New NYS Health Department Regulations to Address Hospital Language Barriers

Effective September 13, 2006 Click here for our article in the Gotham Gazette Click here for our news release As a result of civil rights complaints filed in 2005 by the NYIC�s Immigrant Health Access and Advocacy Collaborative against four hospitals, citing medical harm from communication barriers, the New York State Department of Health has adopted regulations setting basic standards around hospitals� communications with limited-English-proficient patients. The new regulations apply to all public and private hospitals in New York State and go into effect on September 13, 2006. Significantly, the regulations make it clear that every limited-English-proficient patient has a right to meaningful access to a hospital�s services; require every hospital to develop a language assistance program and designate a language assistance coordinator; require hospitals to identify and document each patient's language of preference and the acceptance or refusal of language assistance services; and set clear limits on the use of friends, strangers, and family members as interpreters, including age restrictions. The NYIC worked extensively with hospital associations and the state to craft the regulations, which will significantly improve the ability of persons with limited English to access quality health care. Below are the actual changes in the Title 10 regulation that will appear in the New York State Register on September 13, 2006. For more information, contact Maysoun Freij at 212-627-2227 x 232 or Jenny Rejeske at x 223. ________________________________________________________________________ NOTICE OF ADOPTION Language Assistance and Patient Rights I.D. No. HLT-20-06-00004-A Filing No. 1040 Filing date: Aug. 28, 2006 Effective date: Sept. 13, 2006 PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action: Action taken: Amendment of sections 405.7 and 751.9 of Title 10 NYCRR. Statutory authority: Public Health Law, section 2803 Subject: Language assistance and patient rights. Purpose: To strengthen communications provisions for persons who do not speak English or do not speak it well; and addition of two rights to the Patient's Bill of Rights to be consistent with the Public Health Law. Text of final rule: Paragraph (7) of subdivision (a) is repealed in its entirety and a new paragraph (7) of Section 405.7 is added to read as follows: (7) the hospital shall develop a Language Assistance Program to ensure meaningful access to the hospital�s services and reasonable accommodation for all patients who require language assistance. Program requirements shall include: (i) the designation of a Language Assistance Coordinator who shall report to the hospital administration and who shall provide oversight for the provision of language assistance services; (ii) policies and procedures that assure timely identification and ongoing access for patients in need of language assistance services; (iii) the development of materials that will be made available for patients and potential patients that summarize the process and method to access free language assistance services; (iv) ongoing education and training for administrative, clinical and other employees with direct patient care contact regarding the importance of culturally and linguistically competent service delivery and how to access the hospital�s language assistance services on behalf of patients; (v) signage, as designated by the Department of Health, regarding the availability of free language assistance services in public entry locations and other public locations; (vi) identification of language of preference and language needs of each patient upon initial visit to the hospital; (vii) documentation in the medical record of the patient�s language of preference, language needs, and the acceptance or refusal of language assistance services; (viii) a provision that family members, friends, or non-hospital personnel may not act as interpreters, unless: (a) the patient agrees to their use; (b) free interpreter services have been offered by the hospital and refused; and (c) issues of age, competency, confidentiality, or conflicts of interest are taken into account. Any individual acting as an interpreter should be 16 years of age or older; individuals younger than 16 years of age should only be used in emergent circumstances and their use documented in the medical record. (ix) management of a resource of skilled interpreters and persons skilled in communicating with vision and/or hearing impaired individuals; (a) interpreters and persons skilled in communicating with vision and/or hearing impaired individuals shall be available to patients in the inpatient and outpatient setting within 20 minutes and to patients in the emergency service within 10 minutes of a request to the hospital administration by the patient, the patient�s family or representative or the provider of medical care. The Commissioner of Health may approve time limited alternatives to the provisions of this subparagraph regarding interpreters and persons skilled in communicating with vision and/or hearing impaired individuals for patients of rural hospitals; which: (1) demonstrate that they have taken and are continuing to take all reasonable steps to fulfill these requirements but are not able to fulfill such requirements immediately for reasons beyond the hospital�s control; and (2) have developed and implemented effective interim plans addressing the communications needs of individuals in the hospital service area. (x) an annual needs assessment utilizing demographic information available from the United State Bureau of the Census, hospital administrative data, school system data, or other sources, that will identify limited English speaking groups comprising more than one percent of the total hospital service area population. Translations/transcriptions of significant hospital forms and instructions shall be regularly available for the languages identified by the needs assessment; and (xi) reasonable accommodation for a family member or patient�s representative to be present to assist with the communication assistance needs for patients with mental and developmental disabilities. New paragraphs (18) and (19) are added to subdivision (c) of Section 405.7 to read as follows: (18) Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors. (19) Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the hospital. Subdivisions (n) and (o) are amended and new subdivisions (p) and (q) are added to Section 751.9 to read as follows: (n) approve or refuse the release or disclosure of the contents of his/her medical record to any health-care practitioner and/or health care facility except as required by law or third-party payment contract; [and] (o) access his/her medical record pursuant to the provisions of section 18 of the Public Health Law, and Subpart 50-3 of this Title[.] ; (p) authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors; and (q) make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the center. Final rule as compared with last published rule: Nonsubstantial changes were made in section 405.7(a)(7)(viii)(c), (ix), (ix)(a), (x). Text of rule and any required statements and analyses may be obtained from: William Johnson, Department of Health, Division of Legal Affairs, Office of Regulatory Reform, Corning Tower, Rm. 2415, Empire State Plaza, Albany, NY 12237, (518) 473-7488, fax: (518) 486-4834, email: regsqna@health.state.ny.us

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