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Language Barriers and Your Patients - Let the Evidence Guide Your Decisions so You Can Comply with the Law

In almost every health care setting in the United States (US) these days, nurses and other health care providers are dealing with language barriers as part of care delivery more than ever before. In fact, most countries in the world run into some kind of language barrier issue in the health care setting. Global migration means more tourists and immigrants for every country in the world. 

In the US, language access--meaning the availability of interpreters and their services-- is a civil right. The Affordable Care Act (ACA) also added new provisions for health care services providers around language access that are important for you to know. From CME Learning:
New rules on language access were implemented on July 18, 2016. These changes are sweeping in scope as they apply to “every [federal] health program or activity, any part of which receives Federal financial assistance.” Section 1557 is a “non-discrimination” provision that broadly prohibits discrimination in health care or health coverage on the basis of race, “color”, national origin (including immigration status and English language proficiency). Section 1557 is unique among Federal civil rights laws in that it specifically addresses discrimination in health programs and activities. The final rule combines, expands (by prohibiting discrimination on the basis of sex, sexual orientation and gender identity) and harmonizes existing, well-established federal civil rights laws and clarifies the standards that HHS will apply in implementing Section 1557 of the Affordable Care Act.  Section 1557 explicitly prohibits discrimination by:
  • Any health program or activity that receives federal financial assistance, including credits, subsidies, or contracts of insurance (e.g. Medicaid and CHIP)
  • Any program or activity that is administered by a federal agency (e.g. Medicare and the federally facilitated marketplace); and
  • Any entity created under Title I of the ACA (e.g. state-based, state partnership and the federally facilitated marketplaces).
As these proposed changes apply to national origin discrimination (and hence to immigrants and Limited English Proficient patients), the major changes are as follows:
  • Hospitals, health plans, clinics, nursing homes, physicians and other providers must offer “qualified interpreters” to Limited English Proficient patients. The major problem in the language access field is that too often, providers attempt to “get by” without the use of trained interpreters when treating LEP patients. Despite a strong consensus in the academic and research communities about the quality and safety risks of using untrained bilingual staff, adult family members and friends and minor children as interpreters, even today a majority of providers throughout the U.S. continue to use untrained interpreters even when qualified interpreters are readily available in person or remotely via telephone or video remote devices.
These are critical changes you need to be aware of for your clinical practice. You can learn more about language barriers and working more effectively with interpreters here. CE credits available!

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