Section 1557 compliance requirements: is your organization compliant?
Section 1557 of the Affordable Care Act has been shaping language access in healthcare for over a decade. However, the law has evolved over time—particularly regarding how healthcare organizations manage interpretation, translation, and accessible communications. As federal standards continue to update, it is critical to evaluate whether your organization is still compliant with the latest changes.
Has your organization achieved compliance with the interpretation and translation requirements found in Section 1557 of the Affordable Care Act? Here are four questions to consider:
1. Is your organization bound by Section 1557?
Section 1557 doesn’t impact every healthcare organization, but most providers will find themselves impacted. The Department of Health and Human Services (HHS) has issued guidance explaining that the law applies to healthcare organizations and programs that:
- Receive federal funding (such as hospitals or doctors that accept Medicare/Medicaid); this excludes Medicare Part B
- Are administered by HHS itself (such as Medicare Part D)
- Participate in Health Insurance Marketplaces
Are You Covering All of Your Communication Requirements?
As a federally funded, civil rights law for health care, Section 1557 requires covered entities to post an annual Notice of Nondiscrimination and a separate Notice of Availability of language assistance services in English and the top 15 languages spoken in the state or states where they operate. Under the current rule, this Notice of Availability requirement replaced the short, non-English “tagline” statements that earlier versions of Section 1557 required.
Find your top 15 languages using HHS’s list of the top 15 non-English languages by state. For sample notice language and a full breakdown of the requirement, HHS’s Office for Civil Rights outlines the details in its Dear Colleague letter on Section 1557 language access provisions.
2. Are all the interpreters you use qualified?
Section 1557 requires bilingual staff members who act as interpreters to have interpreting listed as part of their current, assigned job responsibilities. Staff members must also demonstrate:
- Proficiency in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology
- The ability to effectively, accurately, and impartially communicate directly with individuals with limited English proficiency in their primary languages
Demonstrating these skills may require formal interpreter training, testing, or certification. Propio offers staff testing and training for staff interpreters, as well as bilingual doctors and nurses who wish to interpret as part of their patient care duties. We test both language proficiency and interpreter skills so healthcare organizations can document compliance with confidence.
3. Do you allow patients’ families and friends to act as their interpreters?
Providers sometimes turn to a patient’s family and friends to interpret because it’s convenient—often, they’re already present. But emotional involvement and a lack of formal interpreter training may affect accuracy and ability.
For that reason, Section 1557 specifies that providers should not rely on:
- A patient’s minor children (except in emergencies to prevent imminent patient harm)
- Adult family and friends (unless the patient refuses an interpreter; a provider may still use a qualified interpreter if they determine the family member or friend cannot interpret adequately)
4. Are your video interpretation options effective?
HHS’s rule supports using qualified phone and video interpreters to help providers deliver timely language access to patients with limited English proficiency.
The rule also establishes standards for accessibility in video interpretation, linking them to standards set for ASL interpretation by the Americans with Disabilities Act, including:
- Real-time, full-motion video and audio over a dedicated, high-speed, wide-bandwidth video or wireless connection that delivers high-quality images without lags, choppiness, blurriness, graininess, or irregular pauses in communication
- A sharply delineated image large enough to display the interpreter’s face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of body position
- Clear, audible transmission of voices
- Adequate training for users of the technology and other involved individuals, so they can quickly and efficiently set up and operate video-remote interpretation
Building a long-term compliance plan
Section 1557 compliance isn’t a one-time project—it’s an ongoing service that touches every part of patient care, from intake to discharge. Reviewing your interpreter qualifications, language access policies, and video interpretation standards on a regular basis helps your organization stay ahead of federal government expectations and, more important, keep every patient informed about their care.
Partner with Propio for Section 1557 Support
Navigating evolving federal language access requirements doesn’t have to burden your internal operations. Propio provides health plans and healthcare organizations with comprehensive, end-to-end language solutions—including qualified phone and video interpretation in over 300 languages, document translation, digital accessibility, and staff proficiency testing.
