Title VI of the Civil Rights Act ^87
Title VI of the Civil Rights Act prohibits discrimination based on race, color, or national origin. Protections under the Act have been extended to include prohibitions of discrimination against persons with limited English proficiency (LEP).
The Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) has a longstanding position that in order to avoid discrimination against LEP individuals, health care providers who receive Federal financial assistance must take reasonable steps to provide meaningful access to ensure that such LEP individuals receive, free of charge, the language assistance necessary to afford them meaningful access to their services. The OCR’s position is that physicians who receive reimbursement from Medicaid are recipients of Federal financial assistance, and, thus, must comply with the Title VI requirements for language assistance.The OCR has policy guidance on Title VI compliance available on its web site at www.hhs.gov/ocr or by calling 800-368-1019. According to the OCR, the type of language assistance that must be provided to patients with LEP depends on a variety of factors, including the following:
• The size of the medical practice
• The size of the LEP population it serves
• The nature of the service
• The total resources available to the medical practice
• The frequency with which particular languages are encountered
• The frequency with which LEP individuals come into contact with the medical practice
If the medical practice determines that it should provide language assistance services, the practice should develop a plan to address the LEP needs. The OCR suggests five steps for creating a plan: 1) identifying LEP individuals who need language assistance, 2) identifying language assistance measures, 3) training staff, 4) providing notice to LEP individuals, and 5) monitoring and updating the LEP plan.
If implementing accommodations for LEP patients would be so burdensome as to make it difficult for the medical practice to stay in operation, or if there are equally effective alternatives for LEP individuals to have access to the type of services provided, the OCR will not find that the medical practice is noncompliant.
The main role of the OCR is to provide technical assistance to help covered entities, including medical practices, meet their obligations. This can include identifying best practices and strategies, identifying sources of federal reimbursement for translation services, and directing health care providers to other resources.
The OCR will investigate whenever it receives a complaint or other information that indicates possible noncompliance with Title VI. If the investigation results in a finding of noncompliance, the OCR will inform the practice in writing of its findings and will identify the steps that must be taken to become compliant. If the practice will not make corrections voluntarily, the OCR has the authority to terminate Federal assistance after an administrative hearing, and also may refer the case to the Department of Justice for injunctive relief or other enforcement proceedings.