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 the HHS Office for Civil Rights and the Centers for Medicare & Medicaid Services 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 having demonstrated proficiency in both English and the other language, being able to interpret effectively, accurately, and impartially using any necessary specialized vocabulary, and adhering to generally accepted interpreter ethics, including confidentiality.
- An accompanying adult who is not a qualified interpreter, such as a family member, may interpret only as a temporary measure in an emergency, or when the patient asks for it in private with a qualified interpreter present, the adult agrees, both are documented and it is appropriate under the circumstances. A minor child may interpret only as a temporary measure in an emergency.
- Video remote interpreting (VRI) must meet specific technical quality standards if used.
- A notice that language assistance services are available free of charge must be provided in English and in at least the 15 languages most commonly spoken by LEP individuals in the relevant state or states. It must appear on the website, in physical locations and in key documents such as consent forms, discharge papers and billing communications.
Practical implications
A bilingual staff member is not automatically a "qualified interpreter" under Section 1557. The interpreter must have demonstrated proficiency in English and the other language, be able to interpret effectively, accurately and impartially using any necessary specialized vocabulary (in healthcare, medical terminology), and follow generally accepted interpreter ethics, including confidentiality. The rule does not require certification, such as from CCHI or NBCMI, and a certified interpreter must still meet these standards.
For high-stakes clinical interactions (surgical consents, mental health intakes, end-of-life discussions, IMEs) best practice is a certified medical interpreter where certification exists for the language, ideally on-site or via high-quality VRI. The rule itself requires a qualified interpreter, not a certified one. AMS supplies medically trained interpreters for these settings nationwide.