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Section 1557 of the Affordable Care Action: Limited English Proficiency & Language Access Plans

We have received a number of support calls from dental offices regarding the Section 1557 compliance. If you accept Medicaid, Medicare Advantage and/or received funding under the HITECH Act, please read this letter carefully.

Section 1557 of the Affordable Care Act protects individuals from discrimination in health care based on race, color, national origin, age, disability and sex including pregnancy, gender identity, and sex stereotyping.

With 23 million Americans having a limited English proficiency (LEP), the government indicates there is an urgent need for language access services in health care settings in order to ensure that all patients receive accurate as well as culturally competent care.  Without meaningful access, medical errors may result in diagnoses due to misunderstandings in communication. This is dangerous for the patient and is an expensive liability for the provider.

The effective date of the final rule was July 18, 2016 and October 16, 2016 for posting requirements.

Although it is not required to have a Language Assessment Plan in place, development of this policy makes compliance less complicated.  The Plan clearly states how your practice complies and the resources that are in place to assist individuals with Limited English Proficiency.  The Plan also addresses how you assist individuals with disabilities such as communication with deaf individuals.

We must identify qualified interpreters for the languages most likely to be encountered.  Each state identifies the top 15 non-English languages.  For example, Tennessee’s is 111,267 Spanish while Kentucky is 48,275 Spanish.  The second non-English language in Tennessee is Arabic 7,880 while Kentucky is Chinese 4,565.

A bilingual employee may be helpful in providing interpretation; however, having some proficiency in a second language is not equivalent to being completely bilingual.  This distinction is critical in order to ensure meaningful communication.  If your team member is qualified to interpret, please add interpretation to the individual’s job description.  Interpreting may take the employee away from regularly assigned duties and having this built into the job description may avoid staff problems.

If you engage an interpreter, you cannot charge the patient for the interpreter’s fees.  You must enter into a Business Associate Agreement to comply with the privacy provisions of HIPAA.

There are video-remote services available.  However, if you utilize this type of service, you must ensure real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection in order to deliver high-quality video images that do not result in time lags and blurry images.

Keep in mind that blind and deaf individuals come under Title III of the Americans with disabilities Act.  In addition to interpretation, technology must be accessible.  For example, if you are using patient-facing electronic technology such as an online appointment system or online payments, such services should be available to individuals with disabilities.  An exception is if such accessibility is an undue financial or administrative burden.

You must post the nondiscrimination statement and taglines in the top 15 non-English languages of the state in your office and on your website. The top 15 non-English languages are available at

Copy and paste the non-discrimination notice and tag lines according to the languages of the state. The non-discrimination notice is available at The tag lines are available at  These notices go in every significant publication.  Small publications can be limited to the top two non-English languages.

If you have 15 or more employees, you must have a grievance procedure in place and a designated compliance coordinator.

Key documents such as the patient registrations, consent forms, Notice of Privacy Practices and others should be available in regularly encountered languages.

The Office of Civil Rights enforces compliance.  Additionally, an individual or entity may bring a civil action to challenge a violation.

We hope this information provides insight on the requirements for language access plans.  We realize it is yet one more thing practices must do to keep up with compliance. The American Dental Association has excellent resources available for members.

If you need assistance with this area of compliance and would like us to complete the paperwork for you, please contact our office. We can put together your plan and outline the resources necessary on your behalf including translation of your documents.

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