(b) AMENDMENT.—The Public Health Service Act 
(42 U.S.C. 201 et seq.) is amended by adding at the end 
the following: 
‘‘TITLE 
XXXIV—CULTURALLY 
AND LINGUISTICALLY APPRO-
PRIATE HEALTH CARE 
‘‘SEC. 3400. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BILINGUAL.—The term ‘bilingual’ with re-
spect to an individual means a person who has suffi-
cient degree of proficiency in two languages. 
‘‘(2) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ includes a community 
health advocate, a lay health educator, a community 
health representative, a peer health promoter, a 
community health outreach worker, and in Spanish, 
promotores de salud. 
‘‘(3) COMPETENT
INTERPRETER
SERVICES.— 
The term ‘competent interpreter services’ means a 
translanguage rendition of a spoken or signed mes-
sage in which the interpreter comprehends the 
source language and can communicate comprehen-
sively in the target language to convey the meaning 
intended in the source language. The interpreter 
knows health and health-related terminology and 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
provides accurate interpretations by choosing equiva-
lent expressions that convey the best matching and 
meaning to the source language and captures, to the 
greatest possible extent, all nuances intended in the 
source message. 
‘‘(4) COMPETENT
TRANSLATION
SERVICES.— 
The term ‘competent translation services’ means a 
translanguage rendition of a written document in 
which the translator comprehends the source lan-
guage and can write or sign comprehensively in the 
target language to convey the meaning intended in 
the source language. The translator knows health 
and health-related terminology and provides accurate 
translations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source document. 
‘‘(5) CULTURAL COMPETENCE.—The term ‘cul-
tural competence’ means a set of congruent behav-
iors, attitudes, and policies that come together in a 
system, agency, or among professionals that enables 
effective work in cross-cultural situations. In the 
preceding sentence— 
‘‘(A) the term ‘cultural’ refers to inte-
grated patterns of human behavior that include 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00052
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
the language, thoughts, communications, ac-
tions, customs, beliefs, values, and institutions 
of racial, ethnic, religious, or social groups, in-
cluding lesbian, gay, bisexual, transgender and 
intersex individuals, and individuals with phys-
ical and mental disabilities; and 
‘‘(B) the term ‘competence’ implies having 
the capacity to function effectively as an indi-
vidual and an organization within the context of 
the cultural beliefs, behaviors, and needs pre-
sented by consumers and their communities. 
‘‘(6) EFFECTIVE COMMUNICATION.—The term 
‘effective communication’ means an exchange of in-
formation between the provider of health care or 
health-care-related services and the recipient of such 
services who is limited in English proficiency, or has 
a communication impairment such as a hearing, vi-
sion, or learning impairment, that enables access, 
understanding, and benefit from health care or 
health-care-related services, and full participation in 
the development of their treatment plan. 
‘‘(7) GRIEVANCE RESOLUTION PROCESS.—The 
term ‘grievance resolution process’ means all aspects 
of dispute resolution including filing complaints, 
grievance and appeal procedures, and court action. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
‘‘(8) HEALTH CARE GROUP.—The term ‘health 
care group’ means a group of physicians organized, 
at least in part, for the purposes of providing physi-
cians’ services under the Medicaid, SCHIP, or Medi-
care programs and may include a hospital and any 
other individual or entity furnishing services covered 
under the Medicaid, SCHIP, or Medicare programs 
that is affiliated with the health care group. 
‘‘(9) 
HEALTH-CARE
SERVICES.—The 
term 
‘health care services’ means services that address 
physical as well as mental health conditions in all 
care settings. 
‘‘(10) HEALTH CARE-RELATED SERVICES.—The 
term ‘health-care-related services’ means human or 
social services programs or activities that provide ac-
cess, referrals or links to health care. 
‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 
means any Indian tribe, band, nation, or other orga-
nized group or community, including any Alaska Na-
tive village or group or regional or village corpora-
tion as defined in or established pursuant to the 
Alaska Native Claims Settlement Act (85 Stat. 688) 
(43 U.S.C. 1601 et seq.), which is recognized as eli-
gible for the special programs and services provided 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
by the United States to Indians because of their sta-
tus as Indians. 
‘‘(12) INTEGRATED
HEALTH
CARE
DELIVERY 
SYSTEM.—The term ‘integrated health care delivery 
system’ means an interdisciplinary system that 
brings together providers from the primary health, 
mental health, substance use and related disciplines 
to improve the health outcomes of an individual. 
Providers may include but are not limited to hos-
pitals, health, mental health or substance use clinics 
and providers, home health agencies, ambulatory 
surgery centers, skilled nursing facilities, rehabilita-
tion centers, and employed, independent or con-
tracted physicians. 
‘‘(13) 
INTERPRETING/INTERPRETATION.—The 
terms ‘interpreting’ and ‘interpretation’ mean the 
transmission of a spoken, written, or signed message 
from one language or format into another, faithfully, 
accurately, and objectively. 
‘‘(14) LANGUAGE ACCESS.—The term ‘language 
access’ means the provision of language services to 
an LEP individual or individual with communication 
disabilities designed to enhance that individual’s ac-
cess to, understanding of or benefit from health care 
or health-care-related services. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS