The Doctor’s Advocate | Fourth Quarter 2023
Limited English Proficiency (LEP) Patients: Top FAQs
The Doctors Company frequently responds to questions about limited English proficiency (LEP) patients (individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand it).
LEP patients may be entitled to language assistance with respect to a particular type of service, benefit, or encounter. If you accept Medicare or Medicaid patients in your practice, you must comply with federal laws pertaining to LEP patients or face the possibility of fines, sanctions, and penalties.
To help you ensure compliance, we have compiled answers to common questions about LEP patients.
Yes. Practitioners who receive federal financial assistance from the U.S. Department of Health and Human Services (HHS) are required to take reasonable steps to ensure that LEP patients have access to language services. The exception is if you receive only Medicare Part B payments.1
HHS provides guidance to assist practitioners in meeting LEP obligations.2 To determine the extent of your obligation, analyze the following four factors:
- The number or proportion of persons with LEP served or encountered by your practice. The greater the number, the more likely language services will be needed.
- The frequency with which persons with LEP come into contact with your practice. Even if that contact is unpredictable or infrequent, you must have a plan for obtaining interpretive services.
- The nature and importance of your services. The more important the services or greater the consequences, the more likely interpreter services will be needed. Also, determine if a delay in accessing your services could have serious or life-threatening implications.
- The resources available to you and the cost. As a solo practitioner, you are not expected to provide the same level of service as a large, multispecialty group, but you are still required to take reasonable steps to provide the service. Investigate technology services or sharing resources with other providers.
Failure to comply with the provision of meaningful access may result in the suspension or termination of the federal financial assistance.
Yes. The cost is considered a part of business operations. Failure to provide interpreter services may result in an investigation by the Office for Civil Rights (OCR). Depending on the OCR’s findings and conclusions, violations may result in fines, sanctions, and penalties.
No. Declining to give a patient an appointment on the basis of a linguistic barrier is considered noncompliance. All LEP patients are entitled to free access to language assistance. Violations for noncompliance may be enforced by the OCR under Title VI of the Civil Rights Act and by state and local authorities, depending on the jurisdiction. Fines, penalties, and sanctions may be imposed.
Yes, but it is permitted only in limited circumstances. When considering the use of adult family members or companions, it should be noted that lay personnel are rarely familiar with medical terminology and its nuances and may not provide an accurate interpretation. Additionally, the patient may not want a family member or companion to have access to protected health information (PHI). The patient’s minor child should not be engaged for this purpose.
If a family member or companion must be used as an interpreter, that person should be an adult—unless an adult is unavailable and immediate care is necessary to prevent further harm or injury to the patient. Otherwise, it is recommended that you have a clinical staff member trained to provide interpretation or use certified interpreter services to ensure proper translation of medical information. The local hospital should have a list of qualified interpreters.
Possibly. The key consideration is how proficient staff members are in the patient’s spoken language. If they have only a marginal ability to speak the language, hire a certified medical interpreter. Office staff should meet the same standards as professional interpreters.
An individual’s authorization is not required to disclose PHI when the covered entity provides interpreter services under healthcare operations. The practice may either use a member of the workforce (i.e., a bilingual employee, contracted interpreter on staff, or volunteer) or the services of a person or entity engaged as a business associate.3 If you contract with an entity for interpreter services, a business associate agreement is necessary. Find more information on the HHS HIPAA FAQs for Professionals page.
Document the following information in the patient record: mode of interpretation (in person or by telephone), language translated, and the name, contact information, and professional qualifications of the interpreter.
If using the patient’s family member or companion as an interpreter, note that permission was specifically obtained from the patient, and indicate that a professional interpreter was offered at no cost but was declined by the patient. Include the individual’s name, relationship to the patient, and contact information.
For additional FAQs and actionable strategies to help you ensure compliance, read our article "Limited English Proficiency (LEP) Patients: Frequently Asked Questions."
- Fed Regist. 2003;68:47311-47323.
- U.S. Department of Health and Human Services. Guidance to federal financial assistance recipients regarding Title VI prohibition against national origin discrimination affecting limited English proficient persons. Last reviewed July 26, 2013. https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-vi/index.html
- 45 CFR §164.506(c).
The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.
The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.
The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.
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