A prospective patient’s wife called to make an initial appointment for the patient. During the call, she stated that her husband needs a hearing interpreter. Do we have to make an appointment for this patient? Is the office required to provide an interpreter? Can we charge the patient for the cost of the interpreter?
The decision to provide clinical care, whether for a prospective or current patient, should NOT be made on the basis of a patient’s disability or limited English proficiency (LEP).
Physicians, dentists, hospitals, healthcare facilities, and other healthcare providers who receive federal financial assistance and/or funding are generally responsible for providing auxiliary aids or other service accommodations at no cost to the patient, as specified in Section 1557 of the Affordable Care Act (ACA), “Nondiscrimination in Health Programs and Activities.”
Changes to Section 1557 of the ACA, which went into effect July 18, 2016, also require covered entities (CEs) to post a notice of nondiscrimination and taglines about the availability of auxiliary aids and language-assistance services, as well as how patients can access those services. The taglines must be posted in the top 15 non-English languages spoken in the CE’s state. Notices must be posted within 90 days of the effective date. ¹
When selecting an auxiliary aid or language-assistance service, the complexity of the communication and the patient’s accommodation choice are primary considerations. The healthcare provider’s ultimate goal is to facilitate effective communication. A question to ask the patient — either through an interpreter or through use of an assistive device — is “What is the best way for us to talk about your health problem?”
Risk strategies related to patients who require auxiliary aids or services include the following:
- Conduct a four-factor LEP analysis that considers the following:
- The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee
- The frequency with which LEP individuals come in contact with the program
- The nature and importance of the program, activity, or service provided by the program to people’s lives
- The resources available to the grantee/recipient and costs²
- Develop a written policy and procedure on auxiliary aids and language-assistance services for patients who have disabilities or LEP. The policy/procedure should outline a process for (a) identifying and assessing need, (b) notifying patients about the availability of services, and (c) providing auxiliary aids and services.³
- Periodically educate staff regarding the written policy. Document education in each staff member’s employment file.
- Document in the clinical record (a) identification and assessment of need, and (b) each time an interpreter or assistive device was used (including the name and phone number of the interpreter or the type of device).
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- Agency for Healthcare Research and Quality: Health Literacy Universal Precautions Toolkit, 2nd Edition: Address Language Differences (Tool #9) — www.ahrq.gov/professionals/ quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool9.html
- Office for Civil Rights, U.S. Department of Health and Human Services: Example of a Policy and Procedure for Providing Auxiliary Aids for Persons with Disabilities — www.hhs.gov/ ocr/civilrights/clearance/exauxaids.html
- Office for Civil Rights, U.S. Department of Health and Human Services: Limited English Proficiency — http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/index.html
- Office for Civil Rights, U.S. Department of Health and Human Services: Limited English Proficiency (LEP) Resources for Effective Communication — www.hhs.gov/ ocr/civilrights/resources/specialtopics/hospitalcommunication/eclep.html
¹ 81 FR 31375; Garvin, J. (2016, July 1). Updated ACA mandate takes effect July 18. ADA News. Retrieved from www.ada.org/en/publications/ada-news/2016-archive/june/updated-aca-mandate-takes-effect-july-18
² Office for Civil Rights. (2003). Guidance to Federal financial assistance recipients regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. U.S. Department of Health and Human Services. Retrieved from www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipientstitle-VI/index.html
³ Office for Civil Rights. (n.d.). Example of a policy and procedure for providing auxiliary aids for persons with disabilities. U.S. Department of Health and Human Services. Retrieved from www.hhs.gov/ocr/civilrights/clearance/exauxaids.html
Source: MedPro Group Inc.