preting or interpretation for which the interpreter is 
in the physical presence of 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 hear-
ing, vision, or learning. 
‘‘(22) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Services. 
‘‘(23) SIGHT TRANSLATION.—The term ‘sight 
translation’ means the transmission of a written 
message in one language into a spoken or signed 
message in another language, or an alternative for-
mat in English or another language. 
‘‘(24) STATE.—The term ‘State’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Indian tribes, 
the United States Virgin Islands, Guam, American 
Samoa, and the Commonwealth of the Northern 
Mariana Islands. 
‘‘(25) 
TELEPHONIC
INTERPRETATION.—The 
term ‘telephonic interpretation’ (also known as over 
the phone interpretation or OPI) means a method of 
interpreting/interpretation for which the interpreter 
is not in the physical presence of the provider of 
health care or related services and the limited- 
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English-proficient recipient of such services but is 
connected via telephone. 
‘‘(26) TRANSLATION.—The term ‘translation’ 
means the transmission of a written message in one 
language into a written or signed message in an-
other language, and includes translation into an-
other language or alternative format, such as large 
print font, Braille, audio recording, or CD. 
‘‘(27) VIDEO
INTERPRETATION.—The term 
‘video interpretation’ means a method of inter-
preting/interpretation for which the interpreter is 
not in the physical presence of the provider of health 
care or related services and the limited-English-pro-
ficient recipient of such services but is connected via 
a video hook-up that includes both audio and video 
transmission. 
‘‘(28) VITAL DOCUMENT.—The term ‘vital doc-
ument’ includes but is not limited to applications for 
government programs that provide health care serv-
ices, medical or financial consent forms, financial as-
sistance documents, letters containing important in-
formation regarding patient instructions (such as 
prescriptions, referrals to other providers, and dis-
charge plans) and participation in a program (such 
as a Medicaid managed care program), notices per-
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taining to the reduction, denial, or termination of 
services or benefits, notices of the right to appeal 
such actions, and notices advising limited-English- 
proficient individuals and individuals with commu-
nication disabilities of the availability of free lan-
guage services, alternative formats, and other out-
reach materials. 
‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
‘‘(a) PURPOSE.—As provided in Executive Order 
13166, it is the purpose of this section— 
‘‘(1) to improve Federal agency performance re-
garding access to federally conducted and federally 
assisted programs and activities for individuals who 
are limited in their English proficiency; 
‘‘(2) to require each Federal agency to examine 
the services it provides and develop and implement 
a system by which limited-English-proficient individ-
uals can obtain cultural competence and meaningful 
access to those services consistent with, and without 
substantially burdening, the fundamental mission of 
the agency; 
‘‘(3) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide cultural competence and meaningful access to 
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their limited-English-proficient applicants and bene-
ficiaries; 
‘‘(4) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the Limited English Pro-
ficient Guidance of the Department of Justice (as 
issued on June 12, 2002), to ensure cultural com-
petence and meaningful access to their programs 
and activities by limited-English-proficient individ-
uals; and 
‘‘(5) to ensure compliance with title VI of the 
Civil Rights Act of 1964 and that health care pro-
viders and organizations do not discriminate in the 
provision of services. 
‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC-
TIVITIES.— 
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this title, each Fed-
eral agency that carries out health-care-related ac-
tivities shall prepare a plan to improve access cul-
tural competence to the federally conducted, health- 
care-related programs and activities of the agency by 
limited-English-proficient individuals. Not later than 
one year after the date of enactment of this title, 
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each such Federal agency shall ensure that such 
plan is fully implemented. 
‘‘(2) PLAN REQUIREMENT.—Each plan under 
paragraph (1) shall include— 
‘‘(A) the steps the agency will take to en-
sure that limited-English-proficient individuals 
have access to the agency’s federally conducted 
health care and health-care-related programs 
and activities; 
‘‘(B) the policies and procedures for identi-
fying, assessing, and meeting the language 
needs and cultural competence needs of its lim-
ited-English-proficient beneficiaries served by 
federally conducted programs and activities; 
‘‘(C) the steps the agency will take for its 
federally conducted programs and activities to 
improve cultural competence to provide a range 
of language assistance options, notice to lim-
ited-English-proficient individuals of the right 
to competent language services, periodic train-
ing of staff, monitoring and quality assessment 
of the language services and, in appropriate cir-
cumstances, the translation of written mate-
rials; 
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‘‘(D) the steps the agency will take to en-
sure that applications, forms, and other rel-
evant documents for its federally conducted pro-
grams and activities are competently translated 
into the primary language of a limited-English- 
proficient client where such materials are need-
ed to improve access to federally conducted and 
federally assisted programs and activities for 
such a limited-English-proficient individual; 
‘‘(E) the resources the agency will provide 
to improve cultural competence to assist recipi-
ents of Federal funds to improve access to 
health care or health-care-related programs and 
activities for limited-English-proficient individ-
uals; 
‘‘(F) the resources the agency will provide 
to ensure that competent language assistance is 
provided to limited-English-proficient patients 
by interpreters or trained bilingual staff; and 
‘‘(G) the resources the agency will provide 
to ensure that family, particularly minor chil-
dren, and friends are not used to provide inter-
pretation services, except— 
‘‘(i) in the case of a medical emer-
gency where delay directly associated with 
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obtaining a competent interpreter would 
jeopardize the health of the patient; or 
‘‘(ii) on request of the patient, who 
has been informed in his or her preferred 
language of the availability of free inter-
pretation services, if the health care serv-
ices provider has determined that the fam-
ily or friend can provide competent inter-
preter services as defined in section 3400. 
‘‘(3) SUBMISSION
OF
PLAN
TO
DOJ.—Each 
agency that is required to prepare a plan under 
paragraph (1) shall send a copy of such plan to the 
Department of Justice, which shall serve as the cen-
tral repository of such plans. 
‘‘(4) RULE
OF
CONSTRUCTION.—Paragraph 
(2)(G)(i) shall not be construed to mean that emer-
gency rooms or similar entities that regularly pro-
vide health care services in medical emergencies are 
exempt from legal or regulatory requirements related 
to competent interpreter services. 
‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI-
TIES.— 
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this title, each Fed-
eral agency providing health-care-related Federal fi-
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nancial assistance shall ensure that the guidance for 
recipients of Federal financial assistance developed 
by the agency to ensure compliance with title VI of 
the Civil Rights Act of 1964 (42 U.S.C. 2000d et 
seq.) is specifically tailored to the recipients of such 
assistance. Each agency shall send a copy of such 
guidance to the Department of Justice which shall 
serve as the central repository of the agency’s plans. 
After approval by the Department of Justice, each 
agency shall publish its guidance document in the 
Federal Register for public comment. 
‘‘(2) 
REQUIREMENTS.—The 
agency-specific 
guidance developed under paragraph (1) shall take 
into account the types of health care services pro-
vided by the recipients, the individuals served by the 
recipients, and other factors set out in such stand-
ards. 
‘‘(3) EXISTING GUIDANCES.—A Federal agency 
that has developed a guidance for purposes of title 
VI of the Civil Rights Act of 1964 shall examine 
such existing guidance, as well as the programs and 
activities to which such guidance applies, to deter-
mine if modification of such guidance is necessary to 
comply with this subsection. 
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‘‘(4) CONSULTATION.—Each Federal agency 
shall consult with the Department of Justice in es-
tablishing the guidances under this subsection. 
‘‘(d) CONSULTATIONS.— 
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, each Federal agency that carriers out health 
care and health-care-related activities shall ensure 
that stakeholders, such as limited-English-proficient 
individuals and their representative organizations, 
recipients of Federal assistance, and other appro-
priate individuals or entities, have an adequate op-
portunity to provide input with respect to the actions 
of the agency. 
‘‘(2) EVALUATION.—Each Federal agency de-
scribed in paragraph (1) shall evaluate the— 
‘‘(A) particular needs of the limited- 
English-proficient individuals served by the 
agency; 
‘‘(B) particular needs of the limited- 
English-proficient individuals served by the 
agency’s recipients of Federal financial assist-
ance; and 
‘‘(C) burdens of compliance with the agen-
cy guidance and this section for the agency and 
its recipients. 
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‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTH CARE. 
‘‘(a) APPLICABILITY.—This section applies to any 
health program or activity, any part of which is receiving 
Federal financial assistance, including credits, subsidies, 
or contracts of insurance, or any program or activity that 
is administered by an executive agency or any entity estab-
lished under title I of the Patient Protection and Afford-
able Care Act (or amendments made thereby), as such 
programs, activities, agencies, and entities are described 
in section 1557(a) of the Patient Protection and Afford-
able Care Act. 
‘‘(b) STANDARDS.—The programs, activities, agen-
cies, and entities described in subsection (a) shall— 
‘‘(1) implement strategies to recruit, retain, and 
promote individuals at all levels to maintain a di-
verse staff and leadership that can provide culturally 
and linguistically appropriate health care to patient 
populations of the service area of the programs, ac-
tivities, agencies, and entities; 
‘‘(2) educate and train governance, leadership, 
and workforce at all levels and across all disciplines 
of the programs, activities, agencies, and entities in 
culturally and linguistically appropriate policies and 
practices on an ongoing basis; 
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‘‘(3) offer and provide language assistance, in-
cluding trained bilingual staff and interpreter serv-
ices, to individuals who have limited-English pro-
ficiency or other communication needs, at no cost to 
them at all points of contact, and during all hours 
of operation, to facilitate timely access to all health 
care and services; 
‘‘(4) notify patients, in a culturally appropriate 
manner, of their right to receive language assistance 
services in their primary language, verbally and in 
writing; 
‘‘(5) ensure the competence of language assist-
ance provided to limited-English-proficient patients 
by interpreters and bilingual staff, and ensure that 
family, particularly minor children, and friends are 
not used to provide interpretation services— 
‘‘(A) except in case of emergency; or 
‘‘(B) except on request of the patient, who 
has been informed in his or her preferred lan-
guage of the availability of free interpretation 
services if the health care services provider has 
determined that the family or friend can pro-
vide competent interpreter services as defined in 
section 3400; 
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