Have you heard the news? Only 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). With respect to language access in healthcare, it’s the law that currently requires the use of qualified interpreters and translators for people with limited English proficiency (LEP). It also prohibits the use of minors as interpreters (except in cases of emergency), discourages the use of accompanying adults as interpreters, and more! HHS is planning on implementing some changes to address health disparities for marginalized groups, such as people with LEP, that were exacerbated during the COVID-19 pandemic.

These proposed changes are especially exciting to us at Remote Interpreters of the Americas because it has some major implications for discrimination in telehealth. As it stands right now, many telehealth platforms do not integrate interpretation services, nor do they have a user interface accessible to people with LEP. They also tend to rely heavily upon unchecked machine translation. The proposed changes to Section 1557 of the ACA attempt to address many of these issues that contribute towards discrimination against people with LEP in healthcare.

Comment Period Ends on October 3, 2022 at 11:59PM EDT

HHS 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. This is 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 addressed to 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.)

Before Commenting: Learn About the Proposed Changes

You might be saying, “That sounds great! Sign me up! Where do I comment?” but first it’s important to understand some of the things that are being changed. Additionally, it’s important to note the particular wording of some applicable sections, because you might have feedback on these things. Let’s face it: if you’re an interpreter or translator working with people with LEP every day, you probably have a lot to contribute. And your prospective contributions are things that lawmakers might not consider when writing these laws.

Read the Proposed Rule

If you’d like to read it, we’re providing links to the sections of the web version of the Notice of Proposed Rulemaking (NPRM) below. However, we’re only sharing the parts that deal with changes specific to language access for people with LEP.

To be clear: the NPRM document is a whopping 97 pages. Not everything applies to spoken language access in healthcare. We’ve done our best to list all sections relevant to spoken language assistance in healthcare here. That being said, the best way to understand the legislation fully is to read the whole thing.

• § 92.4 Definitions. – Qualified Interpreters & Translators… and more!
• § 92.8 Policies and procedures. – Including written language access procedures
• § 92.10 Notice of nondiscrimination. – Letting people with LEP know about their rights
• § 92.11 Notice of availability of language assistance services and auxiliary aids and services. – Let people know in their language about language assistance
• § 92.201 Meaningful access for limited English proficient individuals. – When/how language assistance should be provided
• § 92.211 Nondiscrimination in the delivery of health programs and activities through telehealth services. – Equal access to telehealth, even for people with LEP!
  • The Justice Department and HHS actually issued a guidance document on Nondiscrimination in Telehealth for people with disabilities and LEP in July of 2022.  While Section 1557 is very general in its requirements, this guidance document offers detailed recommendations. Guidance documents advise healthcare facilities and other covered entities on how to effectively comply with federal nondiscrimination laws, including Section 1557 of the ACA.

If you’re feeling overwhelmed at the amount of information, it’s okay! This is a big proposed change that impacts a lot of things, even beyond language access. If you feel you need more of a helping hand in going through the proposed changes that we’ve listed here, we’ve also prepared a downloadable PDF walkthrough of the sections linked above. We’re also going to provide you with even more resources in this article in case these resources just don’t strike your fancy.

List of Useful Links for Understanding the Proposed Rule

• 🎥 RIA’s Interactive Workshop Recording on Section 1557 of the ACA & The Proposed Rule
  Remote Interpreters of the Americas (RIA) held an interactive workshop to explore, in detail, the changes to Section 1557 of the ACA. We looked at the changes 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
  • 📘Click here to access the list of resources and useful links provided to attendees (Google Doc)
    This includes many of the links here, but also a link to the slides comparing the 2016, 2020, and 2022 (proposed) rules, general information about U.S. laws, and more.
    
• 🎥 CCHI’S Webinar Recording: NEW Proposed Rule on Section 1557 of the ACA: Highlights and Considerations
  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.
  
• 📑 NHeLP: How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP)
  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.
  

Submit Your Comment!

If you feel like you understand (at least the gist) of the proposed rule and interact with the LEP community in any sort of capacity, you likely want to leave comments. There are multiple ways you can submit a comment:

1. Via Regulations.gov through the Federal Register website
2. On the Regulations.gov website
3. Via Mail
   Please note that we do not recommend this method at this time. It’s getting close to the due date for comments and mail may not arrive on time!
4. NHelP’s Comment Submission Page for Ensuring Language Access in Healthcare
   While this page is not an official government page/website, you can still submit through this page, but your comments will be submitted along with others to HHS. It does, however, give a brief rundown of Section 1557, as well as gives you tips on what you should comment on!

Comment Tips

The comment form at Regulations.gov linked in the section above (list item #1) provides a helpful Commenter’s checklist with some useful advice. One suggestion in particular that we find relevant to interpreters and translators is to “Identify credentials and experience that may distinguish your comments from others. If you are commenting in an area in which you have relevant personal or professional experience […] say so.” Mention your interpretation certifications (NBCMI, CCHI), language pair(s), role, and level/years of experience.

You can add attachments to your comment and the commenter’s checklist on the comment form at Regulations.gov linked in the section above (list item #1) has some suggestions for how to name your files if you attach multiple. Bear in mind though that the the text box on leaving a comment has a 5000 character limit.

The link to NHeLP’s comment form in the section above (list item #4) contains some prompts for interpreters and translators, for if you are having a hard time trying to figure out what you’d like to say. You can always go over your comment one last time after reading NHeLP’s list of helpful prompts to make sure you didn’t forget to mention something.

Let us know if you submitted a comment!

Please let us know if you submitted a comment. While it would absolutely delight us if you found our resources helpful and they actually assisted you in submitting a comment, please let us know even if you submitted a comment without reading our article or using the resources contained within. This will help us to get an idea of just how many interpreters and translators made their voice count!