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Summary of State Law Requirements Addressing Language Needs in Health Care Summary of State Law Requirements Addressing Language Needs in Health Care Prepared by: Mara Youdelman National Health Law Program April 2019 © 2003, 2005, 2008, 2019 National Health Law Program Acknowledgments As anyone who has done a 50-state survey can attest, conducting it takes a significant amount of determination, commitment, and time. We could not have produced this update without the incredible support of two law firms who offered pro bono assistance to update our research –– Hogan Lovells US LLP and McDermott Will & Emery LLP. The team at Hogan Lovells US LLP included Brian D. Eyink, Christine Forgues, Samantha L. Dietle, Arthur E. Kim, Komal Karnik Nigam, Erkang Ai, Jane Kalinina, and Yetunde D. Oni. The team at McDermott Will & Emery LLP included Sandra DiVarco, Monica Wallace, Ryan Higgins, Emily Edwards, Jade Jenkins, Candace Polster, and Winnie Uluocha. Thanks to all of them for their hard work! In addition, NHeLP volunteer attorney Ara Janoyan and legal intern Craig Ismaili provided significant support in reviewing drafts of the compiled research, copy-editing and ensuring citations are standardized according to legal requirements. Without all of their help, this update would not have been possible! Summary of State Law Requirements Addressing Language Needs in Health Care 2 Table of Contents Acknowledgements ................................................................................ 2 Introduction ................................................................................................... 4 Methodology .................................................................................................6 State Law Snapshot – What’s Changed between 2008 and 2018 ............................ 7 State Law Totals ........................................................................................ 12 Using the State Charts ......................................................................... 14 State Charts.................................................................................................. 15 Alabama ....................................15 Montana .................................198 Alaska ..........................................25 Nebraska ...............................200 Arizona .......................................29 Nevada ................................... 203 Arkansas .................................... 33 New Hampshire ..............206 California ..................................37 New Jersey ..........................209 Colorado .................................. 89 New Mexico .........................222 Connecticut .......................... 99 New York ................................231 Delaware ................................103 North Carolina ...................245 District of Columbia ..... 104 North Dakota .....................247 Florida ......................................108 Ohio .......................................... 250 Georgia .....................................112 Oklahoma .............................255 Hawaii ........................................113 Oregon ....................................259 Idaho ..........................................117 Pennsylvania .......................269 Illinois .........................................119 Rhode Island ......................275 Indiana .................................... 140 South Carolina ...................281 Iowa ............................................144 South Dakota .....................282 Kansas .......................................151 Tennessee .............................284 Kentucky ................................152 Texas ......................................... 289 Louisiana.................................155 Utah ..........................................303 Maine .........................................161 Vermont .................................305 Maryland ................................165 Virginia ................................... 306 Massachusetts ................... 170 Washington ..........................310 Michigan .................................182 West Virginia........................321 Minnesota ..............................185 Wisconsin ..............................324 Mississippi ..............................194 Wyoming ...............................328 Missouri ...................................196 Summary of State Law Requirements Addressing Language Needs in Health Care 3 Introduction Since the early 2000’s, the National Health Law Program has charted the development of state laws on language access. This edition of our 50-state survey provides an update on state activities since 2008. State laws provide an additional source of protection to federal laws. Indeed, some state legislatures and administrative agencies increasingly recognized the need for linguistically appropriate health care and have adopted measures that require or encourage health and social service providers to overcome language barriers. As of 2019, every state and the District of Columbia had enacted multiple laws addressing language access. California continues to have the most provisions with 257; however, every state now has at least three such provisions. A limited number of states have enacted comprehensive laws while most states’ provisions focus on a particular type of health care provider, service, payer, or patient group. Some of these laws provide detailed guidance; others note the importance of language access but do not specify activities to improve it. Recent trends include provisions addressing private insurers and marketplaces, interpreter competencies, and cultural competency training for health professionals. This update to NHeLP’s prior publications offers citation to and a short description of each state’s statutes and regulations regarding services to LEP persons in health care settings. It supersedes the previous listings published by the National Health Law Program in 2003, 2005, and 2008.1 1 See Jane Perkins, Mara Youdelman, and Doreena Wong, Ensuring Linguistic Access in Health Care Settings: Legal Rights and Responsibilities Appendix D (2d Ed., Aug. 2003) (published by The California Endowment and available from the National Health Law Program, Los Angeles, CA); Jane Perkins, Summary of State Law Requirements Addressing Language Needs in Health Care (Dec. 2005), Jane Perkins and Mara Youdelman, Summary of State Law Requirements Addressing Language Access Needs in Health Care (2008), https://healthlaw. org/resource/summary-of-state-law-requirements-addressing-language-needs-in-health-care/. Summary of State Law Requirements Addressing Language Needs in Health Care 4 While this publication focuses on state laws, a number of federal laws also require language services. States must comply with these laws. The box below summarizes some of the more important federal laws. Federal Laws Requiring Language Access Title VI of the Civil Rights Act of 1964 (“Title VI”) – ensures that all federal fund recipients cannot discriminate on the basis of race, color, or national origin.2 Title VI’s implementing regulations also prohibit “disparate impact” discrimination. Through Executive Order 13166, Title VI applies to federal agencies themselves.3 Section 1557 of the Affordable Care Act – applies both to federal fund recipients as well as all programs and activities administered by the federal agencies and entities created under Title I of the ACA, primarily federal and state marketplaces and qualified health plans.4 The regulations implementing Section 1557 outline requirements for notifying clients/ patients of language services, providing oral interpreting and including taglines on significant written documents.5 Hill-Burton Act – hospitals that received funding under this Act have an ongoing “community service” obligation which includes non-discrimination in the delivery of services.6 These hospitals must post notices of this obligation in English, Spanish, and other languages spoken by ten percent or more of the households in the service area.7 Emergency Medical Treatment and Active Labor Act – requires screening, treatment and transfer requirements which would be challenging to meet without effective communication with a limited English proficient (LEP) patient.8 2 42 U.S.C. § 2000d. See also Title VI of the Civil Rights Act of 1964; Policy Guidance on the Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency, 65 Fed. Reg. 52762 (Aug. 30, 2000), https://www.govinfo.gov/content/pkg/FR-2000- 08-30/pdf/00-22140.pdf. For information on federal requirements, see National Health Law Program, Federal Laws and Policies to Ensure Access to Health Care Services for People with Limited English Proficiency (Dec. 9, 2004), at https://healthlaw.org/resource/federal-laws-and- policies-to-ensure-access-to-health-care-services-for-people-w/. 3 See https://www.govinfo.gov/content/pkg/FR-2000-08-16/pdf/00-20938.pdf. 4 42 U.S.C. § 18116. 5 45 C.F.R. Part 92. 6 See 42 U.S.C. § 291c(e), 42 C.F.R. § 124.603. 7 U.S. Dep’t of Health and Human Services, Office for Civil Rights,Medical Treatment in Hill- Burton Funded Healthcare Facilities, https://www.hhs.gov/civil-rights/for-individuals/hill- burton/index.html. 8 See 42 U.S.C. § 1395dd, 42 C.F.R. § 489.24. Summary of State Law Requirements Addressing Language Needs in Health Care 5 Methodology The National Health Law Program has conducted a 50-state survey of statutes and regulations addressing language access in health care a number of times. Initially appearing in
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