Limited English Proficiency (LEP) Patients: Frequently Asked Questions

Yes. Most solo practitioners are expected to provide interpreter services. HHS has long required language access as part of its prohibition against national origin discrimination.

A limited exception has historically applied to practices that receive only Medicare Part B reimbursement; however, this exception is narrow and must be carefully evaluated in light of evolving requirements under Section 1557 of the Final Rule of the ACA. Notably, the ACA Final Rule (effective July 5, 2024), together with prevailing patient safety standards, reinforces that providing interpreter services in healthcare is the expected—and safest—practice.

Key expectations include:

• Provision of free language assistance services.
• Use of qualified interpreters.
• Restrictions on the use of family members, friends, or untrained staff.
• An expanded definition of “meaningful access” (with accurate, timely, and effective communication).

Beyond regulatory requirements, the use of interpreters is widely recognized as the prevailing standard of care in clinical practice. Qualified interpreter services are essential to support informed consent, ensure accurate diagnosis, and facilitate clear communication of medication instructions, treatment plans, and follow-up care. The bottom line is that patients must truly understand their diagnosis and treatment plan. Section 1557 is now increasingly interpreted to apply to Medicare Part B practitioners and is the guide for medical practices to follow.

The following four factors remain relevant and are still reflected in longstanding federal guidance as a framework for assessing language access needs. Practices should continue to consider: (1) the number or proportion of LEP individuals served, (2) the frequency of LEP encounters, (3) the nature and importance of the services provided, and (4) available resources and cost. See HHS LEP Guidance (Federal Register, August 8, 2003). This analysis, however, should be applied cautiously. Evolving requirements under Section 1557 of the ACA place greater emphasis on ensuring “meaningful access” regardless of practice size. While resources and cost remain a consideration, they do not eliminate the obligation to take reasonable steps to provide timely, effective language assistance. From both a compliance and patient safety perspective, practices are expected to have reliable systems in place to provide qualified interpreter services when needed. It is also advisable to have consent forms—particularly for invasive procedures—professionally translated into relevant non-English languages by certified medical translators to support clear patient understanding. The use of artificial intelligence (AI) translation and interpretation tools is discouraged for this purpose due to potential inaccuracies. For more information, see the section below on the use of AI interpretation.

Yes. The cost is considered a part of business operations. Failure to provide interpreter services may result in an investigation by the Office for Civil Rights (OCR). Depending on the OCR’s findings and conclusions, violations may result in fines, sanctions, and penalties.

No. LEP patients are entitled to language assistance free of charge. In some states (currently 18), the cost of interpreter services is reimbursable under federally funded programs such as Medicaid and the Children’s Health Insurance Program. Medicare and most commercial insurers typically do not separately reimburse interpreter services, and in most cases, practitioners must absorb the cost as part of their operating expenses.

No. The responsibility for arranging and providing qualified interpreter services rests with the healthcare practice. While patients are entitled to language assistance at no cost to them, practitioners are not obligated to reimburse patients who independently secure interpreter services. Practices should have systems in place to ensure timely access to appropriate interpreter services to support effective communication and compliance with federal requirements.

No. Declining to give a patient an appointment on the basis of a language barrier is considered noncompliance. All LEP patients are entitled to free access to language assistance. Violations for noncompliance may be enforced by the OCR under Title VI of the Civil Rights Act and by state and local authorities, depending on the jurisdiction. Fines, penalties, and sanctions may be imposed.

Yes, but it is permitted only in limited circumstances. When considering the use of adult family members or companions, it should be noted that lay personnel are rarely familiar with medical terminology and its nuances and may not provide an accurate interpretation. Additionally, the patient may not want a family member or companion to have access to protected health information (PHI). The patient’s minor child should not be engaged for this purpose.

If a family member or companion must be used as an interpreter, that person should be an adult—unless an adult is unavailable and the patient is experiencing a clinical emergency. Otherwise, it is recommended that you have a clinical staff member trained to provide medical interpretation or use certified medical interpreter services to ensure proper interpretation of medical information. The local hospital should have a list of qualified interpreters.

Additionally, it is recommended that you have written consent forms—especially for invasive procedures—translated into the applicable non-English languages by a certified translator. Avoid the sole use of AI translation due to the potential for errors and inaccuracies; professional medical translation services should always be employed for this purpose.

Possibly. The key consideration is how proficient staff members are in the patient’s spoken language and whether they are familiar with medical terminology. If they have only a marginal ability to speak the language, hire a certified medical interpreter. Office staff should meet the same standards as professional interpreters.

Document clearly in the patient record that an interpreter is being used and identify the language or dialect. For more details, see the section below “How should the use of an interpreter be documented in the medical record?”

A qualified medical interpreter should be able to support accurate, complete communication throughout the clinical encounter. Consistent with the National Council on Interpreting in Health Care (NCIHC), key competencies include:

• Proficiency in English and the patient’s preferred language, including relevant cultural nuances.
• Accurate, impartial interpretation of all aspects of the clinical encounter without omission or distortion.
• Ability to communicate medical terminology and complex information clearly.
• Adherence to confidentiality and applicable privacy laws.
• Professional, neutral conduct while maintaining appropriate role boundaries.

Under Privacy Rule 45 CFR §164.506(c), an individual’s authorization is not required to disclose PHI when the covered entity provides interpreter services under healthcare operations. The practice may either use a member of the workforce (e.g., a bilingual employee, contracted interpreter on staff, or a volunteer) or the services of a person or entity engaged as a business associate. For more information, see the HHS HIPAA for Professionals Frequently Asked Questions.

Yes, a BAA is required if you have a contractual agreement with a language service that provides interpreters and translators. See HHS guidance on business associate contracts. A BAA is not required for practice employees or for family members/friends of the patient.

According to the NCIHC, an interpreter conveys meaning orally, while a translator conveys meaning from written text to written text. An interpreter is used to provide effective oral communication between the practitioner and the patient, including presenting documents to the patient that are not in the patient’s native language, such as forms for new patients, disclosure of PHI, informed consent, or treatment instructions. See NCIHC FAQ—Translators and Interpreters.

Face the patient directly, maintain eye contact with the patient (not the interpreter), and speak as you normally would to a patient who is fluent in English.

The medical practice must provide free, accurate, and timely language assistance with qualified interpreters for their LEP patients. Include the following content in your medical record:

• Patient’s preferred language.
• Identification of the interpreter, including name and whether they were a qualified staff interpreter, a certified interpreter, or a contracted interpreter service.
• Credentials of the interpreter, e.g., certified medical interpreter (CMI) or an internal qualified bilingual staff member.
• Mode of communication, whether in person, by telephone, or by telehealth with video remote interpretation.
• Scope and timing of interpretation, e.g., for the entire visit, for informed consent, for patient instructions, or for other high-risk communications, including the diagnosis and treatment plan.
• Patient understanding using the teach-back method and questions answered.
• Interpreter refusal, if applicable. If the patient declines the interpreter, the practice must document the offer of interpreter services, patient’s refusal, patient’s choice to use family/friend, and the risks explained.
• Confirmation of patient consent if a family member or friend is used, the relationship of the person, and the reason why a professional interpreter was not used. For discussions that carry a high risk—such as an informed consent or treatment plan discussions—the practitioner should carefully explain the risk of not using a qualified interpreter and document that the risks were explained to the patient. Use and document this conversation using the teach-back method.

Practices should consider developing templates to document the use of interpreters for LEP patients.

Practices may consider a number of different options for assisting LEP individuals:

• Professional contracted on-site interpretation.
• Family members or companions in limited situations (such as simple messaging or emergencies).
• Bilingual staff who are proficient in both languages and are familiar with medical terminology.
• Telephone or online services.
• Written messaging/translation services.
• Services provided to patients through health insurance coverage.
• AI interpretation and translation services as an adjunct to certified professional medical language services; however, due to the potential for errors and inaccuracies, AI tools should not be relied on as the sole method of communication with LEP patients.

Given current technological limitations, AI-based interpretation should not be relied on as the sole means of communication with LEP patients. Healthcare communication requires more than language translation alone and must account for cultural context, health literacy, facial expression/body language, dialect, cognitive and physical disabilities, and other communication factors that may influence patient understanding. Qualified human interpreters provide critical judgment, clarification, and contextual understanding that AI systems cannot consistently replicate. Exclusive reliance on AI interpretation may result in errors, omissions, or misinterpretations that compromise patient understanding, informed consent, clinical decision-making, and adherence to treatment plans, thereby increasing the risk of patient harm and adverse outcomes.

Another important consideration is HIPAA compliance and the protection of PHI. Many publicly available AI platforms are not designed for HIPAA-regulated healthcare use and may not provide the privacy, security, or contractual safeguards necessary to protect PHI. Before entering patient information into an AI system, healthcare organizations should ensure that the technology complies with applicable HIPAA requirements and organizational policies. As AI technology and healthcare regulations continue to evolve, additional guidance and best practices are expected to emerge.

The appeal of using AI for interpretation and translation services in healthcare settings is understandable because these tools are readily accessible, easy to use, and often available at little or no cost. However, convenience does not guarantee safe or effective communication. Inaccurate interpretations and translations, misunderstandings, and the failure to account for cultural, literacy, and other communication factors may compromise patient understanding and increase the risk of patient harm. Until the technology demonstrates consistent reliability in healthcare environments, AI should be used only as an adjunct to, and not a replacement for, qualified medical interpreters and professional medical translation services.

Yes. The practice should develop a written “access plan” outlining how it will provide meaningful access for LEP patients. This plan will assist healthcare practitioners in outlining office policies and procedures to comply with HHS and DOJ requirements, as well as demonstrate that the practice has proactively addressed compliance with meaningful access requirements. See the American Medical Association’s Affordable Care Act, Section 1557—Fact sheet and the CMS Guide to Developing a Language Access Plan.

Healthcare practices must provide clear, visible notifications informing patients of their right to meaningful access, including free language assistance services. At a minimum, this includes: (1) a Notice of Nondiscrimination stating the practice does not discriminate based on national origin and provides language assistance; (2) a Notice of Availability of Language Assistance Services indicating that interpreters and translations are provided free of charge; and (3) multilingual taglines in the most common non-English languages in the state advising patients how to access these services. These notices must be conspicuously posted in patient-facing areas and on the practice’s website and also provided in English and in appropriate languages for the population served. See 45 CFR §92.10-11.

Training requirements for healthcare offices are outlined as follows in 45 CFR §92.8:

• Covered entities must train all relevant employees, including permanent and temporary staff who interact with patients or the public and make decisions affecting patient care (including leadership and legal counsel).
• The timeframe for initial training should be as soon as practicable after implementation of required policies, no later than 30 days after implementation, and no later than 300 days after July 5, 2024.
• Ongoing training requires training new employees within a “reasonable timeframe” after hire. Employees are to be retrained if there are “material changes” to civil rights policies and procedures.
• Documentation should include the completion of training contemporaneously, either electronic or paper. Records should be retained for at least three (3) years.