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OCR Launches Nationwide Compliance Review of CAH Language Access Programs

on Friday, 31 May 2013 in Health Law Alert: Erin E. Busch, Editor

On April 30th, the Office of Civil Rights (OCR) announced that it will begin compliance reviews to support language access programs in critical access hospitals (CAHs) as part of federal efforts to reduce health disparities. OCR reviews will focus on compliance with Title VI of the Civil Rights Act of 1964, which requires CAHs to ensure that individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English can effectively participate in and benefi t from hospital programs and services.


The reviews will expand OCR’s 2012 ten-state pilot review of CAH compliance with Title VI nationwide. For each hospital reviewed in the pilot, OCR examined demographic data from the hospital’s service area, conducted on-site visits, evaluated language access policies and procedures, interviewed staff and community stakeholders, and secured corrective action for any compliance issues discovered. The agency provided signifi cant technical assistance to help CAHs audit and enhance their language access services during the pilot and plans to continue to offer this assistance to hospitals moving forward.


As recipients of federal funds, CAHs must take reasonable steps to ensure meaningful access to their services and activities by individuals who may have limited English proficiency (LEP). A hospital’s duty to provide language assistance to LEP individuals is a fact-dependent inquiry that balances four factors: (1) the number or proportion of LEP persons eligible to be served or likely to be encountered by the CAH; (2) the frequency with which LEP individuals come into contact with the CAH’s programs; (3) the nature and importance of the program, activity, or service provided by the CAH to benefi ciaries; and (4) the resources available to the CAH and the costs of interpretation or translation services.


Using this four-factor analysis, a CAH determines whether it should translate specific documents or portions of documents into the languages of various frequently encountered LEP groups eligible to be served by the hospital or likely to be affected by the hospital’s programs. This will depend on the CAH’s assessment of whether specifi c documents are “vital” to its programs and the consequences to an LEP person if the information in question cannot be timely or accurately provided. 


If a hospital identifies a need to provide language-assistance services, it has considerable fl exibility in developing its plan to meet the identifi ed needs of the LEP populations it services. The U.S. Department of Health & Human Services (HHS) explains that there is no “one size fits all” solution for compliance with Title VI, and that what constitutes “reasonable steps” for a large provider may not be reasonable vis-à-vis a smaller hospital.


Anyone who believes that he or she has been discriminated against due to race, color, or national origin by a CAH can file a complaint with OCR. HHS publishes settlement agreements resolving Title VI discrimination complaints on the OCR website: You can also access federal advice and technical assistance on developing and implementing language-access programs through OCR’s website at


Read the Full Newsletter: Health Law Advisory May 31, 2013 »

Whitney C. West

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