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  • Title Vi and title ii
  • Americans with disabilities act
  • the joint commission
  • clas standards


The information contained in this section is for educational purposes only. For more information, we have provided the appropriate website links.

Title VI of the Civil Rights Act of 1964 and Title II of the Americans with Disabilities Act of 1990


In an effort to ensure nondiscrimination and increase the number of individuals who have access to quality healthcare services, OCR investigates entities that receive funding from HHS to ensure they comply with applicable Federal civil rights laws. One of those laws, Title VI of the Civil Rights Act of 1964, protects people of every race, color and national origin from unlawful discrimination. Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act of 1990 prohibit discrimination on the basis of disability.


Through the effective enforcement of these Federal civil rights laws, OCR seeks to decrease healthcare disparities and ensure access to quality healthcare services. Title II of the ADA prohibits discrimination against qualified individuals with disabilities on the basis of disability in all programs, activities, and services of public entities. Public entities include state and local governments and their departments and agencies. Title II applies to all activities, services and programs of a public entity. The Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services has been designated enforcement responsibility under Title II of the ADA for state and local health care and human service agencies.

Recipients and Federal Government
Executive Order 13166
This Order, "Improving Access to Services for Persons with limited English proficiency," directed federal agencies to:
  • Publish guidance on how their receipients can provide access to LEP persons
  • Improve the language accessibility of their own federal programs
  • Break down language barriers by imple-menting consistent standards of language assistance across federal agencies and amongst all receipients of federal financial assistance


The federal government and those receiving assistance from the federal government must take reasonable steps to ensure that LEP (limited English proficient) persons have meaningful access to the programs, services, and information those entities provide. This will require agencies to develop creative solutions to address the needs of this ever-growing population of individuals whose primary language is English.


Different treatment based on a person's inability to speak, read, write, or understand English may be a type of national origin discrimination.






Who Must Comply?

All programs and operations of entities that receive assistance from the federal government (i.e. recipients), including:

  • State agencies
  • Local agencies
  • Private and nonprofit entities

Sub-recipients (entities that receive federal funding from one of the receipients listed above) also must comply.


All programs and operations of the federal government also must comply.


For more information follow the link below:


Americans with Disabilities Act


ADA Business BRIEF:

Communicating with People Who Are Deaf
or Hard of Hearing in Hospital Settings


People who are deaf or hard of hearing use a variety of ways to communicate. Some rely on sign language interpreters or assistive listening devices; some rely primarily on written messages. Many can speak even though they cannot hear. The method of communication and the services or aids the hospital must provide will vary depending upon the abilities of the person who is deaf or hard of hearing and on the complexity and nature of the communications that are required.
Effective communication is particularly critical in health care settings where miscommunication may lead to misdiagnosis and improper or delayed medical treatment.


Situations where an interpreter may be required for effective communication:

  • discussing a patient's symptoms and medical condition, medications, and medical history
  • explaining and describing medical conditions, tests, treatment options, medications, surgery and other procedures
  • providing a diagnosis, prognosis, and recommendation for treatment
  • obtaining informed consent for treatment
  • communicating with a patient during treatment , testing procedures, and during physicians rounds
  • providing instructions for medications, post-treatment activities, and follow-up treatments
  • providing mental health services, including group or individual therapy, or counseling for patients and family members
  • providing information about blood or organ donations
  • explaining living wills and powers of attorney
  • discussing complex billing or insurance matters
  • making educational presentations, such as birthing and new parent classes, nutrition and weight management counseling, and CPR and first aid training




Beginning in 2012, recipients of Federal Funds will be evaluated by the Joint Commission.


Since 2007, The Joint Commission has been working toward improving access to care for all patients at our accredited organizations through better communication, cultural competence and patient-and family-centered care. In December 2009, the patient-centered communication standards were approved by The Joint Commission Board of Commissioners. The standards are published in the 2011 Comprehensive Accreditation Manual for Hospitals (CAMH): The Official Handbook. Joint Commission surveyors will evaluate compliance with the patient-centered communication standards beginning January 1, 2011; however, findings will not affect the accreditation decision until January 1, 2012 at the earliest.


Standards in Support of Language and Culture

The Joint Commission views the issue of the provision of culturally and linguistically appropriate health care services as an important quality and safety issue and a key element in individual-centered care. It is well recognized that the individuals involvement in care decisions is not only an identified right, but is a necessary source of accurate assessment and treatment information. The Joint Commission has been studying these issues through its Hospitals, Language, and Culture: A Snapshot of the Nation (HLC) study, and HLC staff have developed several resources that highlight The Joint Commission standards that support the provision of care, treatment, and services in a manner that is conducive to the communication, cultural, language, health literacy, and spiritual/religious needs of individuals.


For more information, follow the link below:

> Joint Commission

Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care

A Roadmap for Hospitals

> Download it here


Improving Patient-Provider Communication
Joint Commission Standards and Federal Laws



Part 1


Part 2


Part 3


Part 4

National Standards on Culturally and
Linguistically Appropriate Services (CLAS)

US Department of Health & Human Services
The Office of Minority Health


The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.


The 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows:


CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7).

CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).


CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).


Standard 1

Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.


Standard 2

Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.


Standard 3

Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.


Standard 4

Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.


Standard 5

Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.


Standard 6

Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).


Standard 7

Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.


Standard 8

Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.


Standard 9

Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.


Standard 10

Health care organizations should ensure that data on the individual patient's/consumer's race, ethnicity, and spoken and written language are collected in health records, integrated into the organization's management information systems, and periodically updated.


Standard 11

Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.


Standard 12

Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.


Standard 13

Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.


Standard 14

Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.


For more information follow this link: > Office of Minority Health.


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