Section 1557 of the Affordable Care Act prohibits discrimination in any health program or activity that receives federal financial assistance, which covers nearly every hospital, most clinics, every Medicare-participating provider, and any health plan operating in an ACA marketplace.
In the language-access context, Section 1557 layers specific requirements on top of pre-existing Title VI obligations. The 2024 final rule from HHS Office for Civil Rights clarified and expanded several of these requirements.
Key obligations under Section 1557
- Qualified interpreters must be made available to LEP patients at no cost. "Qualified" is defined as adhering to professional ethics, possessing demonstrated proficiency in both English and the other language, and being able to interpret effectively, accurately, and impartially.
- Family members cannot serve as interpreters except in narrow emergency circumstances or when the patient specifically requests it after being offered a qualified interpreter.
- Video remote interpreting (VRI) must meet specific technical quality standards if used.
- Notice of language assistance services must be posted in patient-facing materials in the top 15 languages spoken by the LEP populations served by the provider.
Practical implications
A "qualified medical interpreter" under Section 1557 is not the same as a bilingual staff member. The interpreter must have training in medical terminology, an ethics framework specific to healthcare interpreting (typically CCHI, NBCMI, or equivalent), and the demonstrated ability to interpret accurately under clinical conditions.
For high-stakes clinical interactions (surgical consents, mental health intakes, end-of-life discussions, IMEs) the standard of care is a certified medical interpreter, ideally on-site or via high-quality VRI. AMS supplies medically-trained interpreters for these settings nationwide.