What is Section 1557?  How You Can Help Shape Language Access in Healthcare

On July 25, 2022, the U.S. Department of Health and Human Services (HHS) announced proposed changes to Section 1557, which is the nondiscrimination provision of the Affordable Care Act (ACA). Section 1557 builds upon the protections offered by Title VI of the Civil Rights Act of 1964, which prohibits any entity receiving federal funding from discriminating against certain protected groups. One of those groups is national origin, which includes someone’s ability or inability to speak or understand English. So, Title VI makes it illegal for entities receiving federal funding to discriminate against people with limited English proficiency (LEP), and Section 1557 covers how people with LEP (among other groups of people) can’t be discriminated against in most healthcare settings.

As of right now, when it comes to healthcare, Section 1557 mandates the use of qualified interpreters and translators for people with LEP. It also prohibits the use of minors as interpreters (except in cases of emergency), discourages the use of accompanying adults as interpreters, and so much more. The Department of Health and Human Services (HHS) is planning on implementing some changes to address health disparities for marginalized groups, such as people with LEP, that were amplified during the course of the COVID-19 pandemic.

You Can Make a Difference for People who Need Interpreters in Healthcare!

The U.S. Department of Health and Human Services is accepting comments on the changes they’re proposing to make. Comments are due on October 3, 2022 at 11:59pm Eastern Daylight Time (EDT). If you’re an interpreter, translator, or in some way, shape, or form involved in language services, your knowledge and experience is a valuable asset during this comment period, because many of the changes that are being made will directly affect people with LEP. Not only must HHS consider the comments submitted, these comments can and often do change the proposed rules!

It may feel like a lot of pressure to write something like this addressing a major department of the U.S. government. You may feel like it needs to be perfect or that you might not have what it takes to write something that they’ll take seriously. But your comment doesn’t need to be a work of literary genius, as long as it is impactful and memorable. Sharing personal experiences and the experiences you’ve borne witness to working in the field of language access can make all the difference. (For more on why public comments matter, click here.)

Learn More About the Proposed Changes to U.S. Healthcare Law

We understand that not all of us, even those of us based in the U.S., may be familiar with how U.S. law works. Before we get into the nitty gritty of what’s included in the proposed changes, we’re going to share some general resources about U.S. law so folks can have a general understanding before learning more about the proposed rule.

Commonly-Used Acronyms

If you’re an interpreter or translator, we assume one of your working languages is English, meaning you’re probably familiar with just how much English-speakers love their acronyms! U.S. laws and regulations contain lots of acronyms, and the document on the proposed rule contains a lot of them!

  • ACA – The Affordable Care Act of 2010
  • HHS – The U.S. Department of Health and Human Services
  • LEP – Limited English proficient or limited English proficiency
  • NPRM – Notice of Proposed Rulemaking
  • OCR – Office of Civil Rights (in the context of Section 1557: the HHS OCR)
  • Title VI – Title VI of the Civil Rights Act of 1964

Resources for Understanding the Proposed Rule

The proposed changes to section 1557 are contained in a document called a Notice of Proposed Rulemaking (NPRM, as mentioned in the previous section). It’s 97 pages with lots of references to past laws and legal cases, so it may not be the most accessible or understandable document for many people. Below you will find a bunch of resources in different formats to help you learn more about these proposed changes to Section 1557.

🎥 Videos for Understanding the Proposed Rule

Recording of RIA’s Interactive Workshop on Section 1557 of the ACA & The Proposed Rule: History, Discussion, a Detailed Look

Length: 1h 48m | Detail: Very detailed| Complexity: Medium

Remote Interpreters of the Americas (RIA) held an interactive workshop to explore, in detail, the changes to Section 1557 of the ACA as they related back to spoken language interpretation, as well as sign language interpretation. This recording (1 hour and 48 minutes) has short bursts of lecture but is mostly conversation among participants sharing their observations and feedback.

CCHI’S Webinar Recording: NEW Proposed Rule on Section 1557 of the ACA: Highlights and Considerations

Length: 1h 20m | Detail: Somewhat detailed| Complexity: Low

This webinar was given by Mara Youdelman, former CCHI commissioner and managing attorney of the National Health Law Program (NHeLP). She is a national expert on language access in healthcare and her webinar was incredibly informative! This recording is about an hour of lecture followed by about 45 minutes of Q&A.

📑 Articles for Understanding the Proposed Rule

Remote Interpreters of the Americas: Take Action! Big Changes on the Horizon for Language Access in U.S.Healthcare

Length: Medium| Detail: Very detailed| Complexity: Medium

This article has two useful tools for exploring the proposed changes. The first is a list of links to all the sections in the NPRM that apply to language access to read them yourself. The second is a PDF document that walks you through each and every part of the proposed legislation with explanations!

NHeLP: How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP)

Length: Short| Detail: Not very detailed| Complexity: Low

This is a brief article by the National Health Law Program about how the proposed rule affects people with LEP. This article was adapted from their Section 1557 Q&A Brief. It provides very general, but succinct, information about the proposed rule as it relates back to language access.

The Comment Process & How to Comment

When a U.S. government department like the Department of Health and Human Services would like to make a change, they issue a Notice of Proposed Rulemaking (NPRM) and allow the public to comment on the changes they’re thinking of making for a period of 30-60 days. Because the 2022 NPRM for Section 1557 was published on August 4 of this year, its 60-day comment period ends on October 3, 2022 at 11:59 PM Eastern Time.

Remember: The comment period ends on
October 3, 2022 at 11:59 PM Eastern Time!

Comments are incredibly important, and we can tell you from reading the full NPRM ourselves that even comments from past comment periods on Section 1557 were considered in the drafting of these proposed changes! As we mentioned in the beginning of this article, if you’re involved in language services, your knowledge can be a major asset during this comment period. Many of the changes that are being made will directly affect people with LEP, and HHS is required by law to consider comments left on this proposed rule!

If you’d like to comment, we highly suggest checking out RIA’s article on the proposed changes, which offers detailed tips on commenting. Then, when you’re ready to comment, you can submit your comment to the Federal Register by clicking here!

Did you comment? Be sure to let us know here!

We’re really interested to know just how many interpreters and translators are speaking out in favor of language access in healthcare for the communities they serve. Make sure to comment below if you submitted a comment on the 2022 proposed changes to Section 1557.

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