Talk to your doctor about your LEP… and their LAP

It sounds like a pharmaceutical advertisement, doesn’t it? You can imagine some animated body part tugging a person towards a restroom, a fuzzy rendition of a cat coaxing us to sleep or, my favorite, a couple reclining in a pair of bathtubs, all working to convince us to counter our LEP.  But to paraphrase the immortal Inigo Montoya, “I do not think that word means what you think it means.”

While we could talk for hours regarding the wisdom of direct-to-consumer advertising in the pharmaceutical industry, that is not what we are talking about here.  LEP is not a medical condition, but it is so serious it can derail a medical practice. 

The Affordable Care Act (ACA) includes many provisions regulating the way physicians practice, and section 1557 prohibits discrimination. Discrimination is central to concerns over LEP.  Many may be surprised to learn that failure to take reasonable steps to provide meaningful access to patients with LEP – Limited English Proficiency – can result in suspension from Federal Healthcare programs, the DOJ may bring suit for a civil rights violation against the provider, and more. 

The Department of Health and Human Services has drafted a list of the fifteen languages most commonly encountered by US providers (see Top 15 Languages by State). Providers are obligated to take reasonable steps to ensure meaningful access to these groups. Do these regulations mean Texas physicians need to hire a Gujarati interpreter? An Alaskan clinic an Ilocano translator? A Maine hospital a team of Nilotic speakers?  A practice may not need to add a staff of translators, but there are some specific requirements that must be addressed. And yes, expect the market for health translators to boom after this final rule for implementation of ACA Section 1557.  

Practices must post notices regarding accessibility requirements in the common languages for that locale. These can be downloaded for your locale at this HHS webpage. In addition to posting notices, a practice must have in place a mechanism for providing translator services when necessary to provide meaningful access to individuals with limited English proficiency.  These services must include translation of documents and oral interpretation. The services must be provided free of charge and in a timely manner. Lawyers will ultimately spend hours arguing over the appropriate definition of terms “timely” and “meaningful.” (Practices should be aware that in the legal world, lawyers’ hours typically equate to doctors’ dollars.)

One special caution for practices accustomed to having a staff member serve as an impromptu translator; translation services must be a part of the employee’s written job description. Practices may also want to develop a LAP – a Language Access Plan. It is not required, but as is often the case with federal regulation, having a written plan is used to determine an entity’s compliance with the regulation.

The regulation and proper implementation is Section 1557 will impact medical practices significantly, complicating the delivery of quality care even more. Practices should be proactive and address these issues now.

If you want to know more about this or other legal issues relevant to the delivery of health care, contact the Spiers Group today.