Enhancing Language Access: Section 1557 Final Rule Compliance

The U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) has issued a final rule implementing Section 1557 of the Affordable Care Act, effective July 5, 2024. This rule prohibits discrimination in health programs and activities based on race, color, national origin, sex (including pregnancy status and gender identity), age, or disability. A central focus of the rulemaking is to ensure meaningful access for individuals with limited English proficiency (“LEP”). As such, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum to stakeholders regarding guidance and enforcement of the language access provision within Section 1557 of the ACA.

According to HHS, language access is essential for equitable healthcare delivery, addressing the needs of approximately 68 million U.S. residents who speak a language other than English at home. The final rule mandates reasonable steps to eliminate language barriers and provide accurate, timely, and culturally competent communication. Full compliance with these provisions is required by July 5, 2025.

Employer Action Items

• Assess Population Needs: Identify the language needs of LEP individuals served by the organization.
• Develop Language Assistance Policies: Establish clear procedures for providing language assistance services, including the use of qualified interpreters and translators.
• Train Staff: Train employees on Section 1557 requirements and how to access and provide language assistance services.
• Ensure Availability of Qualified Language Support:
  • Use qualified interpreters proficient in both spoken English and the target language.Employ qualified translators for the development and translation of all written materials.
  • Avoid relying on unqualified individuals or minor children for interpretive services.
• Update Notices:
  • Provide annual notices of nondiscrimination, including information on language assistance services.
  • Ensure all required annual and intermittent notices are available in the top 15 most spoken non-English languages in your state(s) of operation and in accessible formats for individuals with disabilities.
• Monitor and Evaluate Services: Regularly review the effectiveness of language assistance services and make any necessary adjustments to production and/or delivery techniques.

Summary

The Section 1557 final rule sets rigorous standards for providing meaningful language access for individuals with LEP. Covered entities must offer free, accurate, and timely language assistance services, all the while protecting patient privacy and ensuring preservation of independent, individual decision-making. These requirements include the use of qualified interpreters and translators, limitations on machine translation, and detailed nondiscrimination notices. Below, we’ve highlighted a list of key requirements for compliance that go into effect on July 5, 2025:

Key Requirements for Compliance

1. Language Assistance Services
   • Covered entities must provide free, accurate, and timely interpretation and translation services.
   • These services must protect individuals’ privacy and should facilitate independent decision-making.
2. Use of Qualified Interpreters and Translators
   • Interpreters and translators must meet strict proficiency and ethical standards, as detailed in the final rulemaking.
   • Self-identified bilingual staff may not suffice for the performance of translation and interpretive services unless they meet the qualifications outlined in the final rulemaking.
3. Machine Translation Standards
   • Automated translation tools may only be utilized in limited circumstances and must be reviewed for accuracy by qualified translators where accuracy is essential and/or questionable.
4. Notice Requirements
   • Notices of nondiscrimination and availability of language assistance services must be provided annually and prominently displayed throughout the workplace.
   • Such notices must be translated into the top 15 languages spoken by LEP individuals in the relevant service area(s).
   • Formatting rules dictate that notices must be prepared in a sans serif font, utilizing no smaller than 20-point font, and made available in various electronic and written communications. Sample notices can be found at the link provided here.
5. Grievance Procedures
   • Entities receiving federal financial assistance must establish accessible and actionable grievance procedures to address complaints related to language access or discrimination.

Failing to meet these obligations may lead to increasingly poor health outcomes, enhanced regulatory scrutiny, and the assessment of substantial agency imposed civil monetary penalties.

Proactive steps—from assessing community needs to updating policies and training staff—are vital for achieving compliance by the July 5, 2025 deadline.

Additional Resources

• CMS Memo to Stakeholders: Language Access Provisions of the Final Rule Implementing Section 1557 of the ACA
• HHS Section 1557 Final Rule: Nondiscrimination in Health Programs and Activities
• Section 1557 Final Rule: Frequently Asked Questions
• OCR Language Access Resources
• LEP.gov: Tools and Data for Language Access