The Patient Protection Affordable Care Act (also known as ACA or “Obamacare”) includes requirements for insurers and the healthcare industry to provide translation and interpreting services for limited English proficiency (LEP) individuals. Language Scientific provides translation, interpreting and localization services to keep you compliant with all existing and anticipated future language requirements.
We provide full-service translation, interpreting and localization in more than 215 languages. We specialize in medical and scientific translation and interpreting services for the federal government, public and private healthcare industries and institutions. We deliver a wide range of services, including:
- Medical Translation for the Healthcare Industry
- Professional Scheduled Interpreting and On-Demand Phone Interpreting
- Website Translation
- Software and Mobile App Localization
- Multimedia and eLearning Localization
Our Advanced Scientific Knowledge network (ASKnetworkTM) has over 6,000 certified translators who also have advanced medical and scientific degrees and real work experience in their area of expertise.
Our ISO 17100 and ISO9001 certified processes guarantee three sets of eyes (Translator, Editor and Proofer) on all of your translation projects. This three-step validation process ensures that your documents will be translated correctly so that you don’t have to worry about maintaining regulatory compliance. To give you even more peace of mind, we offer a Certificate of Translation Accuracy with every translation project.
We provide one of the most effective, rapid and customer-focused services in the industry.
We are one of the largest translation vendors for the US Government. We hold a Government-wide contract for Medical and Technical Translation Services, Localization and Interpreting services under the Federal Supply Schedule/Multiple Awards Schedule (FSS/MAS) from the General Services Administration (GSA).
An Overview of ACA Language Requirements
The Affordable Care Act attempts to cover all uninsured Americans and will dramatically increase the number of limited English proficiency (LEP) patients who have insurance, along with the need for language services in healthcare. The ACA includes mandates for providing translation and interpreting services for LEP people to increase healthcare access for all.
There are many federal regulations that mandate language services for LEP individuals. The ACA extends previous mandates and explicitly requires insurers and healthcare institutions to provide written translation and interpreting services for qualifying LEP language groups.
Title VI of the Civil Rights Act of 1964
LEP people are protected from discrimination against national origin under Title VI of the Civil Rights Act of 1964. Title VI mandates that
No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” 42 U.S.C. § 2000d.
The Title VI provision includes discrimination based on national origin. It has been ruled that discrimination on basis of national origin includes exclusion due to lack of language access. Title VI protection covers all healthcare institutions and programs receiving Federal aid (such as Medicaid, Medicare). Title VI covers all Health Insurance plans set up under the Affordable Care Act, and thus mandates providing language services.
Executive Order 13166
Executive Order 13166 requires federal agencies to examine the services they provide, identify any need for services for LEP individuals and to develop and implement a system to provide those services so LEP individuals have meaningful access.
Executive Order 13166 requires recipients of Federal funding to take “reasonable steps to ensure meaningful access.” The highlights of Executive Order 13166 are:
- Develop and implement a system to provide LEP individuals with meaningful access to agency services
- Agencies that provide Federal financial assistance must issue guidance to all recipients of Federal funding on their legal obligation to provide meaningful access to LEP individuals under Title VI of the Civil Rights Act of 1964 and how to implement these regulations.
Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA)
Section 504 prohibits disability discrimination by health care providers who receive federal funds. This mandate further extends the principle of language access and communication-related rights in healthcare.
Non-Discrimination Requirement—Affordable Care Act Section 1557
any health program or activity, any part of which is receiving Federal financial assistance … or under any program or activity that is administered by an Executive agency or any entity established under [Title I of ACA]….
Section 1557 of the Affordable Care Act builds on both Title VI and Executive Order 13166 and furthers protection from discrimination by including any health program or activity that any part of which receives Federal financial assistance including credit, subsidies and contracts of insurance.
Section 1557 also extends non-discrimination protection to the Health Insurance Exchanges (as well as any other entity or Executive agency that administers a program or activity established under Title 1 of the ACA).
Plain Language Requirement—Affordable Care Act Section 1331
The ACA explicitly states that patient communication must be given in “plain language.” Following Section 1331 of the Patient Protection Affordable Care Act, all information that must be submitted must be provided in plain language. Section 1331 of the Affordable Care Act states:
The term ‘‘plain language’’ means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is concise, well-organized, and follows other best practices of plain language writing.
Under this provision, patient communications must be clear, concise and easy to understand. For speakers of other languages such communication may only be understandable when translated or interpreted into their native languages.
Culturally And Linguistically Appropriate Requirement—Affordable Care Act Section 1001
Section 1001 of the Affordable Care Act mandates that health insurance companies and group health plans use language that is linguistically and culturally appropriate when communicating with insurance enrollees. In order to make insurance more comprehendible for all, Section 1001 states that language used must be understandable by the “average plan enrollee.” The ACA Section 1001 states:
The standards shall ensure that the summary is presented in a culturally and linguistically appropriate manner and utilizes terminology understandable by the average plan enrollee.
Understandable and linguistically and culturally appropriate is the standard required by Section 1001 for the mandated Summary of Benefits and Coverage and to give notice to enrollees of the appeals processes and of the support available through the Insurance Ombudsman or Commissioner.
Consumer Assistance Accessibility—DHHS Regulation 45 CFR § 155.205(c)
The Department of Health and Human Services is responsible for the regulations and standards associated with the Affordable Care Act and related Health Insurance Exchanges. 45 CFR § 155.205(c) sets up accessibility requirements for Health Exchanges for LEP patients. Specifically, Exchanges must provide oral interpretation, written translation and “tag lines” informing individuals of the availability of translation and interpreting services. 45 CFR § 155.205(c) states:
(c) Accessibility. Information must be provided to applicants and enrollee’s in plain language and in a manner that is accessible and timely to—
(2) Individuals who are limited English proficient through the provision of language services at no cost to the individual, including
(i) Oral interpretation;
(ii) Written translations; and
(iii) Taglines in non-English languages indicating the availability of language services.
10% Threshold For Providing Language Services Under ACA
The threshold to provide translation and interpreting for LEP patients is more than 10% of non-English speaking individuals in a county. However, those LEP individuals must belong to the same language group.
The actual language states, “10 percent or more of the population living in the consumer’s country are literate only in the same non-English language.”
Using this established threshold, insurers and healthcare providers can calculate if they must provide language services, and for which languages.
Documents That Must Be Translated Under the Affordable Care Act
The Affordable Care Act explicitly requires translation of specific documents, including the Summary of Benefits and Coverage (SBC) and the Uniform Glossary. However, translating other documents may be implied, for example provision of claim and appeal notices most likely must be translated since they are to be presented in a linguistically and culturally appropriate manner. The provision of these documents in plain and translated languages applies to all insurance plans, whether they are bought through an employer or privately.
SBC (Summary of Benefits and Coverage)
The Affordable Care Act mandates that all health insurers and group health plans provide a Summary of Benefits and Coverage (SBC) to all clients and consumers.
The US Government has designed a template for insurance companies to use to disclose benefit and coverage information to maintain consistency across all insurance plans. This template helps people compare insurance plan information and includes:
- What is covered
- What is not covered
- Cost-sharing provisions and exclusions
- Examples of coverage
- Website and telephone number for customer service to get more information
Additionally, all English SBCs must include information on the availability of language services that is written in the required languages.
Under the Affordable Care Act, both the insurer and the employer are responsible for creating and distributing the SBC for fully-insured plans. For self-insured plans the employer is solely responsible for creating and distributing the SBC.
The Affordable Care Act requires all insurers to supply a uniform glossary to explain complicated or confusing terms associated with the health insurance provided. Insurers must make a translated version of the uniform glossary available in specific languages for LEP individuals. The languages that are required for translating the SBC and uniform glossary are set by the threshold of 10% of the population having limited English proficiency.