Policy Initiatives

The NCIHC works for the development and advancement of the medical interpreter as an integral part of the health care experience for limited English-speaking patients.

This activity takes the form of, but is not limited to, proactively:

1. Interacting with professional health care organizations and associations to:

• Provide and promote NCIHC standards in the use of medical interpreters.
• Provide and promote NCIHC standards of ethics and behavior for medical interpreters.
• Provide NCIHC guidelines for policy and procedure development.

2. Acting as a national clearinghouse involving federal legislative activity relating to interpreting in health care.

3. Interacting with governmental agencies to promote and advocate for the role of the health care interpreter.

4. Working with health care review and regulatory agencies in developing standards for the role of the medical interpreter and the medical interpreting process.

5. Acting as a resource to local advocacy groups in promoting professionalism in medical interpreting.

6. Act as a resource to the limited English proficient person and ethnic communities in support of educating and promoting understanding of regulatory guidelines, assuring equal access to health care services.

7. Acting as a resource by collaborating with ethnic communities and community-based organizations that work with limited English proficient populations by providing education and understanding of regulatory guidelines assuring equal access to culturally and linguistically appropriate health care services.

NCIHC Policy Education Actions

Federal Guidance on Language Access for Limited English Proficient individuals

Title VI of the 1964 Civil Rights Act states that recipients of federal funds may not run their programs in such a way as to create discrimination on the basis of race, color or country of national origin. The Office for Civil Rights at the Department of Health and Human Services enforces this act and has for many years held that language is an aspect of the country of national origin. In short, any organization that receives federal funding is required to provide language access to its services.

Although regional Offices for Civil Rights have been engaged for years in responding to complaints of violations based on language access, prior to 2000 there was no national guidance for recipients of federal funds on how to assure compliance with this rule. In addition, this act was not applied to the Federal Government itself, meaning that language access to services provided by federal agencies was not guaranteed.

Executive Order 13166

In August of 2000, then-president Bill Clinton signed Executive Order 13166, which required all federal agencies both to provide guidance to recipients of their funds on how to comply with Title VI and to produce a plan on how to provide language access to their own services.

2000 LEP Guidance from the Office for Civil Rights

Almost immediately, the DHHS OCR released guidance on which it had been working for several years. The NCIHC, like other institutions, provided public feedback about that guidance and issued a press release that lauded the publishing of this guidance document.

Soon after, the Department of Justice also released guidance and asked for public comment; NCIHC also provided commentary on that guidance document.

Quite a number of federal departments have been unresponsive in producing guidance. Because of the amount of health care provided to students through school health programs, NCIHC decided to sign on to a letter sent by LEP Advocacy to the Department of Education, protesting its sluggishness in providing guidance on language access.

Opposition to EO 13166 and the OCR Guidance

Opposition to the Executive Order and the OCR Guidance was not long in surfacing. After the election of President Bush in 2000, conservative forces in Congress sought unsuccessfully to have the EO revoked. Riders on several bills tried to defund any efforts to provide language access to federally funded programs; all these efforts failed.

Finally, the American Medical Association decided to join the dialogue. In a letter to the Secretary Tommy Thompson of DHHS, the AMA claimed that providing interpreter services was too expensive and requested that OCR not implement the 2000 guidance. The OCR responded that the regulations governing access have been in place since 1964 and that Congress would need to rescind the entire 1964 Civil Rights Act in order for them to cease implementing the guidance.

The AMA continued to publish in publications around the country its opposition to efforts to guarantee language access. A news wire dated January 8, 2002, is typical of the sort of claims about cost made by the AMA. The NCIHC decided to engage the AMA directly by responding with a letter to the wire.

The Council also wrote an editorial to the Washington Post to correct mistaken allegations made in an article about the AMA letter to Secretary Thompson.

Inquiry by the Office for the Management of the Budget

In response to concerns about the cost of interpreter services, Congress did request that the Office for the Management of the Budget (OMB) investigate the overall cost of implementing the Executive order. In response to an OMH request for public comment on this issue, the NCIHC signed on to a letter written by the National Health Law Project (NHeLP). The OMB concluded that the cost of implementing the Executive Order was minimal.

Response to State Budget Cuts

NCIHC has also intervened in the struggle to maintain funding for interpreter services at a state level. In 2002, the state legislature of Washington State was prepared to cut state financial support for interpreter services to Medicaid patients, a program that had been functioning for over a decade. The NCIHC sent a letter to key state legislatures encouraging the reinstatement of this program back into the budget before the final vote. This intervention, together with strong lobbying by many groups that serve refugees and immigrants, resulted in the funding being reinstated in the Washington State budget.

NCIHC Comments to OCR Regarding 2003 LEP Guidance.