REPORT OF THE COUNCIL ON MEDICAL SERVICE

Subject: Interpreter Services and Payment Responsibilities

Presented by: William E. Kobler, MD, Chair

Referred to: Reference Committee G

(Jane C. K. Fitch, MD, Chair)

CMS Report 5-A-11

1 The House of Delegates adopted Resolution 724-A-10 and adopted as amended Resolution2 823-1-10. Resolution 724-A-10 asked the American Medical Association (AMA) to "study the3 feasibility of requiring hospitals to provide and pay for interpreter services for the follow-up care of4 patients that physicians are required to accept as a result of that patient's emergency room visit."5 Amended Resolution 832-1-10 asked the AMA to "evaluate the impact on a physician practice of6 any federal mandate that requires an interpreter be present for patients who cannot communicate7 proficiently in English, or are hearing impaired." Both of these items are codified in Policy8 D-215.991 (AMA Policy Database). The Board of Trustees referred these items to the Council on9 Medical Service for study.

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11 This report provides background on federal policies relatedto language and hearing interpreter12 services, summarizes AMA policy and advocacy on interpreter guidance, discusses interim13 solutions to addressing care and recommends a comprehensive strategy to provide and pay for14 interpreter services.15

16 BACKGROUND

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18 The immigrant population in the United States is growing, and for many immigrants, English is not19 a first language. According to the 2009 US Census Bureau's American Community Survey, 24.520 million or 8.6% of the US population speaks English less than "very well." Many states report21 significantly higher percentages of people who are limited English proficient (LEP). Interpretation22 is the act of facilitating oral communication between individuals who do not speak the same23 language and may not share the same culture. Translation is changing written documents from one24 language into another. Providing interpretation and translation services to patients who are LEP25 has been shown to improve health care quality, the patient experience, adherence to recommended26 care, and ultimately health outcomes (Flores, Medical Care Research and Review, 2005, Jacobs et27 at, The Milbank Quarterly, 2006, Karliner, Journal of General Internal Medicine, 2004).28

29 Language services30

31 Title VI of the Civil Rights Act of 1964 is a federal law that protects persons from unlawful32 discrimination based on race, color, or national origin in programs and activities that receive33 federal financial assistance. These regulations recognize that an individual's primary language is34 often an essential national origin characteristic. Unlawful discrimination means that recipients of35 federal dollars may not utilize criteria or methods of administration that have the effect of delaying36 or denying services to persons on the basis of their race, color, or national origin.