The ACA Section 1557 Checklist for a Busy Professional

The October 17, 2016 compliance deadline has come and gone.

If you work for a covered entity under Section 1557 of the Patient Protection and Affordable Care Act, being compliant with this law is a must.

The good news is that compliance doesn’t have to be difficult or costly. In reality, it will most likely be more costly in the long run if you fail to comply.

So, what exactly is Section 1557 and how do you ensure compliance?

Being a busy healthcare professional, you don’t have time to waste. To save you time, I’ve put together the following checklist on Section 1557.

1. Is my organization a covered entity?

Start off by determining if this law is applicable to you and your organization. Section 1557 extends non-discrimination protections to individuals participating in any health program or activity receiving funding from U.S. Department of Health and Human Services (HHS).

If you’re not a covered entity, skip the rest of this article. If you are, check this item off and continue reading!

Checklist Item

I work for a healthcare organization or a health insurance marketplace that has a health program or activity which receives funding from HHS.

2. Does my organization currently provide language access services?

How are you currently communicating with your limited-English proficient (LEP) patients?

I bet you already work with an interpreter referral agency or employ interpreters directly. But did you know that language access services also includes written translations of medical documents?

If you are not providing written and spoken language access services, find a reputable interpreter referral agency and/or a translation services provider and contract with them as soon as possible!

The last thing you want to do is have a patient’s relative or a bilingual employee do the interpreting or send a patient home with post-op instructions they don’t understand.

Checklist Item

My organization provides written translated materials and employs professional interpreters and/or contracts with interpreter referral agencies.

3. Do our patients know that language access services are available to them at no cost?

Healthcare organizations must provide LEP patients with qualified interpreters and cannot charge the patients for provision of such services.

The final rule of Section 1557 requires that covered entities post notices of nondiscrimination and taglines that alert individuals with limited English proficiency to the availability of language assistance services. You can view sample notices here.

To customize such notices, reach out to your translation services provider or NWI Global for assistance.

Checklist Item

My organization communicates to its patients about language access services being available to them at no cost.

4. What are the top 15 languages in our area?

This will depend on the state you’re located in. For example, here are the top 15 languages for Oregon and Washington as of August 2016.

Top 15 Languages in Oregon

10Cambodian (Khmer)
11Cushite (Oromo & Somali)
13Farsi (Persian)

Top 15 Languages in Washington

8Cambodian (Khmer)
11Cushite (Oromo & Somali)

For a complete listing of the top 15 languages in your area, visit this page.

Checklist Item

My organization knows the top 15 languages in our area and makes written and oral communication available in those languages.

5. Does my organization have a formal Language Access Plan?

To get your Section 1557 compliance under control, HHS recommends you develop a formal Language Access Plan.

If you don’t have a formal Language Access Plan in place, don’t worry. By providing language translation and interpreting services, you are closer to being compliant.

However, to survive an HHS audit, you may consider putting a plan in place sooner than later.

Work with your language services provider or reach out to us for assistance with your Language Access Plan.

Checklist Item

My organization has a formal Language Access Plan in place and we feel confident about it.

6. We feel confident that our organization is in compliance with Section 1557.

If you do, fantastic! If not, I recommend having your in-house compliance team or legal counsel review your processes to confirm.

If you find that you are lacking in some areas related to this law, it’s never too late to implement changes and improve your business practices.

Checklist Item

My organization had its Section 1557 compliance processes reviewed by a compliance officer and legal counsel.


Section 1557 compliance seems like a daunting task, and it can be if you don’t feel confident in your processes. This checklist will help you get on the right track.

Here are some additional resources to help you, but may take a while to read:

If you have any questions about this topic, feel free to ask in the comments or reach out to me directly.

5 Best Practices for Public Health Language Translation

I have been working closely with public health professionals for over ten years now. My experience includes working with various state and county public health departments, with a specific focus on multicultural communication.

With the APHA Annual Meeting & Expo about to start, I thought this would be a great time to share my experiences with you about the best practices I have learned and implemented over the years doing language translation for public health clients.

One of your goals as a public health professional is to ensure health equity for the people you serve. One way to do that is to offer content in their native language. Here are the 5 best practices for public health language translation you can apply immediately in your field of work.

1. Understand the Target Audience

Prior to having your public health materials translated, you must first understand your target audience. Is the target audience LEP (limited-English proficient) persons that immigrated to the United States, or do they still reside in their native countries? For this article, let’s assume you are targeting LEP populations in the United States.

Diverse Target Audience

The next step is to identify the languages of LEP persons you are targeting. You can do this in person by using I-SPEAK cards available at Once the language is identified, it should be stored in the respective LEP person’s health record. This information can then be aggregated and used to determine the most commonly-requested languages in your public health district to ensure meaningful access to services.

Another source you can use to determine the languages in your area are various demographic surveys. Using this method will give you a high-level view of the languages in your area. It’s not as precise as the first method I mentioned above.

Your takeaway: Know and understand your LEP target audience before translating your public health content.

2. Translate for the Appropriate Reading Level recommends writing your health content for the 7th or 8th-grade reading level. This is perfectly fine for a native English-speaking audience. When you are ready to translate your English public health content into other languages, I recommend targeting the 5th or 6th-grade reading level.

Translate for the appropriate reading level

The reason behind this is that the education level of certain immigrant populations may not be as high as your typical native English speaker. In fact, I’ve personally observed persons in certain communities who can speak their native language, but have a tough time reading.

If a person can’t read in English, let alone their native language, you will have a tough time communicating with him or her. To help ensure better understanding, target a lower reading level and follow the plain language guidelines.

Your takeaway: Instruct your translation vendor to translate for the 5th or 6th-grade reading level.

3. Create a Glossary and Style Guide

Every industry has specific terminology and jargon. Public health is not an exception to this rule.

For example, terms such as assurance, benchmarks, cultural competence, evidence, risk assessment and vector can mean different things in different contexts. To avoid misunderstandings, you probably already have an English public health glossary such as this one.


Many states have their public health glossaries available in languages such as Spanish. For other languages, especially those of rare diffusion, have your translation vendor assist you with creating one. The benefits of having approved bilingual glossaries is improved consistency in public health communication.

A style guide is just as important for the look and feel of the public health materials as a glossary is for the content and context of the translated text. The style guide should address abbreviations, acronyms, units, and terms that should be transliterated or kept in English, among other things.

Here is a great example of an English style guide for public health communication.

Your takeaway: Create and utilize bilingual glossaries and style guides for your translated public health material.

4. Localize Photos and Graphics

Adapting a piece of content into another language typically requires more than translating the text. A publication laid out in InDesign will have text, along with visual elements such as photos and images. Some of those images may contain text within them!

Washington State Dept. of Health English Source

In most cases, it is recommended that you have the photos and images localized for the target audience. This means that you may decide to replace images of people with photos of people who look more like a typical speaker of that language. Having localized photos and images will create a better end-user experience. It will help the person relate to the translated piece of content.

It’s also important to consider cultural factors when localizing photos and images, so you don’t offend your target audience. Here are some things to avoid: hand symbols and gestures, religious symbols, and animal symbols that could have emotional meanings.

Conversely, here are some visual elements you can include: images of nature, abstract shapes, inanimate objects, globally recognized public health symbols and other standardized images that particular cultures won’t find offensive.

Your takeaway: Think beyond text translation. Make sure all photos and images are localized properly.

5. Involve Local Communities

For your public health communication to be successful, you must first build trust with your target audience. This is true regardless of the language you’re communicating in. If your target audience doesn’t have trust in you, your communication will not be as effective as it could be.

Friendly Government

Most public health agencies being government entities must build trust with the local immigrant communities in their districts. The reason behind this is that in some countries, government agencies are viewed as corrupt entities that are out to extort people. This is especially true in developing countries that are torn by war and other conflicts.

How do you build trust?

By involving your local communities before, during and after translating your public health content. The best way to do this is through community meetings and workgroups. You will be getting the communities involved, with the help of language interpreters, and build trust.

By doing this you will emphasize that government is not a threat. This will help focus more on the public health issues you’re addressing to begin with.

Your takeaway: Communicate and build trust with the local immigrant communities for your public health communication to be successful.


Language translation plays a big part in ensuring health equity in public health. You can define the success of your public health communication by understanding your target audience, their cultural and educational background, creating a glossary and style guide, localizing photos and images, and building trust.

Following these best practices and working with language translation vendors who can help you execute them is essential to successful communications. It’s also time and money well spent.

Please share other best practices you’ve come across as a public health professional working with diverse communities in the comments.

3 Reasons to Provide Interpreters for Your Customers

For businesses in certain industries, it’s a fairly common practice to provide interpreters for their customers. In this article, I will use the healthcare industry as an example, where the patient is a customer.

You may view providing interpreters as just another unnecessary business expense. Let me show you why it is necessary and how working with interpreters can be beneficial to you, regardless of the industry you are in.

Whether you are a seasoned consumer of interpreting services or are just now looking into launching a language access program, I will give you three solid reasons to provide interpreters for your customers.

1. Increase Brand Awareness

Everyone wants their business to be successful, and one way to do that is to create brand awareness. As a healthcare practice, you might be doing that by sponsoring local events, investing in your online presence and offering referral discounts.

Why not advertise the fact that you also provide language interpreters?

Brand Awareness

It’s true that some states and insurance companies will reimburse you for providing interpreters for your patients, while most of the time you will have to cover the cost directly. If you pay for interpreters directly, here’s how to justify it as a marketing expense.

Run a local awareness campaign, advertising that you serve diverse communities of patients who speak Spanish, Russian, Vietnamese and other languages. Include that you also serve the Deaf and Hard of Hearing community with the help of sign language interpreters.

Such an approach will only help increase brand awareness of your business in the local community and allow you to justify interpreters as a marketing expense.

Providing interpreters for your customers will improve your position in the market you’re serving. By limiting your communication to one language, you do not realize the full potential of your business. Turn that around by letting your customers know you can serve them in many languages.

2. Improve Customer Satisfaction

Every business wants satisfied customers. After all, satisfied customers tell friends and colleagues about their experience interacting with you. They may even leave a review about your business on Yelp or elsewhere.

Ratings and Reviews

Your job is to leverage that to your advantage. Be known as that awesome clinic that helps all patients, regardless of the language they speak (or sign). Don’t be the clinic that takes shortcuts and lacks in providing a great patient experience.

Improving customer satisfaction is an investment, so you must be ready and committed to pay for it. If you hire staff interpreters, that’s fantastic. If you contract with language service companies for interpreter referrals, that’s also a good thing.

Regardless of how you approach providing interpreters for your patients, be sure to do it right. Work with interpreters that help your business succeed so you can reap the rewards of satisfied customers – getting more customers and five-star online reviews.

3. Comply with Laws and Regulations

Every business wants to comply with laws and regulations. If they are not, it would be tough to continue staying in business. Being subjected to a lawsuit or a government audit will not only drain your bank account, but may also put you out of business.

Laws and Regulations

When it comes to providing language interpreters, particularly in healthcare settings, it’s required by law more often than not. The cost of providing interpreters for your patients is marginal compared to what you would pay to survive an audit or pay out in a legal settlement.

And no, you cannot pass the cost of interpreters to your patients.

Taking this approach, you can categorize interpreter services as a compliance expense.


You now have three reasons to provide interpreters for your customers, regardless of whether your business is in healthcare or another industry. Each reason gives you a unique angle and justification for providing such services.

If you are already providing interpreter services, you are a third of the way there! Why not try some of the tactics I outlined in reasons one and two? If you are new to requesting interpreters, here’s an article that will explain how to do it.

It will only benefit your business to increase brand awareness and improve customer satisfaction.

Have more reasons or thoughts to share about this topic?

Post them in the comments.

7 Documents All Health Care Providers Should Have Translated

As a health care provider, you already know that you may be required by law to provide language access to your patients. The cost of providing interpreters is already part of your budget, right?

You might as well leverage it to provide a better patient experience and reduce your risk exposure.

A good way to do this is to have certain documents translated into the languages spoken by your patients. I will share my experience with you in helping hospitals and clinics provide translated content for their patients.

You will also be able to download several templates that were translated into Spanish for use in your practice. Read on to find out more!

For those of you in a hurry, download the templates now by clicking here and comeback when you have time to read the article.

Narrow down the languages

Before you hire a company or a translator to translate your health care documents, figure out your most frequently requested languages. I bet Spanish is probably your top language other than English.

According to Pew Research, by 2020 there will be 41 million Hispanic Spanish speakers in the United States, and not all of them speak English.

Hispanic Spanish Speakers in the U.S.

Translation can get expensive as you add more documents and languages. If you are going to have your documents translated into just one language, I’d recommend you choose Spanish.

Here is more on how translation pricing works.

Gather your documents

As you get ready to have your documents translated, you should first gather them all together. The last thing you want to do is take a paper copy of a document, scan it in and send it off to your translation vendor.

That scanned copy is most definitely going to be low quality and will need to be retyped.

Avoid scanning documents when possible

And retyping leads to additional costs.

What you should do is provide your translation vendor with the documents in an editable format such as MS Word. Editable files are much easier to work with.

Editable files such as MS Word are the way to go

Working with editable files also helps maintain quality and consistency, and reduce overall cost.

Contact your translation vendor

Since you have the editable files, you can simply email them to your translation vendor. In your email, specify what language you want them translated into and your turnaround time requirements. Your vendor will provide you with a cost and time estimate to complete the project.

Email Request for Translation

Once the translation has been completed, the translated documents will be emailed back to you. You can then start using them in your health care organization.

Recommended list of documents for translation

I’ve worked with dozens of health care clients in the past decade and helped them translate hundreds of documents. As a result, I am providing you with a narrowed down list of most popular ones.

Here are the documents all health care providers should have translated.

1. Patient Information Form

This is one of the most essential forms you should use in your practice. It captures all basic health information about the patient that you can then input into the electronic health record (EHR).

Your front desk staff will give this form to the patient to fill out before the appointment is scheduled to start. If the patient speaks Spanish, it will just make it that much easier for him or her to fill out the form.

Patient Information Form

The patient information form may include the following elements: patient’s contact info, medical history and changes since their last visit with a doctor. You can get as detailed as you need, but I’d recommend keeping this form limited to two pages.

2. Patient Rights & Responsibilities

This should also be a fairly short document. It includes the rights your patients have when visiting your practice as well as their responsibilities to you.

Remember that one of those rights is having an interpreter available at no cost to the patient.

Language access in Spanish

I’ve included a sign for your convenience that you can print and place near your reception area that will make it easier for the patient to know that interpreter services are available.

You can download it with the rest of the templates.

3. Consent and Assent Forms

Your patients have the right to consent to treatment. They also have the right to refuse treatment. In many cases, you may be required by law or corporate policy to have such decisions documented.

Signing an informed consent

Some of the common consent and assent forms include:

  1. Release of Information
  2. Consent to Treat
  3. Consent to Procedure
  4. Consent to Immunization

If your patients don’t understand what they are consenting to, it does not do you any good having consent forms to begin with.

Have your consent and assent forms translated to keep your patients informed.

4. Patient Instructions

Your patients will need instructions that they should follow after they visit with you and perhaps even before their next visit.

For some procedures, such as a colonoscopy, one has to prepare. He or she does that by following your instructions.

Patient Instructions

In physical therapy, you may have just treated someone for a sports–related injury. That patient now needs instructions for what to do and what to avoid in order for his or her treatment to be effective.

Translate those patient instructions and give them to your patients.

5. History Questionnaires and Progress Notes

This is something that you may or may not need translated. For history questionnaires, you can write down the answers provided to you by the patient with the help of an interpreter.

As you interview the patient, the interpreter will relay the information between you and the patient in English and your patient’s language. Your task is to write down the information in English.

Things get a bit tricky with progress notes. Let’s say your patient presents you with progress notes from Mexico.

Those progress notes are handwritten in Spanish. There could be critical health information in those notes and you should have them translated from Spanish into English.

Handwritten progress notes are hard to read

Handwritten text is difficult enough to read. Handwriting done by a doctor or nurse in Spanish is even more difficult.

Scan those progress notes into a PDF and send them off to your translation vendor to have them translated (this is the only time it’s appropriate to scan your documents).

Your vendor will provide you with a translation in an easy-to-read, typed-up document.

6. Missed Appointment Policy

Everyone hates untimely cancellations and no-shows. It’s a huge waste of time for everyone, including the staff at your practice. In this case, time also equals money.

If your patient doesn’t show up for an appointment, you lose money. Additionally, the interpreter will expect to be compensated in such occurrences.

Medical appointment schedule

To mitigate patients missing their appointments, many health care providers implement a missed appointment policy. According to the American Medical Association, it is ethical for health care providers to charge patients for missed appointments.

However, your patients must know of this policy in advance.

Have your missed appointment policy translated and provide it to your patients so they understand the consequences of missing appointments without providing you with sufficient notice.

7. Patient Financial Responsibility Waiver

All citizens and legal residents of the United States are now required to have health insurance, or face a penalty. I bet most of your patients are insured, with the exception of those few that prefer to pay cash.

Having the ability to bill your patient’s insurance for your services is great. Of course, until the claim is denied and you’re in an awkward spot having to contact your patient with the bad news.

Medical bills

Clear this up in advance by having your patients sign off on a financial waiver. This will cover you in the event insurance doesn’t cover a certain medical procedure or refuses to pay for your services for one reason or another.

By communicating this information to your patients in advance and having them sign a financial waiver protects you. You now have an ability try and collect from your patients directly.

Free Templates to Get You Started

The American College of Physicians has many great patient care and office forms you can download here. With the permission of the ACP, NWI Global went ahead and translated some of these forms into Spanish.

This is great news for you since you can start utilizing these forms without any additional overhead cost for translation.

Click Here to Download the ACP Patient Care and Office Forms in Spanish

These are just general templates, so if you need to customize them, make sure you work with your translation vendor to do that. You can also reach out to us for assistance.


Providing interpreters for your patients isn’t enough. You should also provide them with written content that’s been translated into their languages. You now have a good starting point and a list of recommended documents to have translated.

By doing this, you are going to improve patient satisfaction. You will also reduce your risk of not being in compliance with Title VI and other regulations.

It’s true that translating documents will cost you, but in the long run the payoff will be immeasurable.

What other documents can you think of that need to be translated for your practice?

Share your thoughts in the comments.

Are Hospitals Required to Provide Language Access Services?

You are reading this article because you are not sure that you may have to provide language access services for your patients, right?

You are not the only one, as this is very important topic that is often clouded in confusion. To provide an expert answer, I reached out to the National Health Law Program (NHeLP) for assistance.

The staff at NHeLP did a great job clarifying the requirements for us in very simple terms.

Language access services are generally provided with the help of professional interpreters and translators.

For the purpose of this article, I will assume that you are a health care provider fitting one of the following four categories:

1. You provide language access services for your patients, but are unsure if you are required to do so.

2. You don’t provide language access services for your patients, but understand you may be required to do so.

3. You didn’t provide language access services for a patient and are being threatened with legal action.

4. A law suit has been filed against your practice for failure to provide language access services by, or on behalf, of the patient.

Regardless of which category fits you, the information below should help clarify your responsibility to provide language access services for your patients.

Unless of course you fall into category 4. If that’s the case, contact your attorney as soon as possible.

Are hospitals required to provide language access services?


Here is why.

Under Title VI of the Civil Rights Act of 1964, discrimination on the basis of race, color or national origin is prohibited.

Therefore, health care providers, including hospitals, that receive federal funding, including Medicare, Medicaid and SCHIP, are required to provide language access services for their patients.

What if health care providers opt out of federal funding?

When federal funds are not in question, health care providers may not be subject to Title VI requirements. However, there may be state laws that require you to provide language access services.

Can health care providers bill the patient for language access services?


If you are receiving federal funding, you are required to cover interpreter costs for all your limited English proficient (LEP) patients, including those with private insurance and no insurance.

State laws may also prohibit you from billing your patients for language access services.

What health care entities are covered under Title VI?

The entities covered by Title VI include hospitals, doctor’s offices, nursing homes, managed care organizations, state Medicaid agencies, home health agencies, health service providers and social service organizations.

How can health care organizations provide language access services to patients?

Health care providers may choose to hire staff interpreters as employees to interpret the most frequently requested languages. Many health care providers typically contract with language service companies to provide language access services.

A language services company can greatly streamline the process by providing scheduling, quality assurance, billing and project management.

What types of language access services should health care providers have readily available to patients?

At a minimum, it is recommended that all health care providers be able to provide on-site interpretation, over-the-phone interpretation and document translation services.

Can health providers use family members, friends or bi-lingual staff to interpret for patients?

It is strongly advised against using family members, friends or bi-lingual staff members to interpret for patients. You could risk malpractice, the cost of which would far outweigh any money you might save by asking friends or family members to help.

In fact, your legal fees in dealing with just one malpractice lawsuit could potentially cover your language access services budget for several years to come.

What about written translation services for patient communication?

According to U.S. Department of Health and Human Services Office for Civil Rights, various types of documents may require translation from English into other languages. Some of the documents include patient forms, discharge instructions and information about the availability of interpreter services.

Learn about the 7 most common document types all health care providers should have translated.

I’d like more information on developing a Language Access Plan for our health care organization.

For more information, check out these publications:

Like this Article?

Download it now in PDF format.


Dozens of law suits are filed every year against health care facilities for failing to provide language access services.

My advice to you is to set aside a budget for language access services and deliver the best patient experience you can. It will cost you less in the long run.

Share your questions, thoughts and experiences in the comments.

This article was originally published on July 8, 2011 and has been updated on February 8, 2016.