Group Sign-On Comment to the Office of Minority Health on Development of a Universal Symbol for Language Assistance Services in Health Settings

View a PDF of the comments here.

May 20, 2024

Office of Minority Health
1101 Wootton Parkway, Suite 100
Rockville, MD 20852

Re: Request for Information: Development of a Universal Symbol for Language Assistance Services in Health Settings

To whom it may concern:

The 104 undersigned organizations that advocate for improved access to health care and language access for individuals with limited English proficiency (LEP) appreciate the opportunity to comment on the Office of Minority Health’s Request for Information regarding Development of a Universal Symbol for Language Assistance Services in Health Settings (the RFI).

Overall, we strongly support the development of a universal symbol for language assistance services. Language access is essential to ensuring effective communication between individuals and the health care system and their health care providers. Without language services, Individuals with limited English proficiency (LEP) may not enroll in programs for which they are eligible, may not receive timely or comprehensive healthcare, and may not know their rights to free, timely and competent language services. We believe having a universal symbol – with comprehensive education of Individuals with LEP about the symbol and widespread adoption by all entities participating in the health and health care arenas – would help improve understanding about how to request language assistance services and ensure effective communication for Individuals with LEP.

Meaningful Access for Individuals with LEP

Under both Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act, individuals with LEP have the legal right to receive language assistance services. Yet many go without these services because they do not know how to request them. The need for language access in health care is significant: more than 8% of the U.S. population – more than 26 million individuals – is limited English proficient (LEP).[1] The provision of language access in health care is correlated with better patient outcomes, better compliance with instructions such as prescriptions and hospital discharge orders, and greater patient satisfaction.[2]  Given the strong desire across the federal government to address racial disparities and social determinants of health, improving awareness of language access services, and how to access them, is important. For example, patients with LEP who are provided with interpreters make more outpatient visits, receive and fill more prescriptions, and report a high level of satisfaction with their care. Additionally, these patients do not differ from their English proficient counterparts in test costs or receipt of intravenous hydration and have outcomes among those with diabetes that are superior or comparable to those of English proficient patients.[3]

Response to RFI Questions

The RFI asks whether a new graphic symbol could increase access to information about health services, programs and/or products. We believe it would. Many individuals with LEP never receive information about their rights, do not know how to access interpreters, and do not know how to file a complaint or a grievance. Current methods of informing individuals about language access tend to be at the end of multi-page notices or on hard to find web-pages. A symbol prominently placed on the header of paper letters or at the top of websites would be a significant improvement.

The RFI asks for what should be considered in development of a new symbol. We believe that, to be effective, a new symbol needs to be user tested with a diversity of individuals from differing linguistic communities and with differing levels of health literacy. It also must be designed with the input of the entities intended to use it, including HHS operating divisions, health insurance companies, providers, and hospitals.

The RFI asks about what steps should be taken in implementing, disseminating, and ensuring effectiveness of a new symbol. We believe that the symbol cannot be effective unless HHS engages in a significant education campaign involving community organizations, direct service providers, immigrant service agencies, health industry groups and others aimed at helping individuals with LEP understand its intent and utilization. It should be adopted by HHS in all programs and communications, and HHS should provide technical assistance to hospitals, Medicaid agencies, health care providers, health insurance companies and other health entities in adoption. There should be an evaluation component to ensure there is sufficient awareness among the target population and entities before any campaign is concluded.

Conclusion

Thank you for the opportunity to comment on this important issue. If you have further questions, please contact Mara Youdelman, National Health Law Program, [email protected] or Ben D’Avanzo, National Immigration Law Center, [email protected].

Sincerely,

National Health Law Program
National Immigration Law Center

[1] See American Community Survey, Language Spoken at Home, Table S1601 — 2019: ACS 5-Year Estimates Subject Tables, https://bit.ly/3nBFPci (last visited Apr. 25, 2024).

[2] See, for example, Karliner et al., “Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency,” Medical Care, March 2017, vol. 55, issue 3, pp. 199-206.

[3] Truda S. Bell et al., Interventions to Improve Uptake of Breast Screening in Inner City Cardiff General Practices with Ethnic Minority Lists, 4 Ethnic Health 277 (1999); Thomas M. Tocher & Eric Larson, Quality of Diabetes Care for Non-English-Speaking Patients: A Comparative Study, 168 Western J. of Medicine 504 (1998); David Kuo & Mark J. Fagan, Satisfaction with Methods of Spanish Interpretation in an Ambulatory Care Clinic, 14 J. of General Internal Medicine 547 (1999); L.R. Marcos, Effects of Interpreters on the Evaluation of Psychopathology in Non-English-Speaking Patients,136 American J. of Psychiatry 171 (1979).