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Policy Guidance on Health Services to Limited English Proficient Persons

What is the LEP guidance?

On August 20, 2000, the U.S. Department of Health and Human Services issued "Policy Guidance on the Title VI Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency (LEP)" pursuant to Executive Order 13166 issued on services to LEP persons. The guidance clarifies the responsibilities of providers of health and social services who receive federal financial assistance. The policy guidance specifically addresses the lack of language assistance capability among many providers that has resulted in barriers to meaningful access for LEP individuals as well as the dangers of using untrained interpreters, particularly those that the client brings with him or her. The policy guidance spells out four keys to Title VI compliance with respect to individuals with LEP: (1) development of a comprehensive LEP plan, (2) notice to consumers of right to language assistance, (3) staff training, and (4) vigilant monitoring of the program to ensure that LEP persons meaningfully access the services offered by the provider.

Is this policy guidance a new unfunded mandate for health providers?

No. The policy guidance is based on Title VI of the Civil Rights Act of 1964 and reflects over 30 years of DHHS Office of Civil Rights enforcement and court cases implementing Title VI. The policy guidance simply clarifies what steps a health provider needs to take in order to be in compliance with Title VI, existing law for 37 years.

Moreover, the guidance reflects basic standards of clinical practice and patient-provider communication taught in every health professional school in the country (excluding veterinary schools). It is simple. If a provider cannot communicate with their patient, they are not meeting clinical and ethical practice standards. They put their patient's health at risk and their practice at risk from subsequent liability.

Does the guidance require all health providers to speak the language of the patient or hire translation staff for each language?

No. The guidance requires that health providers inform their patients of their rights to a translator and to make use of translation services. For a health provider that does not see many non-English speaking patients, this can simply mean use using a phone translation service and over the phone having a trained medical translator interpret for the patient and doctor.

Won't compliance with the policy guidance create prohibitive costs for the health provider?

No. A wide range of cost effective solutions are available to providers that do not see significant numbers of LEP patients. These include use of phone translation services and shared interpreter banks. Also, for providers who see a significant number of non-English speaking patients, they can send a member of their staff who speaks that language to a certified medical interpreter program. However, most of these providers have already made the necessary arrangements to communicate with their patients.

Prohibitive costs are created by not complying with the policy guidance on language services. According to the Institute of Medicine, every year medical errors, which are reduced by communication, result in more deaths than are attributable to breast cancer or HIV/AIDS and result in $9 to $15 billion in health care costs annually.

Is delivering services in Spanish enough since fewer people speak other languages?

No. If a patient cannot communicate with their health provider, no matter the language, their health is at risk. In a health care setting communication is basic. While a provider cannot be expected to have trained staff that speaks all languages, they should know how to access a trained medical translator when the need is presented, including easily accessible and cost-effective phone translation services.