The rules require that providers offer interpretation services during direct encounters and translations of vital written communications, including discharge and medication instructions, explanations of benefits and appeal notices.
They also require that interpreters be trained in medical terminology and health care ethics. Family members or friends may not substitute for a trained interpreter unless requested by the patient, and bilingual staff members can only interpret in an emergency.
The new regulations apply to all hospitals and other health care providers — doctor’s offices, dental offices, and clinics — that take federal money. Doctors who see patients on Medicaid are covered, but physicians who treat patients in certain Medicare plans would be exempt (unless they also see patients on Medicaid). The regulations also apply to insurance marketplaces created under the ACA, and insurers that participate in them.
Health policy experts say the new rules will improve the health of non-English speakers by making it easier for them to get preventive care, helping them avoid more serious — and costly — health crises. Studies have found that language barriers prevent patients from receiving regular checkups, cholesterol and cancer screenings, breast exams and flu shots. When they do visit a doctor, non-English speakers often misunderstand their doctor’s advice, or struggle with prescription directions.
"If someone can't understand what their doctor says or what they are signing in a consent form, that is not considered equal access to health care," said Marina Hadjioannou Waters, a vice president of the National Council on Interpreting in Health Care, which advocates for greater availability of interpreting and translation services for non-English speakers.
The requirement also may save money by making it less likely that non-English speakers will be readmitted to the hospital after they are released, and by reducing the likelihood of malpractice claims. One analysis of medical malpractice claims found that 2.5 percent of the reviewed claims were the result of inadequate language services.
The Medicaid programs in 14 states (Connecticut, Idaho, Iowa, Kansas, Maine, Minnesota, Montana, New Hampshire, New York, Utah, Virginia, Vermont, Washington, and Wyoming) and the District of Columbia will cover the cost of language services, according to the National Health Law Program, which assists low-income people with health care.
For patients who are not covered by Medicaid or for those who live in other states, providers must pick up the tab.
Hennepin County Medical Center in Minneapolis has 140 full- and part-time interpreters who speak 23 languages (Spanish, Somali and Hmong are the most common languages requested). The hospital expects to provide language services 340,000 times by the end of the year. Michelle Chillstrom, who oversees the program at Hennepin said the cost is about $8.8 million a year, out of a total budget of $850 million. The hospital receives about $3.4 million in reimbursement from Medicaid and other medical assistance programs, she said.
Michigan’s Medicaid program does not cover language services. At the University of Michigan Health System, interpretation and translation costs about $3 million a year out of a total budget of $3.1 billion, according to Michelle Harris, who oversees the program there. The hospital system has 100 in-house interpreters, and in the last year they provided help in 80 languages. The hospital receives about 2,000 requests a month, most frequently for Spanish, Mandarin and Arabic.
Like many others, the Minnesota and Michigan hospitals contract with private companies for more obscure languages they may encounter among patients, and often use video conferencing for those services.
That's how hospitals in less-populated areas frequently meet their language service needs. Central Maine Medical Center in Lewiston contracts with a private company to provide all interpretive services through video links. A spokeswoman for the hospital said its greatest needs are for Somali, because of a large refugee population that was settled in central Maine, and French, as a result of the French-Canadians who move across the border for work.
The National Rural Health Association and America's Essential Hospitals, which represent public and nonprofit hospitals, said their members were worried about paying for the new requirement, though they support its intent.
Rosemary Blackmon, chief operating officer of the Alabama Hospital Association, said the new rules may be perplexing to some hospitals in her state."They have to have notices in the top 15 languages spoken in the state," Blackmon said, "but we have counties that probably don’t even have a single person who speaks a foreign language."
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