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Limited English Proficiency
Limited English Proficiency
There is no single law that covers Limited English
Proficiency (LEP). It is the combination of
several existing laws that recognize and require
compliance to LEP.
Additionally, Medicare and Medicaid both have a
variety of regulations that also clarify the law(s)
and outline our compliance requirements.
Limited English Proficiency
• Title VI of the Civil Rights Act of 1964
• The Americans with Disabilities Act
• The Rehabilitation Act of 1973
• Executive Order 13166 restated the legal
requirement for compliance
What regulations?
• Limited English Proficiency (LEP)
• Americans with Disabilities Act (ADA)
There are two sets of regulations that govern working with
clients who are not able to speak, read and write English
well enough to effectively participate in their own care.
LEP covers individuals whose first language is something
other than English.
ADA covers individuals who may know English, but have
eyesight or hearing problems.
Both groups have the legal right to free language
It is the intent of GT Independence and the staff of all
its divisions, to be both willing and prepared to help
those for whom language may be a barrier to obtaining
necessary services and assistance.
Limited English Proficiency
Who is covered by
Limited English
Proficiency requirements?
LEP is for Everyone
The law says “persons,” which is obviously all
encompassing and specifically includes illegal
Understand that discrimination need not be
intentional to break the law. We have a clear
legal obligation to avoid it.
What is Discrimination?
Discrimination Defined
Title VI of the Civil Rights Act of 1964 provides that no
person shall be subjected to discrimination on the basis of
race, color or national origin.
We serve Clients whose expenses are paid for with
Medicaid dollars, therefore we receive federal financial
The courts have determined that discriminating against a
person based on language is the same as discriminating
against them based on nationality.
Translate or Interpret?
That is the Question
Translation and Interpretation
They are not the same even though they are meant to
accomplish the same goal.
• Translation is the conversion of written documents
from one language to another.
• Interpretation is listening to one language and restating what was said in another language
• Translation is written
• Interpretation is verbal
Translators and Interpreters
must be Competent
Improperly translated documents or poorly interpreted
conversations can lead to confusion and
The goal is to provide clear concise information about
services in a language or format the Client can
Translation is not Easy
While it is fairly simple to translate a word from one
language to another, getting that translation to give the
sentence the same meaning is quite the opposite.
Consider the sentence “The bus didn’t pick me up.”
• In English this sentence implies that the bus was at fault
because it didn’t arrive at the pick-up point.
• In Spanish this sentence translates to “I didn’t get on the
bus” implying that the bus was present but the rider
refused to get on.
This is America…speak English
After all, isn’t English the official language
of the USA?
Limited English Proficiency
“You are in America, speak English.” is a discriminatory
English is not the “official” language of the United States,
in fact, there is no official language in this country. While
English is very common it is not a legal standard. We cannot
force Clients to communicate in English, it is illegal.
Clients may communicate in any language they feel
comfortable with, it’s the law.
Limited English Proficiency
• All clients are equal.
• Clients have a choice to speak which language
they want.
How much Assistance should
we give Clients?
While we strive to treat all clients equally, when it comes to the
types of assistance outlined by LEP and ADA we must take into
consideration each client as an individual insuring that we provide
assistance to the extent needed.
Additionally, we must allow the individual to choose the type of
assistance they receive.
Remember, clients have the choice to speak any language they wish
and we are required to provide assistance in that language.
Language assistance, to whatever extent it is provided, must be free
to the individual receiving it.
Limited English Proficiency
Can’t we have the client bring along a relative or
friend that already knows the language? Why do
we have to provide the Interpreter?
Limited English Proficiency
NO! You must never suggest a client bring an
interpreter with them. This is specifically
forbidden. The law says that we must provide
the individual with a competent interpreter free
of charge.
Limited English Proficiency
• Children or Minors
• Friends
• Other Clients
Minors or children cannot be expected to understand the
terms used in many of the services we provide or equally
important, the concept of confidentiality, therefore they
don’t make good interpreters. This may also apply to
family members or friends of the client.
While other clients may understand terminology and
confidentiality, allowing another client to act as an
interpreter is clearly a breach of confidentiality and
OK…Then who CAN we use?
Those trained in the work of Interpretation/Translation
Who should be Used to
Remember anyone providing these services must be
competent. Interpreters must be competent in both the
language spoken by the client and English.
• The Interpreter must be competent in the terminology
appropriate to the occasion.
• The Interpreter must be knowledgeable of and
committed to confidentiality requirements as required
by HIPAA guidelines and GT Independence standards.
It’s an emergency…
Let’s define an emergency
Emergency Situations:
Non-Emergency Situations:
• Medical Emergencies
• Scheduling conflicts
• Accident Scenes
• Non-Urgent changes to services
• Urgent changes to services
• Routine explanation of services
To be an emergency the situation must require immediate need for
assistance and that need would have to involve some injury or risk
of injury.
It is an emergency—Who can I use?
Once you determine that the situation is an
actual emergency you may use anyone available
to communicate and interpret for the client.
However some guidelines still apply.
Documenting an Emergency
Clearly document any instance when you believe the
circumstances warranted use of an interpreter whose
qualifications you have not verified. What made it an
•Who was used to interpret
LEP and Client Choice
• What if my client insists on a certain person to
interpret? Can I force them to use the person I
provide for them?
LEP and Client
Person Centered Planning requires client choice. Did the
client agree to this interpreter?
Clearly document every time and any occasion when a
friend of the client or a family member is used as an
interpreter. Did the client make the decision and did
they make it after being clearly informed that they have
a legal right to free language assistance?
We don’t have any foreign
language clients
Are you sure about that?
It is a common misconception to think that because an agency does
not have any clients (they know of) who need language assistance,
they are not denying anyone’s legal right to access.
It is difficult to imagine a service area in any state with no potential
clients who would need language assistance to have equal access to
services. The fact that many agencies are not aware of anyone is
most likely evidence of unintended barriers to access rather than
evidence of the lack of need.
The legal requirements to provide language assistance are based on
who is in your service area, not who is on your current client list.
If the Client can’t speak my language
how will I know what assistance they
Excellent Question!
I Speak cards help determine which language a
person speaks. These card have a request for
assistance in English on one side and the client’s
chosen language on the reverse side.
Limited English Proficiency
Language help is not just for people who speak
another language, but for people with poor
hearing and limited eyesight as well.
Things to remember
• An interpreter is always free to the client.
• It’s best to use an interpreter, but a client can insist
on having their family interpret.
• A client cannot use another client to interpret, unless
it is an emergency.
• In an emergency anyone can act as an interpreter, but
you must document why it was an emergency.
• Assistance is not limited to individuals who speak an
different language. Eyesight and hearing problems can
result in the need as well.
Your trainer will be happy to answer any
questions you may have today.
During the course of your employment with GT
Independence please direct your questions to
your Supervisor or Team Leader. They will assist
you in making the best decision in specific
Please complete the LEP Quiz and return it to
your trainer.
Thank you for participating in this LEP training.

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