144 
care beneficiaries in a grantee’s service area uti-
lizing— 
(A) data on the numbers of limited English 
proficient individuals who speak English less 
than ‘‘very well’’ from the most recently avail-
able data from the Bureau of the Census or other 
State-based study the Secretary determines likely 
to yield accurate data regarding the number of 
LEP individuals served by the grantee; or 
(B) the grantee’s own data if the grantee 
routinely collects data on Medicare beneficiaries’ 
primary language in a manner determined by 
the Secretary to yield accurate data and such 
data shows greater numbers of LEP individuals 
than the data listed in subparagraph (A). 
(4) LIMITATIONS.— 
(A) REPORTING.—Payments shall only be 
provided under this section to grantees that re-
port their costs of providing language services as 
required under subsection (e). If a grantee fails 
to provide the reports under such section for the 
first year of a grant, the Secretary may termi-
nate the grant and solicit applications from new 
grantees to participate in the subsequent two 
years of the demonstration program. 
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(B) TYPE OF SERVICES.— 
(i) IN
GENERAL.—Subject to clause 
(ii), payments shall be provided under this 
section only to grantees that utilize com-
petent bilingual staff or competent inter-
preter or translation services which— 
(I) if the grantee operates in a 
State that has statewide health care in-
terpreter standards, meet the State 
standards currently in effect; or 
(II) if the grantee operates in a 
State that does not have statewide 
health care interpreter standards, uti-
lizes competent interpreters who follow 
the National Council on Interpreting 
in Health Care’s Code of Ethics and 
Standards of Practice. 
(ii) EXEMPTIONS.—The requirements 
of clause (i) shall not apply— 
(I) in the case of a Medicare bene-
ficiary who is limited English pro-
ficient (who has been informed in the 
beneficiary’s primary language of the 
availability of free interpreter and 
translation services) and who requests 
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146 
the use of family, friends, or other per-
sons untrained in interpretation or 
translation and the grantee documents 
the request in the beneficiary’s record; 
and 
(II) in the case of a medical emer-
gency where the delay directly associ-
ated with obtaining a competent inter-
preter or translation services would 
jeopardize the health of the patient. 
Nothing in clause (ii)(II) shall be construed 
to exempt an emergency rooms or similar 
entities that regularly provide health care 
services in medical emergencies from having 
in place systems to provide competent inter-
preter and translation services without 
undue delay. 
(d) ASSURANCES.—Grantees under this section shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in lin-
guistically appropriate service delivery; ensure the 
linguistic competence of bilingual providers; 
(2) offer and provide appropriate language serv-
ices at no additional charge to each patient with lim-
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147 
ited English proficiency at all points of contact, in a 
timely manner during all hours of operation; 
(3) notify Medicare beneficiaries of their right to 
receive language services in their primary language; 
(4) post signage in the languages of the com-
monly encountered group or groups present in the 
service area of the organization; and 
(5) ensure that— 
(A) primary language data are collected for 
recipients of language services; and 
(B) consistent with the privacy protections 
provided under the regulations promulgated pur-
suant to section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 
U.S.C. 1320d–2 note), if the recipient of lan-
guage services is a minor or is incapacitated, the 
primary language of the parent or legal guard-
ian is collected and utilized. 
(e) REPORTING REQUIREMENTS.—Grantees under this 
section shall provide the Secretary with reports at the con-
clusion of the each year of a grant under this section. each 
report shall include at least the following information: 
(1) The number of Medicare beneficiaries to 
whom language services are provided. 
(2) The languages of those Medicare beneficiaries. 
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