2024. Accessed August 1, 2024. https://www.hhs.gov/civil-rights/for-individuals/section-1557/1557-fact-sheet/index.html

4. Section 1557 of the Affordable Care Act: A Civil Rights Training for Health Providers and Employees of Health Programs and Health Insurance Issuers. US Department of Health and Human Services. July 2016. Accessed August 1, 2024. https://www.hhs.gov/sites/default/files/section1557-training-slides.pdf