Question: How should we quantify community benefit related to language services provided through our clinics? We have seen the guidance that only services provided above the legal requirement would qualify as community benefit. However, we are having a tough time quantifying where the legal requirement really ends, especially with respect to language services provided to our refugee population (many languages, relatively small population).
Recommendation: Language services for individuals with limited English proficiency (LEP) include two types of services: interpreter services and translation services. Both types of services have been the subject of federal laws and regulations.
In May 2016, the U.S. Department of Health and Human Services (HHS) issued a Final Rule that implemented Section 1557 of the Affordable Care Act. The Final Rule, entitled Nondiscrimination in Health Programs and Activities applies to hospitals that accept Medicare and any other health programs that HHS administers. Among other protections (including requirements for individuals with disabilities and prohibitions against sex discrimination), the rule requires “covered entities” like hospitals to take reasonable steps to provide meaningful access to each individual with limited English proficiency.
Language assistance (interpreter) services must be made available to every individual who needs them. Hospitals also are required to post “taglines” (short statements written in non-English languages that alert individuals about the availability of language assistance services, free of charge, and how the services can be obtained) in the top 15 languages spoken in their home state.
Other federal rules govern requirements to translate certain “vital documents.” These documents must be translated for every limited English proficiency (LEP) language group “that constitutes 5 percent or 1,000 persons – whichever is less – of the population served” (translation threshold). Some states have more stringent requirements.
Pursuant to the above regulations, we recommend not counting costs associated with interpreter services. Costs to translate documents for LEP language groups that fall below translation thresholds may be reported; however, hospitals that report such costs should carefully assess both demographic data and regulations before reporting translation services as community benefit.
(Updated May 2019)
Question: Can we report the costs of providing sign language interpretation services as community benefit?
Recommendation: Providing sign language interpretation to patients is required by federal law therefore the costs of providing these services should not be reported as community benefit.
(Updated May 2019)