By Paloma Peña, Director of Quality and Customer Experience; Sarah Stockler-Rex, Quality Assurance Supervisor; and Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.
This piece is the second in a new series, written by Cloudbreak Health’s quality and training leaders, that discusses medical language access and related topics.
In our last installment, we discussed how Video Remote Interpretation (VRI) is an important component in today’s world of language access. Like everything else in health care, language access requires some serious planning. In this volume, we will discuss exactly that: how to create a Language Access Plan that includes VRI to ensure your facility is not only compliant but providing appropriate patient care.
So, what is a Language Access Plan? A Language Access Plan (LAP) is summarized as an effective written plan for providing interpreter services that are appropriate to the particular circumstances. Section 1557 of the Affordable Care Act (ACA) does not explicitly say when OPI, VRI, or onsite modalities should be used. Evaluation of what mode of language assistance is optimal will depend on length, complexity, context of communication, prevalence of the language, and frequency of the language encountered. Section 1557 stresses the importance of providing timely service while ensuring meaningful access and avoiding delay or denial of the service or benefit. A decision tree, such as the example below, can be incorporated into a LAP to help guide staff in providing the appropriate resource for commonly encountered scenarios.
Now that we understand the what, it’s time to consider the who. Health care administrators and other leaders are instrumental in developing LAPs. In both LAP development and revision, it’s important for administrators to consider different clinical and operational needs of each department. Section 1557 explicitly says all entity staff need to be trained on how to obtain language assistance and how to operate and use OPI and VRI if they are resources. All personnel should be thoroughly trained and provided proper scripting for answering what language services are available. This includes volunteers who frequently staff the points-of-entry desks as well as facility operators who triage calls and inquiries. In some cases, bilingual staff may even be incorporated into the LAP to provide language services directly, however, they should only interpret if they are qualified and it is a part of their official job duties.
For language access to be meaningful, the interpreter must be qualified, having demonstrated proficiency in speaking and understanding English and their other language(s), including any specialized vocabulary, terminology, and phraseology. In other words, qualified interpreters are those who have been specially trained and assessed for language proficiency needed for the profession and understand the code of ethics or professional conduct and standards of practice. Remote interpreting has grown so much in the last several years that while interpreters performing remotely have the same performance expectations as onsite interpreters, they may have greater exposure to some specialized topics. The VRI provider can answer questions regarding their requirements for qualification, ongoing training, as well as language availability.
Last but certainly not least, we must consider the patient. The patient’s preferences on how to communicate should be taken into consideration when choosing which interpreting modality is going to be used. For example, Section 1557 specifically says that Deaf individuals can specify how their communication needs should be met. And if a patient requests to use a companion as their interpreter, it is recommended providers have a qualified interpreter present (whether onsite or remotely) to ensure accurate and complete communication. It is never appropriate to work with an unqualified interpreter for informed consent, discharge instructions, diagnosis, treatment options, proper use of medications, or insurance coverage for health-related issues.
Section 1557 further specifies that minor children cannot interpret unless it is an emergency and there is imminent threat to the safety or welfare of the patient or public and no qualified interpreter is available. In yet other cases, the patient themselves may not need interpreting services but is accompanied by a family member, spouse, or partner who does. This individual should be provided access to a qualified interpreter even if the patient does not need one. One of the benefits of incorporating VRI and OPI solutions into your LAP is more timely access to qualified interpreters for all the above-mentioned scenarios.
LAPs are not mandated by Section 1557, but they are referenced throughout the document as a best practice. Whether or not a LAP exists would be taken into consideration if an investigation were to take place. Having one would show the entity took action to prepare to meet the needs of Limited English Proficient/Deaf/Hard of Hearing (LEP/D/HoH) patients. Even though LAPs are not mandated, language access is. Therefore, in most instances, VRI must be incorporated into the LAP because the interpreting demand exceeds the onsite resources available due to the frequency of request, language availability, or distance from the facility. If incorporating VRI, Section 1557 outlines specific video quality requirements that must be met.
A LAP should be created as soon as possible so your facility is prepared to serve its LEP/D/HoH patient populations. Once in place, LAPs should be reviewed for effectiveness and updated at least annually, taking into account stakeholder feedback as well as any changes in demographics within the community. Any shifts or growth within community populations could shape demand and decisions around VRI or OPI services as part of the LAP. There should also be an active mechanism for renewing awareness and training of the Language Services policies within the organization.
Throughout this article we have shared advisement on how to develop and revise a LAP that includes VRI. Below is a summary of the main steps for LAP implementation:
- Identify key stakeholders that will be involved in the creation of the plan.
- Complete a self-assessment of your organization to identify and assess the following:
- LEP/D/HoH community demographics
- How LEP/D/HoH individuals interact with your organization (via telephone for scheduling, written mailed documents, in-person, etc.)
- Based on the results of your organization’s assessment, document your plan to include:
- Modalities of language interpretation (onsite, VRI, and OPI)
- Decision tree to determine appropriate use for each interpreting modality
- Resources such as internal staff and language service providers
- Document and website translations
- Process for monitoring and evaluating services
- Staff training
- Patient notification and outreach on available language services
- Develop a process to update the LAP regularly.
Additionally, there are many resources available for further reading to help get you started with a LAP that would include VRI, which we have linked below.
Although this planning process might seem overwhelming, you are not alone; your language services department and vendors can provide expertise to help you with the process of developing or reviewing a LAP. We invite you to continue reading our ongoing VRI series as we dig deeper into more of the many related topics. If there is a topic you are interested in, feel free to contact us and let us know more about your questions about delivering optimal language access.
- Guide to Developing a Language Access Plan by the Centers for Medicare and Medicaid Services:
- Language Access Assessment and Planning Tool:
- Example of Language Access Policy by HHS:
- National Health Law Program’s Language Services Resource Guide for Health Care Providers:
- SHLP’s Instructions for Developing a Language Access Plan:
- Health Resources and Services Administration worksheet: