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September 15, 2020 Webinar FAQs

What does the law mean by “meaningful” access?

Per Title VI of the Civil Rights Act of 1964 and Executive Order 13166, recipients are obligated to take reasonable steps to ensure that people who are limited English proficient have meaningful access to a recipient’s programs and activities. 

While there is no official federal definition of meaningful access, federal law and guidance focus on ensuring that people who are limited English proficient (i.e., their primary language is not English and they are limited in their ability to read, write, speak, or understand English) can effectively communicate with a recipient.

Many recipients are unaware of the existence of language barriers and health disparities that are the result of limited English proficiency.

To improve communication with people who are limited English proficient (LEP) and help ensure that it is effective, recipients are encouraged to determine what reasonable steps should be taken to provide language access by conducting an individualized assessment using a four-factor analysis detailed in the 2003 Revised HHS LEP Guidance.

Common reasonable steps may include the provision of language assistance services, such as oral language assistance or written translation.

A recipient may determine that written translation of vital documents into multiple languages would be a reasonable step to provide meaningful access to its programs and activities. Is there a baseline number of languages that a recipient’s documents should be translated into?

As general guidance, recipients are encouraged to translate vital documents into the language of each frequently-encountered LEP group by the recipient’s program.

Whether or not a document is vital depends on the seriousness of consequences that the LEP individual may face if the information in question is not provided accurately or in a timely manner.

For examples on what materials may be vital, see the 2003 Revised HHS LEP Guidance.

Currently, there is no minimum number of languages required for translation.

However, it is important to note that if a recipient provides written translations of vital documents under the following two circumstances, such action will be considered by HHS as strong evidence of compliance with the recipient’s language access obligations.

  1. The recipient provides written translations of vital documents for each LEP language group that constitutes 5% or 1,000 (whichever is less) of the LEP population likely to be served; or
  2. If there are fewer than 50 people in an LEP language group, the recipient does not translate vital written materials, but provides translated written notice of the right to receive oral interpretation of those written materials free of cost.

Are recipients under an obligation to provide care that is culturally and linguistically appropriate?  In other words, must recipients adopt policies and tools outlined in the National CLAS Standards?

No, but we encourage it.

As a baseline, Title VI of the Civil Rights of 1964 states that recipients must prohibit discrimination on the basis of race, color, and national origin in their programs and activities.

Recipients must also take reasonable steps to provide meaningful access by LEP individuals to their programs and activities.

The National Standards on Culturally and Linguistically Appropriate Services (CLAS), developed by the HHS Office of Minority Health, provides specific guidelines to healthcare organizations to help deliver services that are

  • Culturally and linguistically appropriate and respectful; and
  • Responsive to patients’ cultural health beliefs, preferences, and communication needs.

These 15 standards are not mandatory for recipients to adopt, but are increasingly recognized as effective in improving quality of care by addressing cultural and communication barriers that many individuals face when receiving services.

Review National CLAS Standards (PDF - 2 MB) and how to implement them within your organization.

Under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, recipients must provide full and equal access to their programs and activities by people with disabilities through reasonable modifications of policies, practices, and procedures. Are there any exceptions to this requirement?

Yes. Disability law allows recipients to deny a requested modification of their program or service if they can demonstrate that the request would result in a fundamental alteration.

A fundamental alteration is a change that is so significant that it would alter the essential nature of the care or service being provided.

However, the bar to deem a requested modification as a fundamental alteration is high. Recipients must conduct an individualized assessment of the request and, even if it is deemed to be a fundamental alteration, must consider reasonable alternatives to provide program access by people with disabilities.

For example, a healthcare provider that specializes in care for older adults may refuse to see a patient under the age of five because it is a fundamental alteration of the healthcare service normally provided.

However, the healthcare provider should consider providing a reasonable alternative to this request, such as a referral to a nearby pediatrician.

Review Section 504 of the Rehabilitation Act and the Americans with Disabilities Act.

If a recipient is part of a large healthcare system that has a Language Access Plan or Disability Access Plan in place, does that sub-recipient need to create additional plans specific to HRSA programming?

No, but we encourage it.

Language Access and Disability Access Plans assist HRSA recipients in determining how to balance meaningful access by LEP individuals and people with disabilities to its services and programs while not imposing undue burdens.

Through an individualized assessment, a sub-recipient may determine that accessibility measures, in addition to what is systemically required, are not sufficient for the different types of programs or activities in which it engages.

For example, some of a sub-recipient’s activities may have a greater impact on or contact with LEP individuals and thus may require more in the way of language assistance.

If you have questions about creating a Language Access or Disability Access Plan, contact HRSACivilRights@hrsa.gov for help.

Date Last Reviewed:  November 2020