Understanding Patient Rights to Medical Interpreters, Language Access

Federal requirements for medical interpreters

Under both Title VI of the Civil Rights Act and Executive Order 13166, federal entities must provide interpreter services for LEP individuals. This includes healthcare organizations receiving federal funds, such as through Medicare or Medicaid/CHIP.

Section 1557 of the Affordable Care Act has also created protections for medical interpreter services as part of its protections from discrimination on the basis of race, color, or country of origin.

Title VI, Executive Order 13166, and Section 1557 have also created requirements for medical translation services, meaning vital written materials must also be offered in other languages.

Medical interpretation services refer to verbal services bridging the language gap between patient and provider. These services must be free-of-charge to the individual receiving them. Neither Medicare nor Medicaid are required to reimburse providers for offering language services, although Medicaid has clarified that state programs, plus CHIP programs, are not beholden to doing so.

“States may consider the cost of language services to be included in the regular rate of reimbursement for the underlying direct service,” according to Medicaid.gov. “In those cases, Medicaid/CHIP providers are still obligated to provide language services to those with LEP and bear the costs for doing so. Still, states do have the option to claim Medicaid reimbursement for the cost of interpretation services, either as medical-assistance related expenditures or as administration.”

CMS policy states that language services may receive the standard 50 percent federal matching rate for translation/interpretation activities that are claimed as an administrative expense. Those reimbursements may not be made as part of the rate for direct services.

Considerations for medical interpreter services

Some healthcare organizations employ certified medical interpreters to facilitate these services. These interpreters are humans bound by HIPAA who join the patient and provider to interpret the medical interaction.

There are a few organizations that certify medical interpreters and offer training for those services. Those programs help professionals fulfill criteria set forth in federal, and in some cases state, regulations for medical interpreters.

But employing a certified medical interpreter does have its limitations. Staffing can be challenging, and being that most public insurance options do not reimburse for medical interpretation, staffing can also be costly.

That is not to mention the limitations of interpretation services needed; a healthcare organization receiving federal funding is required to offer interpretation services for a patient even if the organization does not have an interpreter on staff who speaks that language.

Some healthcare organizations have implemented virtual medical interpretation services. These technologies can connect healthcare organizations to medical interpreters with a wider breadth of language options. In some cases, technology options also cut out the lag time to obtain interpretation services.

Some data has indicated video quality limitations. A 2019 study looking into video interpreters for deaf or hard-of-hearing individuals indicated that better video quality and interpreters with medical expertise would make for a better patient experience.

Notably, the Department of Health & Human Services advises against relying on family members for interpretation services. Federal rules state that organizations must offer “an individual who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any specialized vocabulary required by the circumstances,” the agency says online.

Relying on a family member may not accomplish those goals, HHS continued. In cases of domestic abuse, for example, a family member may have an interest in misrepresenting what is being said. Family members are also unlikely to have medical expertise, opening the door for inadvertent misinterpretation. Finally, family members may misrepresent what is being said to cushion the blow of a difficult diagnosis for a loved one.

Therefore, healthcare organizations should consider a careful mixture of certified in-person and virtual medical interpretation services. Organizations may consider the language needs of their population when choosing what kind of language services they will offer. In addition, organizations will need to consider contingency plans when a patient speaks a language for which the organization has no interpreter at that time.

Benefits of medical interpreters

Providing patient access to medical interpreters goes beyond compliance; healthcare organizations working toward health equity and cultural competence need to be able to provide language services to all patients.

Medical interpretation services make for more meaningful patient engagement. With language barriers in the way, LEP patients may not understand their healthcare status or their care management plan, nor will they benefit from patient-centered care and empathic patient-provider communication. In turn, LEP patients may experience unequal clinical or patient experience outcomes.

For example, an October 2021 study found that home health patients who prefer to speak a language besides English saw a 20 percent hospital readmission rate. That compares to an 18 percent readmission rate for English speakers and indicates lapses in patient engagement and care management.

And in November 2020, a separate group of researchers found that patients with limited English language proficiency experience all of the same care access barriers English-speaking patients do, but with the added element of language barriers.

Specifically, individuals with limited or no English language proficiency face challenges interacting with front office staff, medical personnel, and organization representatives over the phone, the study found. This comes on top of existing care access barriers patients often face regardless of language preference, like poor facility navigability or lack of convenient appointments.

That can result in poor patient trust and a tendency to disengage with the medical institution, including primary care, and potentially leaving patients to access higher-acuity care in place of low-acuity care management.

Research has shown that language concordance can address these challenges. August 2021 data from SCAN Health Foundation revealed that LEP patients visiting a clinician who spoke the same language had higher primary care utilization rates and lower specialty care and emergency department utilization rates.

Among those who did not speak the same language as their providers, researchers observed the inverse. These patients were less likely to regularly access primary care, but higher specialty care and ED utilization.

Cultivating a diverse medical workforce will be key to achieving the ideal of patient-provider language concordance. But as the healthcare field continues down its road toward health equity, which will include workforce diversity, it will need to invest in medical interpreter services that could achieve the same good care access and outcomes.

In doing so, organizations will be working toward cultural competency and fulfilling federal mandates.