Section 1557: Language Access Gets an Update with New Federal Rules

After years of advocacy and legal battles, language access in the U.S. healthcare system is getting a long-awaited overhaul. The U.S. Department of Health and Human Services (HHS) recently issued revised regulations under Section 1557 of the Affordable Care Act (ACA) aimed at strengthening protections against national origin discrimination and ensuring meaningful language access for individuals with limited English proficiency (LEP).  The final ruling under Section 1557: 

• Issued on 4/26/2024 
• Published on 5/6/2024 
• Goes into effect 60 days after publishing 

The new rules represent a significant win for language access advocates, patients, and healthcare professionals dedicated to promoting equitable care. They also have several implications for remote interpreting services, including quality, technology accessibility, and training and qualification of remote interpreters.  

Let’s explore the key provisions

Notification of Language Access Rights  

Healthcare entities must inform individuals with LEP about their rights to free language assistance services and non-discrimination policies, both upon first encounter and through visible notices. 

Telehealth Access 

Telehealth providers must be accessible to individuals with limited English proficiency and those with disabilities. This ruling will push forward the continued integration of interpreting services into telehealth platforms, which until recently have been underdeveloped. 

Expanded Scope and Coverage  

The revised regulations now explicitly cover Medicare Part B (doctors’ offices), Medigap plans, telehealth providers, and any companions accompanying patients with LEP – ensuring language support extends across the healthcare field. In recent years, hospitals and healthcare systems have been making progress in understanding their language access responsibilities. The new ruling will apply the same mandate to thousands of smaller healthcare providers nationwide. 

Untrained Interpreters  

One of the most impactful changes is stronger restrictions on using ad-hoc or untrained interpreters like family members or friends, children, and bilingual staff. Patients with LEP must now affirmatively request an untrained interpreter, in private with a professional interpreter present, except in emergency situations while awaiting a qualified interpreter. 

Quality Standards for Remote Interpreting  

The regulations restore the 2016 quality requirements for video and phone interpreting. This includes maintaining high-quality video and audio connections, ensuring the reliability and accessibility of the technology, and working with qualified interpreters with remote medical training. Providers are also encouraged to implement quality assurance measures for video and phone interpreting services.

Training for Staff

The regulations add that if providers are working with interpreters, they must receive training on using their services effectively. Training should include clear procedures on how to quickly and effectively access both in-person and remote (video or phone) interpreting services. This includes understanding the technology used for remote interpreting. 

Larger Organizations 

Larger providers with 15+ staff must designate a Section 1557 coordinator, establish written language access procedures, grievance processes, and provide annual staff training on meeting LEP communication needs compliantly. 

Artificial Intelligence (AI) and Language Access  

In a first for federal policy, the regulations address AI’s role in language services. Any critical communications involving communicating with LEP individuals using machine translation must be reviewed by qualified human translators. HHS also seeks further input on broader AI applications.’  Boostlingo recently hosted a workshop on ethical AI in interpreting that discussed the responsible application of this tool. We shared a blog covering the key takeaways from the session. 

Boostlingo commentary  

Merrie Wallace, MN BSN, Chief Revenue Officer at Boostlingo commented on the new rulings, “As the U.S. becomes increasingly multilingual and multicultural, effective language access is not just a matter of compliance, but a moral and professional imperative. There are over 25.7 million individuals with LEP in the US and 11 million who are Deaf or Hard-of-hearing. These new regulations provide a robust framework to uphold every patient’s right to understand and be understood during healthcare encounters. It’s an exciting milestone in our nation’s journey toward health equity.” 

Next steps

While robust – compliance will require investment from healthcare organizations, these regulations are a big step toward eliminating discrimination and improving quality of care for diverse populations. By prioritizing language access, providers can facilitate trusting relationships, promote healthcare literacy, and ensure safety – ultimately leading to better outcomes.  To learn more about how this new ruling might affect your organization, please contact our team today. Boostlingo is proud to work with its partners to help assess their current language access plan and ensure they successfully meet new federal guidelines.

More on Section 1557 

The revised regulations under Section 1557 of the Affordable Care Act aim to reinforce civil rights protections in healthcare. The rules explicitly prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in health programs and activities that receive federal funding from the Department of Health and Human Services. This includes most healthcare providers, health insurance issuers offering health plans, and many other entities in the healthcare sector.  The regulations restore important nondiscrimination protections related to sex discrimination, such as discrimination based on sexual orientation and gender identity. Health clinics, hospitals, doctors’ offices, and insurance companies will need to update their policies, training, notice of nondiscrimination statements, and grievance procedures to comply with these legal requirements.  Expanding access to health insurance coverage and healthcare services is a core goal. The rules help ensure equitable access to health care and health programs, regardless of an individual’s sexual orientation or gender identity. Providers cannot deny services or health insurance coverage, or otherwise discriminate, based on factors like sexual orientation.  Overall, these nondiscrimination protections aim to address long-standing disparities and discrimination in healthcare. By strengthening civil rights laws in the healthcare context, the new rules represent an important step toward more equitable, non-discriminatory access to health services and health insurance nationwide.