114 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services shall establish 
and distribute guidelines concerning the implementa-
tion of this subsection. 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language services to limited- 
English-proficient individuals, the product of— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00114
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
115 
(i) the average per person cost of lan-
guage services, determined according to 
the methodology devised under paragraph 
(2); and 
(ii) the number of limited-English-pro-
ficient individuals who are provided lan-
guage services by the entity and for whom 
no reimbursement is available for such 
services under the amendments made by 
subsections (a), (b), (c), or (d) or by pri-
vate health insurance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; or 
(III) a federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00115
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
116 
(ii) provide language services to at 
least 8 percent of the entity’s total number 
of patients, not later than 6 months after 
the date of the enactment of the Act; and 
(iii) prepare and submit an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
mation as the Secretary may require to as-
certain the entity’s eligibility for funding 
under this subsection. 
(C) 
LANGUAGE
SERVICES.—The 
term 
‘‘language services’’ has the meaning given such 
term in section 1861(iii)(1) of the Social Secu-
rity Act. 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 
OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 
that protect the civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
made by this section shall take effect on January 1, 
2013. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00116
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
117 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity and the Administrator of the Health Resources and 
Services Administration, in consultation with the Director 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00117
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
118 
of the National Institute on Minority Health and Health 
Disparities and the Office of Minority Health, shall award 
grants to eligible entities to improve health care for pa-
tient populations that have low functional health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—Grants awarded under subsection (a) 
through the Agency for Healthcare Research and 
Quality shall be used— 
(A) to define and increase the under-
standing of health literacy; 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00118
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
119 
(D) for any other activity determined ap-
propriate by the Director of the Agency. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—Grants awarded under subsection (a) 
through the Health Resources and Services Adminis-
tration shall be used to conduct demonstration 
projects for interventions for patients with low 
health literacy that may include— 
(A) the development of new disease man-
agement programs for patients with low health 
literacy; 
(B) the tailoring of existing disease man-
agement programs addressing mental, physical, 
oral, and behavioral health conditions for pa-
tients with low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; and 
(F) other activities determined appropriate 
by the Administrator of the Health Resources 
and Services Administration. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00119
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
120 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2015 through 2019. 
SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 
(a) IN GENERAL.—Any health program or activity, 
any part of which is receiving Federal financial assistance, 
including credits, subsidies, or contracts of insurance, and 
any program or activity that is administered by an execu-
tive agency or any entity established under title I of the 
Patient Protection and Affordable Care Act (or amend-
ments made thereby), as such programs, activities, agen-
cies, and entities are described in section 1557(a) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18116), in order to ensure the right of LEP individuals 
to receive access to quality health care, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in lin-
guistically appropriate service delivery; 
(2) offer and provide appropriate language serv-
ices at no additional charge to each patient with lim-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00120
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
121 
ited-English-proficiency at all points of contact, in a 
timely manner during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only competent interpreter or trans-
lation services, as defined in section 3400 of the 
Public Health Service Act. 
(b) EXEMPTIONS.—The requirements of subsection 
(a)(4) shall not apply as follows: 
(1) When a patient (who has been informed in 
his or her primary language of the availability of 
free interpreter and translation services) requests 
the use of family, friends, or other persons untrained 
in interpretation or translation if the following con-
ditions are met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
(B) The recipient informs the patient that 
he or she has the option of having the recipient 
provide an interpreter for him or her without 
charge, or of using his or her own interpreter. 
(C) The recipient informs the patient that 
the recipient may not require an LEP person to 
use a family member or friend as an inter-
preter. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00121
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
122 
(D) The recipient evaluates whether the 
person the patient wishes to use as an inter-
preter is competent. If the recipient has reason 
to believe that the interpreter is not competent, 
the recipient provides the recipient’s own inter-
preter to protect the recipient from liability if 
the patient’s interpreter is later found not com-
petent. 
(E) If the recipient has reason to believe 
that there is a conflict of interest between the 
interpreter and patient, the recipient may not 
use the patient’s interpreter. 
(F) The recipient has the patient sign a 
waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s lan-
guage. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
(c) RULE
OF CONSTRUCTION.—Subsection (b)(2) 
shall not be construed to mean that emergency rooms or 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00122
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
123 
similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act and annually thereafter, the Sec-
retary of Health and Human Services shall enter into a 
contract with the Institute of Medicine for the preparation 
and publication of a report that describes Federal efforts 
to ensure that all individuals with limited-English pro-
ficiency have meaningful access culturally competent to 
health care and health-care-related services. Such report 
shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
(3) recommendations on the development and 
implementation of policies and practices by providers 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00123
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
124 
of health care and health-care-related services for 
limited-English-proficient individuals; 
(4) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(5) a description of the costs associated with or 
savings related to the provision of language services. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2015 through 2019. 
SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (here-
after referred to as ‘‘ESL’’) instruction and shall deter-
mine, after consultation with appropriate stakeholders, the 
mechanism for administering and distributing such 
grants. 
(b) ELIGIBLE ENTITY DEFINED.—For purposes of 
this section, the term ‘‘eligible entity’’ means a State or 
community-based organization that employs, and serves, 
minority populations. 
(c) APPLICATION.—An eligible entity may apply for 
a grant under this section by submitting such information 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00124
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS