summary of state law requirements january 2008 Addressing Language Needs in Health Care PREPARED BY: Jane Perkins Mara Youdelman National Health Law Program © 2008 National Health Law Program Summary of State Law Requirements Addressing Language Needs in Health Care PREPARED BY: Jane Perkins Mara Youdelman National Health Law Program SUPPORT: This publication was made possible with the generous support of The California Endowment. © 2008 National Health Law Program National Health Law Program Table of Contents Introduction ..................................................................................................................... 4 using the State Charts ..................................................................................................... 7 Methodology .................................................................................................................... 8 State Charts ............................................................................................................... 9-135 Alabama.................... 9 Kentucky................... 59 North Dakota........... 101 Alaska....................... 11 Louisiana.................. 60 Ohio........................102 Arizona ......................13 Maine....................... 62 Oklahoma................105 Arkansas................... 15 Maryland.................. 63 Oregon....................107 California................... 17 Massachusetts.......... 65 Pennsylvania............110 Colorado................... 33 Michigan................... 70 Rhode Island............113 Connecticut...............36 Minnesota................. 71 South Carolina..........117 Delaware.................. 38 Mississippi.................75 South Dakota...........118 District of Columbia... 39 Missouri.................... 76 Tennessee................119 Florida.......................41 Montana................... 77 Texas........................121 Georgia..................... 43 Nebraska...................78 Utah.........................122 Hawaii...................... 44 Nevada..................... 80 Vermont...................123 Idaho........................ 45 New Hampshire........ 81 Virginia.....................124 Illinois....................... 46 New Jersey................82 Washington..............126 Indiana..................... 53 New Mexico..............88 West Virginia.............133 Iowa......................... 55 New York.................. 93 Wisconsin................134 Kansas...................... 58 North Carolina.........100 Wyoming.................135 Endnotes ................................................................................................................... 136 Summary of State Law requirements addressing Language needs in Health Care Introduction1 There are a number of federal laws that address language access in health care settings. Virtually all health care providers must comply with Title VI of the Civil Rights Act of 1964. Its purpose is to ensure that federal money does not support activities that discriminate on the basis of race, color, or national origin. Another federal law requires hospitals that received funding through the Hill-Burton Act to have an ongoing “community service” obligation which includes non-discrimination in the delivery of services. According to the U.S. Department of Health measures that require or encourage health and Human Services Office for Civil Rights, and social service providers to overcome these hospitals must post notices of this language barriers. obligation in English, Spanish, and other This publication of state-by-state laws offers languages spoken by ten percent or more of citation to and a short description of each the households in the service area. There state’s statutes and regulations regarding are also federal laws that implicate the need services to LEP persons in health care settings. for meaningful language access if they are It supersedes the previous listings originally to be effectively implemented. Under the published by the National Health Law Program Emergency Medical Treatment and Active in August 2003 and updated in 2005.6 Labor Act, for instance, it would be difficult for a hospital to comply with the Act’s screening, All 50 states have enacted laws concerning treatment and transfer requirements without language access in health care settings. effective communication with a limited California continues to have the most laws; English proficient (LEP) patient.5 Despite such however, every state now has at least two federal requirements, lack of knowledge and such laws. A limited number of states have enforcement leaves millions of LEP individuals enacted comprehensive laws while most without meaningful access to health care. states’ provisions focus on a particular type of health care provider, service, payer, State laws provide an additional source of or patient group. Some of these laws protection. Indeed, state legislatures and provide detailed guidance; others note administrative agencies are increasingly the importance of language access but do recognizing the need for linguistically- not specify activities to improve it. Recent appropriate health care and have adopted National Health Law Program trends include provisions addressing cultural requirements for health care service plans competency training for health professionals (or managed care plans) and for individual and Medicaid funding for language services. and group insurers to provide insured individuals with appropriate access to Some highlights are: translated materials and language assistance in obtaining covered benefits. AWashington Comprehensive Laws. law requires all health carriers to file an access California has enacted a number of plan with the insurance commissioner that comprehensive provisions, including a Title includes a description of the health carrier’s VI look-alike that authorizes enforcement by efforts to address the needs of covered individuals who are not provided language persons with limited English proficiency. services. California has developed some of Meanwhile, Texas repealed a provision the most comprehensive provisions that guide that prohibited health insurers from using state agencies, general acute hospitals, and underwriting guidelines based on the ability the provision of services for individuals with of the insured or applicant to speak or read developmental disabilities and/or mental English (former Tex. Ins. Code § 21.21 7). health needs. Based on the finding that an Health Educational requirements. inability to speak, understand, or read English New Jersey, California and Washington is a barrier to public services, Maryland’s require cultural competency instruction as 2002 “Equal Access to Public Services for an educational component or continuing Individuals with Limited English Proficiency education for health professionals. Act” requires State agencies to provide equal access to public services for LEP individuals. Mental Health. Washington, D.C. followed suit in 2004—any Laws in 46 states address mental health, District agency, department, or program that including in- and out-patient services.7 These furnishes information or renders services range from translating patient rights notices directly to the public or contracts with other to mandating interpreters for commitment entities to furnish such services must provide proceedings. For example, Illinois requires oral language services to LEP persons who state mental health facilities to provide seek the services offered by the covered entity. interpreters during admission and intake, when denying admission, and during Health Insurance Coverage. assessments or evaluations while the Some states address the interplay between individual is being interviewed or tested by health insurance and language access. a psychologist, psychiatrist, or physician. California requires the Department of Managed Health Care and the Insurance Women’s Health. Commissioner to promulgate regulations Thirty-five states have laws concerning establishing language standards and women’s health, including 30 that focus on Summary of State Law requirements addressing Language needs in Health Care abortion or sterilization and 14 that address assessment and care planning conferences. other issues such as pre-natal care. Provisions Funding. in 17 states to assure that Medicaid will cover A number of states have enacted laws to sterilization only after informed consent has provide funding to pay for language services. been obtained in the LEP patients’ primary Texas authorized Language Interpreter language.8 Eleven states have “Women’s Service Pilot Programs to pay for language Right to Know Acts,” which typically require services in Medicaid in five sites statewide. information about adoption, fetal pain In 2007, Connecticut authorized Medicaid associated with abortion, the possible payments for language services, and New detrimental psychological effects of abortion, York enacted funding for hospitals. and fetal development at two-week intervals to be published in English and in each Interpreter Certification. language that is the primary language of two Four states require or are initiating state-based percent or more of the state’s population. certification. This is due, in part, to recognition that self-identification as bilingual is insufficient Other Population Groups. to be a competent interpreter. Washington States have also adopted provisions has the oldest certification program. More addressing services for children