Sec. 207. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs

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Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Centers for Medicare & Medicaid Services and in consultation with the Center for Medicare and Medicaid Innovation, shall establish a demonstration program under which the Secretary shall award grants to eligible Medicare service providers to improve communication between such providers and Medicare beneficiaries who are English learners, including beneficiaries who live in diverse and underserved communities. The demonstration project under subparagraph

(A)shall be conducted in a manner that is consistent with the applicable provisions of subsections (b), (c), and

(d)of section 1115A of the Social Security Act ( 42 U.S.C. 1315a ). To the extent practicable, the Secretary shall award not less than 24 grants under this subsection. Except as provided under paragraph (2)(D) , each grant awarded under this subsection shall be for a 3-year period. To be eligible for a grant under this subsection, an entity must meet the following requirements: The entity must be— a provider of services under part A of title XVIII of the Social Security Act; a provider of services under part B of such title; a Medicare Advantage organization offering a Medicare Advantage plan under part C of such title; or a PDP sponsor offering a prescription drug plan under part D of such title. The entity must serve a community that, with respect to necessary language services for improving access and utilization of health care among English learners, is disproportionally underserved. The entity must prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require. In the case of a grantee that received a grant under this subsection in a previous year, such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph

(9)for such year. If a grantee fails to meet the requirement of such paragraph for the first year of a grant, the Secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program. To the extent feasible, the Secretary shall award— at least 6 grants to providers of services described in paragraph (2)(A)(i) ; at least 6 grants to service providers described in paragraph (2)(A)(ii) ; at least 6 grants to organizations described in paragraph (2)(A)(iii) ; and at least 6 grants to sponsors described in paragraph (2)(A)(iv) . In awarding grants under this subsection, the Secretary shall select grantees to ensure the following: The grantees provide many different types of language services. The grantees serve Medicare beneficiaries who speak different languages, and who, as a population, have differing needs for language services. The grantees serve Medicare beneficiaries in both urban and rural settings. The grantees serve Medicare beneficiaries in at least two geographic regions, as defined by the Secretary. The grantees serve Medicare beneficiaries in at least two large metropolitan statistical areas with racial, ethnic, sexual, gender, disability, and economically diverse populations. In awarding grants under this subsection, the Secretary shall give priority to eligible entities that have a partnership with— a community organization; or a consortia of community organizations, State agencies, and local agencies, that has experience in providing language services. Subject to subparagraph

(E), a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to Medicare beneficiaries who are English learners. For purposes of this subsection, the term competent language services means— interpreter and translation services that— subject to the exceptions under subparagraph

(C)— if the grantee operates in a State that has statewide health care interpreter standards, meet the State standards currently in effect; or if the grantee operates in a State that does not have statewide health care interpreter standards, utilizes competent interpreters who follow the National Council on Interpreting in Health Care’s Code of Ethics and Standards of Practice; and that, in the case of interpreter services, are provided through— onsite interpretation; telephonic interpretation; or video interpretation; and the direct provision of health care or health-care-related services by a competent bilingual health care provider. The requirements of subparagraph (B)(i)(I) do not apply, with respect to interpreter and translation services and a grantee— in the case of a Medicare beneficiary who is an English learner if— such beneficiary has been informed, in the beneficiary’s primary language, of the availability of free interpreter and translation services and the beneficiary instead requests that a family member, friend, or other person provide such services; and the grantee documents such request in the beneficiary’s medical record; or in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient. Clause

(ii)shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to patients who are English learners from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay. If a grantee is a Medicare Advantage organization offering a Medicare Advantage plan under part C of title XVIII of the Social Security Act or a PDP sponsor offering a prescription drug plan under part D of such title, such entity must provide at least 50 percent of the grant funds that the entity receives under this subsection directly to the entity’s network providers (including all health providers and pharmacists) for the purpose of providing support for such providers to provide competent language services to Medicare beneficiaries who are English learners. A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph

(9). Payments to grantees under this subsection shall be calculated based on the estimated numbers of Medicare beneficiaries who are English learners in a grantee’s service area utilizing— data on the numbers of English learners who speak English less than very well from the most recently available data from the Bureau of the Census or other State-based study the Secretary determines likely to yield accurate data regarding the number of such individuals in such service area; or data provided by the grantee, if the grantee routinely collects data on the primary language of the Medicare beneficiaries that the grantee serves and the Secretary determines that the data is accurate and shows a greater number of English learners than would be estimated using the data under clause

(i). Subject to subparagraph

(C), the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the Secretary, based on changes in the data under subparagraph

(A)with respect to the service area of a grantee for the year. The amount of a grant made under this subsection to a grantee may not exceed $500,000 for the period under paragraph (1)(D) . Grantees under this subsection shall, as a condition of receiving a grant under this subsection— ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery; ensure the linguistic competence of bilingual providers; offer and provide appropriate language services at no additional charge to each patient who is an English learner for all points of contact between the patient and the grantee, in a timely manner during all hours of operation; notify Medicare beneficiaries of their right to receive language services in their primary language; post signage in the primary languages commonly used by the patient population in the service area of the organization; and ensure that— primary language data are collected for recipients of language services and such data are consistent with standards developed under title XXXIV of the Public Health Service Act, as added by section 202 of this Act, to the extent such standards are available upon the initiation of the demonstration program; and consistent with the privacy protections provided under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. 1320d–2 note), if the recipient of language services is a minor or is incapacitated, primary language data are collected on the parent or legal guardian of such recipient. Medicare beneficiaries who are English learners shall not have to pay cost sharing or co-payments for competent language services provided under this demonstration program. Not later than the end of each calendar year, a grantee that receives funds under this subsection in such year shall submit to the Secretary a report that includes the following information: The number of Medicare beneficiaries to whom competent language services are provided. The primary languages of those Medicare beneficiaries. The types of language services provided to such beneficiaries. Whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies. The types of interpretation services provided to such beneficiaries, and the approximate length of time such service is provided to such beneficiaries. The costs of providing competent language services. An account of the training or accreditation of bilingual staff, interpreters, and translators providing services funded by the grant under this subsection. Not later than 1 year after the completion of a 3-year grant under this subsection, the Secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the Congress a report that includes the following: An analysis of the patient outcomes and the costs of furnishing care to the Medicare beneficiaries who are English learners participating in the project as compared to such outcomes and costs for such Medicare beneficiaries not participating, based on the data provided under paragraph

(9)and any other information available to the Secretary. The effect of delivering language services on— Medicare beneficiary access to care and utilization of services; the efficiency and cost effectiveness of health care delivery; patient satisfaction; health outcomes; and the provision of culturally appropriate services provided to such beneficiaries. The extent to which bilingual staff, interpreters, and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider, service, or other category as determined by the Secretary to ensure the provision of high-quality interpretation, translation, or other language services to Medicare beneficiaries if such services are expanded pursuant to section 1115A(c) of the Social Security Act ( 42 U.S.C. 1315a(c) ). Recommendations, if any, regarding the extension of such project to the entire Medicare Program, subject to the provisions of such section 1115A(c). There is appropriated to carry out this subsection, in equal parts from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act ( 42 U.S.C. 1395i ) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act ( 42 U.S.C. 1395t ), $16,000,000 for each fiscal year of the demonstration program. In this subsection, the term English learner has the meaning given such term in section 8101(20) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and

(D)of such section shall not apply. Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (aa)(1)— in subparagraph (B), by striking and at the end; by adding and at the end of subparagraph (C); and by inserting after subparagraph

(C)the following new subparagraph: language assistance services as defined in subsection (jjj)(1), ; and by adding at the end the following new subsection: The term language assistance services means language access or language assistance services (as those terms are defined in section 3400 of the Public Health Service Act) furnished by a qualified interpreter for an individual with limited-English proficiency or a qualified translator (as those terms are defined in such section 3400) to an individual with limited English proficiency (as defined in such section 3400) or an English learner (as defined in paragraph (2)). The term English learner has the meaning given that term in section 8101(20) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and

(D)of such section shall not apply. . Section 1832(a)(2) of the Social Security Act ( 42 U.S.C. 1395k(a)(2) ) is amended— by striking and at the end of subparagraph (I); by striking the period at the end of subparagraph

(J)and inserting ; and ; and by adding at the end the following new subparagraph: language assistance services (as defined in section 1861(jjj)(1)). . Section 1833(a) of the Social Security Act ( 42 U.S.C. 1395l(a) ) is amended— by striking and at the end of paragraph (8); by striking the period at the end of paragraph

(9)and inserting ; and ; and by inserting after paragraph

(9)the following new paragraph: in the case of language assistance services (as defined in section 1861(jjj)(1)), 100 percent of the reasonable charges for such services, as determined in consultation with the Medicare Payment Advisory Commission. . For the 3-year period beginning on the date of enactment of this section, the budget neutrality provision of section 1848(c)(2)(B)(ii) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B)(ii) ) shall not apply with respect to language assistance services (as defined in section 1861(jjj)(1) of such Act). Medicare Advantage plans under part C of title XVIII of the Social Security Act and prescription drug plans under part D of such title shall comply with title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq.) and section 1557 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18116 ) to provide effective language services to enrollees of such plans. Section 1857(e) of the Social Security Act ( 42 U.S.C. 1395w–27(e) ) is amended by adding at the end the following new paragraph: A contract under this part shall require a Medicare Advantage organization (and, through application of section 1860D–12(b)(3)(D), a contract under section 1860D–12 shall require a PDP sponsor) to annually submit (for each year of the contract) a report that contains information on the internal policies and procedures of the organization (or sponsor) related to recruitment and retention efforts directed to workforce diversity and linguistically and culturally appropriate provision of services in each of the following contexts: The collection of data in a manner that meets the requirements of title I of the Health Equity and Accountability Act of 2018 , regarding the enrollee population. Education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population. Evaluation of the language services programs and services offered by the organization (or sponsor) with respect to the enrollee population, such as through analysis of complaints or satisfaction survey results. Methods by which the plan provides to the Secretary information regarding the ethnic diversity of the enrollee population. The periodic provision of educational information to plan enrollees on the language services and programs offered by the organization (or sponsor). . Section 1903(a)(2)(E) of the Social Security Act ( 42 U.S.C. 1396b(a)(2)(E) ), as amended by section 203(g)(3), is further amended by— striking 75 and inserting 90 ; striking translation or interpretation services and inserting language assistance services ; and striking children of families and inserting individuals . Section 1902(a)(10)(A) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A) ) is amended by striking and

(28)and inserting (28), and

(29). Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended by— in paragraph (28), by striking and at the end; by redesignating paragraph

(29)as paragraph (30); and by inserting after paragraph

(28)the following new paragraph: language assistance services, as such term is defined in section 1861(jjj)(1), provided in a timely manner to individuals with limited-English proficiency as defined in section 3400 of the Public Health Service Act; and . Section 1916(a)(2) of the Social Security Act ( 42 U.S.C. 1396o(a)(2) ) is amended by— by striking or at the end of subparagraph (D); by striking ; and at the end of subparagraph

(E)and inserting , or ; and by adding at the end the following new subparagraph: language assistance services described in section 1905(a)(29); and . Section 2103 of the Social Security Act ( 42 U.S.C. 1397cc ) is amended— in subsection (a), in the matter before paragraph (1), by striking and

(7)and inserting (7), and

(9); and in subsection (c), by adding at the end the following new paragraph: The child health assistance provided to a targeted low-income child shall include coverage of language assistance services, as such term is defined in section 1861(jjj)(1), provided in a timely manner to individuals with limited-English proficiency (as defined in section 3400 of the Public Health Service Act). ; and in subsection (e)(2)— in the heading, by striking and inserting preventive ; and certain by inserting or subsection (c)(9) after subsection (c)(1)(D) . Section 2110(a)(27) of the Social Security Act ( 42 U.S.C. 1397jj(a)(27) ) is amended by striking translation and inserting language assistance services as described in section 2103(c)(9) . Pursuant to the reporting requirement described in section 2107(b)(1) of the Social Security Act ( 42 U.S.C. 1397gg(b)(1) ), the Secretary of Health and Human Services shall require that States collect data on— the primary language of individuals receiving child health assistance under title XXI of the Social Security Act ( 42 U.S.C. 1397aa et seq.); and in the case of such individuals who are minors or incapacitated, the primary language of the individual’s parent or guardian. Section 2105 of the Social Security Act ( 42 U.S.C. 1397ee ) is amended— in subsection (a)(1), by striking 75 and inserting 90 ; and in subsection (c)(2)(A), by inserting before the period at the end the following: , except that expenditures pursuant to clause

(iv)of subparagraph

(D)of such paragraph shall not count towards this total . Subject to subparagraph (B), the Secretary of Health and Human Services (referred to in this subsection as the Secretary ) shall make payments (on a quarterly basis) directly to eligible entities to support the provision of language assistance services to English learners in an amount equal to an eligible entity’s eligible costs for providing such services for the quarter. Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services such sums as may be necessary for each of fiscal years 2019 through 2023. Payments under this subsection shall not offset or reduce payments under section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ), nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language assistance services for the purposes of this section. The Secretary shall establish a methodology to determine the average per person cost of language assistance services. In establishing such methodology, the Secretary may establish different methodologies for different types of eligible entities. The Secretary may not require eligible entities to submit individual claims for language assistance services for individual patients as a requirement for payment under this subsection. For purposes of this subsection, the Secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the Secretary or relevant accrediting organizations regarding the number of individuals to whom language access are provided. Not later than 6 months after the date of enactment of this Act, the Secretary shall establish and distribute guidelines concerning the implementation of this subsection. Entities receiving payment under this subsection shall provide the Secretary with a quarterly report on how the entity used such funds. Such report shall contain aggregate (and may not contain individualized) data collected using the instrument under paragraph

(3)and shall otherwise be in a form and manner determined by the Secretary. Not later than 2 years after the date of enactment of this Act, and every 2 years thereafter, the Secretary shall submit a report to Congress concerning the implementation of this subsection. In this subsection: The term eligible costs means, with respect to an eligible entity that provides language assistance services to English learners, the product of— the average per person cost of language assistance services, determined according to the methodology devised under paragraph

(2); and the number of English learners who are provided language assistance services by the entity and for whom no reimbursement is available for such services under the amendments made by subsections (a), (b), (c), or

(d)or by private health insurance. The term eligible entity means an entity that— is a Medicaid provider that is— a physician; a hospital with a low-income utilization rate (as defined in section 1923(b)(3) of the Social Security Act ( 42 U.S.C. 1396r–4(b)(3) )) of greater than 25 percent; or a federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) )); not later than 6 months after the date of the enactment of this Act, provides language assistance services to not less than 8 percent of the entity’s total number of patients; and prepares and submits an application to the Secretary, at such time, in such manner, and accompanied by such information as the Secretary may require, to ascertain the entity’s eligibility for funding under this subsection. The term English learner has the meaning given such term in section 8101(20) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and

(D)of such section shall not apply. The term language assistance services has the meaning given such term in section 1861(jjj)(1) of the Social Security Act, as added by subsection (b). Nothing in this section shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq.) or other laws that protect the civil rights of individuals. Except as otherwise provided and subject to paragraph (2), the amendments made by this section shall take effect on January 1, 2019. In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

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U.S. Code

5 references not yet in our index

42 USC 1320d–2
42 USC 1395w–4(c)(2)(B)(ii)
42 USC 1395w–27(e)
42 USC 1396r–4
42 USC 1396r–4(b)(3)

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cites case law

Sec. 207

Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs

Cite42 USC 1320d–2

Cite42 USC 1395w–4(c)(2)(B)(ii)

Cite42 USC 1395w–27(e)

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