‘‘(A) comprehends the source language and 
can write or sign comprehensively in the target 
language to convey the meaning intended in the 
source language; and 
‘‘(B) knows health and health-related ter-
minology and provides accurate translations by 
choosing equivalent expressions that convey the 
best matching and meaning to the source lan-
guage and capture, to the greatest possible ex-
tent, all nuances intended in the source docu-
ment. 
‘‘(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 
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 
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‘‘(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. 
‘‘(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 
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under the Medicaid, SCHIP, or Medicare programs 
that is affiliated with the health care group. 
‘‘(9) 
HEALTHCARE
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 
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 
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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. 
‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV-
ICES.—The term ‘language or language access serv-
ices’ means provision of health care services directly 
in a non-English language, interpretation, trans-
lation, signage, video recording, and English or non- 
English alternative formats. 
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‘‘(16) LEP.—The term ‘LEP’ means limited- 
English-proficient. 
‘‘(17) MEDICARE, MEDICAID, AND SCHIP.—The 
terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ mean the 
respective programs under titles XVIII, XIX, and 
XXI of the Social Security Act. 
‘‘(18) MINORITY.— 
‘‘(A) IN GENERAL.—The terms ‘minority’ 
and ‘minorities’ refer to individuals from a mi-
nority group. 
‘‘(B) POPULATIONS.—The term ‘minority’, 
with respect to populations, refers to racial and 
ethnic minority groups. 
‘‘(19) MINORITY GROUP.—The term ‘minority 
group’ has the meaning given the term ‘racial and 
ethnic minority group’. 
‘‘(20) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ means 
American Indians and Alaska Natives, African- 
Americans (including Caribbean Blacks, Africans, 
and other Blacks), Asian-Americans, Hispanics (in-
cluding Latinos), and Native Hawaiians and other 
Pacific Islanders. 
‘‘(21) ONSITE
INTERPRETATION.—The term 
‘onsite interpretation’ means a method of inter-
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