ACA Section 1557
Final Rule

2016 Rule:

Section 1557 mandates that providers “take reasonable steps to provide meaningful access to each individual with limited English proficiency eligible to be served or likely to be encountered in its health programs and activities.” It also bans discrimination based on association, meaning providers must supply interpreters as needed to their patients’ families, spouses, or partners as needed.

2020 Rule:

The Rule maintains that entities are obligated to take reasonable steps to ensure meaningful access to covered health programs and activities for LEP individuals.

Changed:

HHS replaced the two-factor test with the Department of Justice’s 2003 LEP Guidance four-factor test, which assesses how an entity should provide meaningful access:

• The number or proportion of LEP individuals eligible to be served or likely to be encountered in the eligible service population;
• The frequency with which LEP individuals come in contact with the entity’s health program, activity, or service;
• The nature and importance of the entity’s health program, activity, or service; and
• The resources available to the entity and costs.

HHS also repealed the language that prohibits discrimination against an individual or entity on the basis of being known to or believed to have a relationship or association.

Same:

This Final Rule clarifies where language assistance services are required to be offered by a covered entity:

1. they must be no-cost, timely, and accurate;
2. that translators or interpreters provided in order to comply with the law must meet specific minimum qualifications, including ethical principles, confidentiality, proficiency, effective interpretation, and the ability to use specialized terminology as necessary in the healthcare setting;
3. and that a covered entity may not require an individual with LEP to bring his or her own interpreter or rely on a minor child or accompanying adult to facilitate communication, except under limited exceptions