For day 10 of Better Speech and Hearing Month, I will be outlining federal legislation that connects to cultural competence. Yesterday, I discussed the ASHA Code of Ethics and Cultural Competence. Today’s article is a broader extension of that topic.
Federal Legislation
- Here are the pieces of federal legislation I am outlining:
- Title VI of the Civil Rights Act of 1964
- National Standards on Culturally and Linguistically Appropriate Services
- Americans with Disabilities Act
- Medicare
- Medicaid
Title VI of Civil Rights Act
No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.
Program or activities can include:
- Portions of the state or local governments
- college, university, postsecondary institution
- local education agencies, system of vocational education
- corporation, partnership, private organization
Source: Title VI, Civil Rights Act of 1964 | U.S. Department of Labor (dol.gov)
National Standards for Culturally and Linguistically Appriate Services in Health and Health Care
“These standards aim to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for health and health care organizations”. Their principal standard is to “provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred langauges, health literacy, and other communicationeeds.”
Here are some policies within the federal legislation related to communication and healthcare:
- Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate
timely access to all health care and services. - Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writin
- Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Click the link below to read more important aspects of this federal legislation.
Americans with Disabilities Act
The ADA prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications. It also applies to the United States Congress.
Here are some critical portions of the ADA related to communication and cultural competence:
Title IV addresses telephone and television access for people with hearing and speech disabilities. It requires common carriers (telephone companies) to establish interstate and intrastate telecommunications relay services (TRS) 24 hours a day, 7 days a week. TRS enables callers with hearing and speech disabilities who use TTYs (also known as TDDs), and callers who use voice telephones to communicate with each other through a third party communications assistant. Title IV also requires closed captioning of Federally funded public service announcements.
The Fair Housing Act, as amended in 1988, prohibits housing discrimination on the basis of race, color, religion, sex, disability, familial status, and national origin. Its coverage includes private housing, housing that receives Federal financial assistance, and State and local government housing.
The Civil Rights of Institutionalized Persons Act (CRIPA) authorizes the U.S. Attorney General to investigate conditions of confinement at State and local government institutions such as prisons, jails, pretrial detention centers, juvenile correctional facilities, publicly operated nursing homes, and institutions for people with psychiatric or developmental disabilities. Its purpose is to allow the Attorney General to uncover and correct widespread deficiencies that seriously jeopardize the health and safety of residents of institutions. The Attorney General does not have authority under CRIPA to investigate isolated incidents or to represent individual institutionalized persons.
Medicare
Medicare
Medicare is the federal health insurance program for people aged 65 and older and certain younger people with disabilities.
There are three parts of Medicare:
- Part A: Hospital insurance (hospital stays, skilled nursing stays, hospice care, home health care)
- Part B: Medical Insurance (doctor’s services, outpatient care, medical supplies, preventative services
- Part D: Prescription Drug Coverage (cost of prescription drugs and many vaccines)
Here are Medicare Requirements for Cultural Competence:
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs, and the federally facilitated Marketplace. CMS doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.
CMS provides free auxiliary aids and services including information in accessible formats like Braille, large print, data/audio files, relay services and TTY communications. If you request information in an accessible format from CMS, you won’t be disadvantaged by any additional time necessary to provide it. This means you will get extra time to take any action if there’s a delay in fulfilling your request.
- Get health care services in a language you understand and in a culturally-sensitive way.
- Your rights as a nursing home resident include the right to be free from discrimination.
Source: medicare.gov
Medicaid
Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.
Programs and Expansions within Medicaid Related to Cultural Competence:
The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. See if your state has expanded Medicaid coverage to low-income adults.
- Medically Needy Program: for individuals with significant health needs whose income is too high to otherwise qualify for Medicaid under other eligibility groups. Medically needy individuals can still become eligible by “spending down” the amount of income that is above a state’s medically needy income standard. Individuals spend down by incurring expenses for medical and remedial care for which they do not have health insurance. Once an individual’s incurred expenses exceed the difference between the individual’s income and the state’s medically needy income level (the “spenddown” amount), the person can be eligible for Medicaid. The Medicaid program then pays the cost of services that exceeds the expenses the individual had to incur to become eligible.
In addition to states with medically needy programs, 209(b) states also must allow a spenddown to the income eligibility levels eligibility groups based on blindness, disability, or age (65 and older), even if the state also has a medically needy program. Thirty-six states and the District of Columbia use spenddown programs, either as medically needy programs or as 209(b) states.
Source: medicaid.gov
This was day 10 of Better Speech and Hearing month. We discussed an overview of U.S. Federal Legislation that relates to cultural competency and healthcare. Tomorrow, I will discuss different state legislation that incorporate cultural competency into healthcare.
If you missed the first ten days of BHSM, click here to check them out.
Come back tomorrow to learn more about cultural sensitivity as an SLP. For more cultural sensitivity tips, make sure to subscribe to my SLP Survival Newsletter!
