Sec. 204. Culturally and linguistically appropriate health care in the Public Health Service Act
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The Public Health Service Act ( 42 U.S.C. 201 et seq.) is amended by adding at the end the following: In this title: The term bilingual , with respect to an individual, means a person who has sufficient degree of proficiency in 2 languages. The term cultural means relating to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups, including lesbian, gay, bisexual, transgender, queer, and questioning individuals, and individuals with physical and mental disabilities.
The term culturally and linguistically appropriate means being respectful of and responsive to the cultural and linguistic needs of all individuals. The term effective communication means an exchange of information between the provider of health care or health-care-related services and the recipient of such services who is limited in English proficiency, or has a communication impairment such as a hearing, vision, speaking, or learning impairment, that enables access to, understanding of, and benefit from health care or health-care-related services, and full participation in the development of their treatment plan.
The term grievance resolution process means all aspects of dispute resolution including filing complaints, grievance and appeal procedures, and court action. The term health care group means a group of physicians organized, at least in part, for the purposes of providing physician services under the Medicaid program under title XIX of the Social Security Act, the State Children's Health Insurance Program under title XXI of such Act, or the Medicare program under title XVIII of such Act and may include a hospital and any other individual or entity furnishing services covered under any such program that is affiliated with the health care group.
The term health care services means services that address physical as well as mental health conditions in all care settings. The term health-care-related services means human or social services programs or activities that provide access, referrals, or links to health care. The term health educator includes a professional with a baccalaureate degree who is responsible for designing, implementing, and evaluating individual and population health promotion and chronic disease prevention programs.
The terms Indian and Indian Tribe have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act. The term individual with a disability means any individual who has a disability as defined for the purpose of section 504 of the Rehabilitation Act of 1973. The term individual with limited English proficiency means an individual whose primary language for communication is not English and who has a limited ability to read, write, speak, or understand English.
The term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health, mental health, substance use disorder, and related disciplines to improve the health outcomes of an individual. Such providers may include hospitals, health, mental health, or substance use disorder clinics and providers, home health agencies, ambulatory surgery centers, skilled nursing facilities, rehabilitation centers, and employed, independent, or contracted physicians.
The terms interpreting and interpretation mean the transmission of a spoken, written, or signed message from one language or format into another, faithfully, accurately, and objectively. The term language access means the provision of language services to an individual with limited English proficiency or an individual with communication disabilities designed to enhance that individual’s access to, understanding of, or benefit from health care services or health-care-related services.
The term language assistance services includes— oral language assistance, including interpretation in non-English languages provided in-person or remotely by a qualified interpreter for an individual with limited English proficiency, and the use of qualified bilingual or multilingual staff to communicate directly with individuals with limited English proficiency; written translation, performed by a qualified and competent translator, of written content in paper or electronic form into languages other than English; and taglines.
The terms minority and minorities refer to individuals from a minority group. The term minority , with respect to populations, refers to racial and ethnic minority groups, members of sexual and gender minority groups, and individuals with a disability. The term minority group has the meaning given the term racial and ethnic minority group . The term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care services or health-care-related services and the recipient of such services who is limited in English proficiency or has a communication impairment such as an impairment in hearing, vision, or learning.
The term qualified individual with a disability means, with respect to a health program or activity, an individual with a disability who, with or without reasonable modifications to policies, practices, or procedures, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of aids, benefits, or services offered or provided by the health program or activity.
The term qualified interpreter for an individual with a disability , for an individual with a disability— means an interpreter who by means of a remote interpreting service or an onsite appearance— adheres to generally accepted interpreter ethics principles, including client confidentiality; and is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology, and phraseology; and may include sign language interpreters, oral transliterators (individuals who represent or spell in the characters of another alphabet), and cued language transliterators (individuals who represent or spell by using a small number of handshapes).
The term qualified interpreter for an individual with limited English proficiency means an interpreter who via a remote interpreting service or an onsite appearance— adheres to generally accepted interpreter ethics principles, including client confidentiality; has demonstrated proficiency in speaking and understanding both spoken English and one or more other spoken languages; and is able to interpret effectively, accurately, and impartially, both receptively and expressly, to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology.
The term qualified translator means a translator who— adheres to generally accepted translator ethics principles, including client confidentiality; has demonstrated proficiency in writing and understanding both written English and one or more other written non-English languages; and is able to translate effectively, accurately, and impartially to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology. The term racial and ethnic minority group means Indians and Alaska Natives, African Americans (including Caribbean Blacks, Africans, and other Blacks), Asian Americans, Hispanics (including Latinos), and Native Hawaiians and other Pacific Islanders.
The term sexual and gender minority group encompasses lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expression, or reproductive development varies from traditional, societal, cultural, or physiological norms. The term sight translation means the transmission of a written message in one language into a spoken or signed message in another language, or an alternative format in English or another language. Notwithstanding section 2, the term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
The term telephonic interpretation (also known as over the phone interpretation or OPI ) means, with respect to interpretation for an individual with limited English proficiency, a method of interpretation in which the interpreter is not in the physical presence of the provider of health care services or health-care-related services and such individual receiving such services, but the interpreter is connected via telephone. The term translation means the transmission of a written message in one language into a written or signed message in another language, and includes translation into another language or alternative format, such as large print font, Braille, audio recording, or CD.
The term video remote interpreting services means the provision, in health care services or health-care-related services, through a qualified interpreter for an individual with limited English proficiency, of video remote interpreting services that are— in real-time, full-motion video, and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication; and in a sharply delineated image that is large enough to display.
The term vital document includes applications for government programs that provide health care services, medical or financial consent forms, financial assistance documents, letters containing important information regarding patient instructions (such as prescriptions, referrals to other providers, and discharge plans) and participation in a program (such as a Medicaid managed care program), notices pertaining to the reduction, denial, or termination of services or benefits, notices of the right to appeal such actions, and notices advising individuals with limited English proficiency with communication disabilities of the availability of free language services, alternative formats, and other outreach materials.
In any reference in this title to a regulatory provision applicable to a handicapped individual , the term handicapped individual in such provision shall have the same meaning as the term individual with a disability as defined in subsection (a). The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish and support a center to be known as the Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care (referred to in this section as the Center ) to carry out each of the following activities:
The Center shall provide resources via the internet to identify and link health care providers to competent interpreter and translation services. The Center shall provide, directly or through contract, vital documents from competent translation services for providers of health care services and health-care-related services at no cost to such providers. Such documents may be submitted by covered entities (as defined in section 92.4 of title 42, Code of Federal Regulations, as in effect on May 16, 2016) for translation into non-English languages or alternative formats at a fifth-grade reading level.
Such translation services shall be provided in a timely and reasonable manner. The quality of such translation services shall be monitored and reported publicly. For each form developed or revised by the Secretary that will be used by individuals with limited English proficiency in health care or health-care-related settings, the Center shall translate the form, at a minimum, into the top 15 non-English languages in the United States according to the most recent data from the American Community Survey or its replacement.
The translation shall be completed within 45 calendar days of the Secretary receiving final approval of the form from the Office of Management and Budget. The Center shall post all translated forms on its website so that other entities may use the same translations. The Center shall provide, through a toll-free number, a customer service line for individuals with limited English proficiency— to obtain information about federally conducted or funded health programs, including the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children's Health Insurance Program under title XXI of such Act, marketplace coverage available pursuant to title XXVII of this Act and the Patient Protection and Affordable Care Act, and other sources of free or reduced care including federally qualified health centers, title X clinics, and public health departments; to obtain assistance with applying for or accessing these programs and understanding Federal notices written in English; and to learn how to access language services.
The Center shall develop and maintain an information clearinghouse to facilitate the provision of language services by providers of health care services and health-care-related services to reduce medical errors, improve medical outcomes, improve cultural competence, reduce health care costs caused by miscommunication with individuals with limited English proficiency, and reduce or eliminate the duplication of efforts to translate materials. The clearinghouse shall include the information described in subparagraphs
(B)through
(F)and make such information available on the internet and in print. The Center shall collect and evaluate for accuracy, develop, and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care, including templates for each of the following: Administrative and legal documents, including— intake forms; forms related to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children's Health Insurance Program under title XXI of such Act, including eligibility information for such programs; forms informing patients of the compliance and consent requirements pursuant to the regulations under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. 1320–2 note); and documents concerning informed consent, advanced directives, and waivers of rights. Clinical information, such as how to take medications, how to prevent transmission of a contagious disease, and other prevention and treatment instructions. Public health, patient education, and outreach materials, such as immunization notices, health warnings, or screening notices. Additional health or health-care-related materials as determined appropriate by the Director of the Center. In operating the clearinghouse, the Center shall— ensure that the documents posted in English and non-English languages are culturally and linguistically appropriate; allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally and linguistically appropriate for the target populations; allow health care providers to customize the documents for their use; facilitate access to these documents; provide technical assistance with respect to the access and use of such information; and carry out any other activities the Secretary determines to be useful to fulfill the purposes of the clearinghouse. The Center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for individuals with limited English proficiency, including case studies using de-identified patient information, program summaries, and program evaluations. The Center shall provide information relating to culturally and linguistically appropriate health care for minority populations residing in the United States to all health care providers and health-care-related services at no cost. Such information shall include— tenets of culturally and linguistically appropriate care; culturally and linguistically appropriate self-assessment tools; culturally and linguistically appropriate training tools; strategic plans to increase cultural and linguistic appropriateness in different types of providers of health care services and health-care-related services, including regional collaborations among health care organizations; and culturally and linguistically appropriate information for educators, practitioners, and researchers. The Center shall— develop and publish on its website translation glossaries that provide standardized translations of commonly used terms and phrases utilized in documents translated by the Center; and make these glossaries available— free of charge; in the 15 languages in which the Center translates materials; and in alternative formats in accordance with the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12101 et seq.). The Center shall regularly collect and make publicly available information about the progress of entities receiving grants under section 3402 regarding successful innovations in implementing the obligations under this subsection and provide public notice in the entities’ communities about the availability of this information. The Center shall be headed by a Director who shall be appointed by, and who shall report to, the Director of the Agency for Healthcare Research and Quality. The Director shall collaborate with the Deputy Assistant Secretary for Minority Health, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration to notify health care providers and health care organizations about the availability of language access services by the Center. The Secretary, directly or through contract, shall undertake a national education campaign to inform providers, individuals with limited English proficiency, individuals with hearing or vision impairments, health professionals, graduate schools, and community health centers about— Federal and State laws and guidelines governing access to language services; the value of using trained and competent interpreters and the risks associated with using family members, friends, minors, and untrained bilingual staff; funding sources for developing and implementing language services; and promising practices to effectively provide language services. There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2021 through 2025. The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall award grants to eligible entities to enable such entities to design, implement, and evaluate innovative, cost-effective programs to improve culturally and linguistically appropriate access to health care services for individuals with limited English proficiency. The Director of the Agency for Healthcare Research and Quality shall coordinate with, and ensure the participation of, other agencies including the Health Resources and Services Administration, the National Institute on Minority Health and Health Disparities at the National Institutes of Health, and the Office of Minority Health, regarding the design and evaluation of the grants program. To be eligible to receive a grant under subsection (a), an entity shall— be— a city, county, Indian Tribe, State, or subdivision thereof; an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code; a community health, mental health, or substance use disorder center or clinic; a solo or group physician practice; an integrated health care delivery system; a public hospital; a health care group, university, or college; or any other entity designated by the Secretary; and prepare and submit to the Secretary an application, at such time, in such manner, and containing such additional information as the Secretary may reasonably require. An entity shall use funds received through a grant under this section to— develop, implement, and evaluate models of providing competent interpretation services through onsite interpretation, telephonic interpretation, or video remote interpreting services; implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the entity; develop and maintain a needs assessment that identifies the current demographic, cultural, and epidemiological profile of the community to accurately plan for and implement language services needed in the service area of the entity; develop a strategic plan to implement language services; develop participatory, collaborative partnerships with communities encompassing the patient populations of individuals with limited English proficiency served by the grant to gain input in designing and implementing language services; develop and implement grievance resolution processes that are culturally and linguistically appropriate and capable of identifying, preventing, and resolving complaints by individuals with limited English proficiency; develop short-term medical and mental health interpretation training courses and incentives for bilingual health care staff who are asked to provide interpretation services in the workplace; develop formal training programs, including continued professional development and education programs as well as supervision, for individuals interested in becoming dedicated health care interpreters and culturally and linguistically appropriate providers; provide staff language training instruction, which shall include information on the practical limitations of such instruction for nonnative speakers; develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bilingual provider; develop other language assistance services as determined appropriate by the Secretary; develop, implement, and evaluate models of improving cultural competence, including cultural competence programs for community health workers; and ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and any applicable State privacy laws, data on the individual patient or recipient’s race, ethnicity, and primary language are collected (and periodically updated) in health records and integrated into the organization’s information management systems or any similar system used to store and retrieve data. In awarding grants under this section, the Secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience in improving language access. An entity that receives a grant under this section shall submit to the Secretary an evaluation that describes, in the manner and to the extent required by the Secretary, the activities carried out with funds received under the grant, and how such activities improved access to health care services and health-care-related services and the quality of health care for individuals with limited English proficiency. Such evaluation shall be collected and disseminated through the Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care established under section 3401. The Director of the Agency for Healthcare Research and Quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request. The Director of the Agency for Healthcare Research and Quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section. There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2021 through 2025. The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall expand research concerning language access in the provision of health care services. The Director of the Agency for Healthcare Research and Quality may conduct the research described in subsection
(a)or enter into contracts with other individuals or organizations to conduct such research. Research conducted under this section shall be designed to do one or more of the following: To identify the barriers to mental and behavioral services that are faced by individuals with limited English proficiency. To identify health care providers’ and health administrators’ attitudes, knowledge, and awareness of the barriers to quality health care services that are faced by individuals with limited English proficiency. To identify optimal approaches for delivering language access. To identify best practices for data collection, including— the collection by providers of health care services and health-care-related services of data on the race, ethnicity, and primary language of recipients of such services, taking into account existing research conducted by the Government or private sector; the development and implementation of data collection and reporting systems; and effective privacy safeguards for collected data. To develop a minimum data collection set for primary language. To evaluate the most effective ways in which the Secretary can create or coordinate, and subsidize or otherwise fund, telephonic interpretation services for health care providers, taking into consideration, among other factors, the flexibility necessary for such a system to accommodate variations in— provider type; languages needed and their frequency of use; type of encounter; time of encounter, including regular business hours and after hours; and location of encounter. There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2021 through 2025. .
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- 42 USC 1320–2
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Sec. 204
Culturally and linguistically appropriate health care in the Public Health Service Act
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