Language Access Program Knowledge Center
Who is a Limited English Proficient (LEP) individual?
Individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English are referred to as limited English proficient or LEP. These individuals may be entitled language assistance with respect to a particular type or service, benefit, or encounter.
What are the relevant laws concerning language access for LEP individuals?
Federal laws particularly applicable to language access include Title VI of the Civil Rights Act of 1964, and the Title VI regulations, prohibiting discrimination based on national origin, and Executive Order 13166 issued in 2000. Many individual federal programs, states, and localities also have provisions requiring language services for LEP individuals. See frequently asked question on these laws to learn more.
Which industries are required to provide language access programs for LEP individuals?
Any organizations, regardless of sizes or industry, may be required to comply with federal, state, or local government laws based on the nature and scope of their work. Government, healthcare, legal, and non-profit organizations are primarily affected by Title VI of 1964 Civil Rights Act and Executive Order 13166. See frequently asked question on these laws to learn more.
What are the standards types of services available for LEP individuals?
What is the standards for interpretation for LEP individuals?
Deaf/Hard of Hearing
Which laws relate to the deaf and hard of hearing?
Federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing. These laws include:.
What are the services required by the ADA Section 504?
Who must comply with the ADA and related laws?
Are private health care providers required to comply with ADA regulations?
What is the obligation of health care providers under the ADA for individuals who are deaf or hard of hearing?
Health care providers have a duty to provide appropriate auxiliary aids and services when necessary to ensure that communication with people who are deaf or hard of hearing is as effective as communication with others. 28 C.F.R. § 36.303(c).
Is this obligation limited to deaf or hard of hearing patients?
What kinds of auxiliary aids and services are required by the ADA to ensure effective communication with deaf or hard of hearing individuals?
Auxiliary aids and services include equipment or services a person needs to access and understand aural information and to engage in effective communication. For example, the rule includes qualified interpreters, computer-aided transcription services (also called CART), written materials, assistive listening devices, captioning, or other effective methods of making aural information and communication accessible. 28 C.F.R. § 303(b)(1).
How does a health care provider determine which auxiliary aid or service to provide for a patient who is deaf or hard of hearing?
The auxiliary aid and service requirement is flexible, and the health care provider can choose among various alternatives as long as the result is effective communication with the deaf or hard of hearing individual. An individual who is deaf or hard of hearing likely has experience with auxiliary aids and services to know which will achieve effective communication with his or her health care provider. The U.S. Department of Justice expects that the health care provider will consult with the person and consider carefully his or her self-assessed communication needs before acquiring a particular auxiliary aid or service. 56 Fed. Reg. at 35566-67.
Why are auxiliary aids and services so important in medical settings?
Auxiliary aids and services are often needed to provide safe and effective medical treatment. Without these auxiliary aids and services, medical staff run the grave risk of not understanding the patient’s symptoms, misdiagnosing the patient’s medical problem, and prescribing inadequate or even harmful treatment. Similarly, patients may not understand medical instructions and warnings or prescription guidelines.
Are there any limitations on the ADA’s auxiliary aids and services requirements?
Yes. The ADA does not require the provision of any auxiliary aid or service that would result in an undue burden or in a fundamental alteration in the nature of the goods or services provided by a health care provider. 28 C.F.R. § 36.303(a). Making information or communication accessible to an individual who is deaf or hard of hearing is unlikely ever to be a fundamental alteration of a health care service. An individualized assessment is required to determine whether a particular auxiliary aid or service would be an undue burden.
When would providing an auxiliary aid or service be an undue burden?
An undue burden is something that involves a significant difficulty or expense. For example, it might be a significant difficulty to obtain certain auxiliary aids or services on short notice. Factors to consider in assessing whether an auxiliary aid or service would constitute a significant expense include the nature and cost of the auxiliary aid or service; the overall financial resources of the health care provider; the number of the provider’s employees; the effect on expenses and resources; legitimate safety requirements; and the impact upon the operation of the provider. 28 C.F.R. § 36.104. Showing an undue burden may be difficult for most health care providers. When an undue burden can be shown, the health care provider still has the duty to furnish an alternative auxiliary aid or service that would not result in an undue burden and, to the maximum extent possible, would ensure effective communication. 28 C.F.R. § 36.303(f).
Must a health care provider pay for an auxiliary aid or service for a medical appointment if the cost exceeds the provider’s charge for the appointment?
Can a health care provider charge a deaf or hard of hearing patient for part or all of the costs of providing an auxiliary aid or service?
Who is qualified to be an interpreter in a health care setting?
Do all individuals who are deaf or hard of hearing use the same kind of interpreter?
Can a health care provider require family members or friends to interpret for deaf or hard of hearing patients?
Generally, no. Family members and friends often do not possess sufficient skills to interpret effectively in a medical setting. Family members and friends are also very often too emotionally or personally involved, may have interests that conflict with the patient’s, may cause role confusion, and are unable to interpret “effectively, accurately, and impartially."Finally, using family members and friends as interpreters can cause problems in maintaining patient confidentiality. 56 Fed. Reg. at 35553.
In what medical situations should a health care provider obtain the services of a qualified interpreter?
Is lipreading an effective form of communicating with individuals who are deaf or hard of hearing?
Do written notes offer an effective means of communicating with deaf and hard of hearing individuals?
Must health care providers make conferences, health education, and training sessions that are open to the general public accessible to deaf and hard of hearing individuals?
What are the penalties for Non-Compliance?
Can health care providers receive any tax credits for the costs of providing auxiliary aids and services?
Title VI of 1964 CRA
Why are LEP individuals protected from national origin discrimination under Title VI?
Does the failure by a recipient to provide meaningful access to LEP persons constitute national origin discrimination?
What are the types of language assistance services available?
Do Department of Justice (DOJ) Title VI implementing regulations prohibit both intentional discrimination and practices that have a discriminatory impact?
Why is it important to have a Language Access Implementation Plan, Policy Directives, and Procedures in place?
Who should be trained to access and manage language services:
Why is it important to modify or update your Language Access Implementation Plan and related Language Access Procedures?
Why is it important to monitor the effectiveness of your Language Access Implementation Plan?
Why is it important to track the number of LEP individuals that your agency has served or who have participated in your program or activity:
What impact does Title VI have on court interpretation?
Executive Order 13166
What is Executive Order 13166?
What is a recipient of federal financial assistance?
What are recipients of federal funds and federal agencies required to do to meet LEP requirements?
Do recipients of federal funds have to submit written language access plans to the Department of Justice or to their federal funding agency each year?
No. While planning is an important part of ensuring that reasonable steps are taken to provide meaningful access to LEP individuals seeking services, benefits, information, or assertion of rights, there is no blanket requirement that the plans themselves be submitted to federal agencies providing federal financial assistance. In certain circumstances, such as in complaint investigations or compliance reviews, recipients may be required to provide to federal agencies a copy of any plan created by the recipient.
When developing plans and guidance regarding translation of documents, how do we determine which documents must be translated?
Vital documents must be translated when a significant number or percentage of the population eligible to be served, or likely to be directly affected by the program/activity, needs services or information in a language other than English to communicate effectively. For many larger documents, translation of vital information contained within the document will suffice and the documents need not be translated in their entirety.
Does Executive Order 13166 apply to materials on websites?
What do recipients of federal financial assistance do if they are operating in a state or locality that has an English-only or official English law that requires the use of English in communications?
Does the Executive Order 13166 apply to federally conducted activities overseas or to foreign recipients of federal financial assistance?
Does Executive Order 13166 require that bids be let in languages other than English?
If a federal agency contracts with a private or other entity to conduct certain activities of the agency, does the Executive Order apply to the activities of the contractor?
Where can I get a copy of the Executive Order and the DOJ General LEP Guidance?
A copy of the Executive Order and DOJ's general LEP Guidance (both translated into Spanish and Chinese) can be found on the Federal Coordination and Compliance Section website at https://www.justice.gov/crt/executive-order-13166. For more information on Executive Order 13166, please contact the Federal Coordination and Compliance Section, 202-307-2222.
ACA's Section 1557
What is Section 1557?
Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs or activities that receive Federal financial assistance or are administered by an Executive agency or any entity established under Title I of the ACA. Section 1557 has been in effect since enactment of the ACA.
How does Section 1557 protect consumers?
How are covered entities under Section 1557 supposed to let consumers know about their rights?
What does the final rule of Section 1557 require for individuals with limited English proficiency (LEP)?
What does the final rule of Section 1557 require concerning individuals with disabilities?
What steps can be taken when an individual believes that his or her civil rights have been violated under Section 1557?
How is the final rule under Section 1557 different from rules under the other civil rights laws the Office for Civil Rights already enforces?
Is Section 1557 currently being enforced?
What is the effective date for the final rule?
Why is OCR issuing a final rule addressing Section 1557?
Section 1557 of the ACA require each covered entity to “post taglines in at least the top 15 languages spoken by individuals with LEP within the relevant State or States.” 45 C.F.R. § 92.8(d)(1). What are these languages in each State?
What data did OCR use to compile its list of the top 15 languages spoken by individuals with LEP in each of the 50 States, the District of Columbia, and Puerto Rico?
Why did OCR rely on the ACS 5-year estimates rather than the 1-year estimates?
What data did OCR use to compile its estimates of the top languages spoken by individuals with LEP for each of the U.S. Territories, other than Puerto Rico?
Did OCR make any technical adjustments to the data? For example, how did OCR address the fact that even the detailed 2013 ACS 5-year estimates by State contain information on language groups, as opposed to individual languages?
Why do some of the States on OCR’s list have more than 15 languages listed?
In OCR’s list, why are there significantly fewer than 15 languages listed for each of the U.S. Territories other than Puerto Rico? For instance, only one language is listed for Guam.