[Federal Register: December 15, 1999 (Volume 64, Number 240)] [Notices] [Page 70042-70044] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr15de99-78] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Call for Comments on Draft Standards on Culturally and Linguistically Appropriate Health Care and Announcement of Regional Informational Meetings on Draft Standards AGENCY: Office Secretary OS/Office of Public Health and Science, Office of Minority Health, DHHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: The DHHS Office of Minority Health announces the publication of an solicitation of public comments on draft national standards on culturally and linguistically appropriate health care. The 120-day comment period, beginning January 1, 2000, will include three regional meetings on the draft standards. Individuals and organizations are encouraged to submit their views on the 14 draft standards and the accompanying commentary. The national standards, as revised according to comments received, will be published in a final version in the fall of 2000. DATES: The comment and submission period is January 1 through April 30, 2000. ADDRESS: (1) By mail, comments postmarked no later than April 30, 2000, can be submitted to: CLAS Standards, c/o HHS Office of Minority Health, Rockwall II, 5515 Security Lane, #1000, Rockville, MD 20852. Comments sent by courier will be accepted until 5 PM EST on April 30. Comments may also be submitted electronically by email to: OMHRC__Standards@IQSolutions.com or through the Office of Minority Health Resource Center WebPages at www.omhrc.gov/clas. (2) Individuals may register for one of the regional meetings by using the online registration form at www.omhrc.gov/clas. To request a registration form by mail, write to: CLAS Standards meeting, c/o IQ Solutions, 11300 Rockville Pike, Suite 801, Rockville, MD 20852. A reading room will be made available Monday through Friday from 9:00 a.m. B 5:00 p.m., at HHS Office of Minority Health, Rockwall II, 5515 Security Lane, #1000, Rockville, MD 20852. The reading room will contain all pertinent material related to the CLAS standards and regional meetings. FOR FURTHER INFORMATION CONTACT: Guadalupe Pacheco, Office of Minority Health, 5515 Security Lane, Suite-1000, Rockville, MD 20852, Attn: CLAS, Office: (301) 443-5084, FAX: (301) 594-0767, EMAIL: gpacheco@osophs.dhhs.gov. SUPPLEMENTARY INFORMATION: Background Cultural and linguistic competence suggests and ability by health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by patients to the health care encounter. As health providers begin to treat a more diverse clientele as a result of demographic shifts and changes in participation in insurance programs, interest in designing culturally and linguistically appropriate services that lead to improved outcomes, efficiency and satisfaction is increasing. The provision of linguistically and culturally appropriate services is in the interest of providers, policymakers, accreditation and credentialing agencies, purchasers, patients, advocates, educators, and the general health care community. Many health care providers do not have clear guidance on how to prepare for or respond to culturally sensitive situations. Until now, no comprehensive nationally recognized standards of cultural or linguistic competence in health care service delivery have been developed. Instead, Federal health agencies, state policymakers, and national organizations have independently developed their own standards and practices. Some have developed definitions of cultural competence while others mandate providing language services to limited English speakers. Some specify collection of language, race, and ethnicity data. Many approaches attempt to be comprehensive, while others target only a specific issue, geographic area, or subfield of health care, such as mental health. The result is a wide spectrum of ideas about what constitutes culturally competent health services, including significant differences with respect to target population, scope, and quality of services. Although limited in their jurisdiction, many excellent policies do exist, and the increasing numbers of model programs and practices prove that culturally competent health [[Page 70043]] services are viable, beneficial, and important to health care consumers. In 1997, the U.S. Department of Health and Human Services' Office of Minority Health (OMH) asked Resources for Cross Cultural Health Care and the Center for the Advancement of Health to review and compare existing cultural and linguistic competence standards and measures in a national context, propose draft national standard language where appropriate, assess the information or research needed to relate these guidelines to outcomes, and develop an agenda for future work in this area. The result of this effort was a two-part report submitted to OMH in May, 1999 entitled Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda. The first part of this report recommends national standards for culturally and linguistically appropriate services (CLAS) in health care. Based on an analytical review of key laws, regulations, contracts, and standards currently in use by Federal and State agencies and other national organizations, these recommended standards were developed with input from a national project advisory committee of policymakers, health care providers, and researchers. Each standard is accompanied by commentary that addresses the proposed guideline's relationship to existing laws and standards, and offers recommendations for implemented and oversight to providers, policymakers, and advocates. Public Comment Period and Regional Informational Meetings The Office of Minority Health has determined that the appropriate next step is for the draft CLAS Standards to undergo a national process of public comment that will result in a broader awareness of HHS interest in CLAS, significant input from stakeholder groups on the draft standards, and a final revision of the standards and accompanying commentary supported by the expertise of a national project advisory committee. The final revisions will be published in the Federal Register as recommended national standards for adoption or adaptation by stakeholder organizations and agencies. The publication of the CLAS standards in the Federal Register, and publicizing the availability of the complete report with commentary on the Internet and through local, regional, and national organizations will facilitate reaching as wide an audience of stakeholders as possible. This period of dissemination and awareness-raising will include three regional meetings to gather and solicit detailed input from interested individuals and organizations that will complement and enhance the public comments received by HHS through written and electronic means. The 14 recommended standards are published below and, along with Part One of the full report, are also available online at www.omhrc.gov/clas. Individuals and organizations desiring to comment on the standards are encouraged to read the full report and to send comments during the public comment period, which will run from January 1, 2000 to April 30, 2000. Individuals may use one of the following methods for submitting comments: by mail to: CLAS Standards, c/o HHS Office of Minority Health, Rockwall, II, 5515 Security Lane, #1000, Rockville, MD 20852, by email to: OMHRC__Standards@IQSolutions.com or through the Website comment form at www.omhrc.gov/clas, or by participating in one of the regional meetings. Individuals sending comments are requested to include the following information: name, position, organization, mail, and email addresses; and to identify specifically those portions of their comments that pertain to: the overall report, the wording or content of individual standards, or the commentary on individual standards contained in the full report (indicate the appropriate standard number for each comment). Individuals will also have an opportunity to participate in one of three regional meetings on the CLAS standards. The purpose of these 1- day meetings is to present information on the standards development process and for participants to discuss and provide comments on the standards themselves or their implementation. Due to space constraints, participation will be limited to the first 150 individuals who register. Registration will be accepted starting on December 15, 1999. The dates and locations of the meetings are as follows: January 21, 2000 meeting to be held in San Francisco, CA; March 10, 2000 meeting to be held in Baltimore, MD; April 5, 2000 meeting to be held in Chicago, IL. Complete information on the regional meetings, including draft and final agendas, will be available online at www.omhrc.gov/clas. Individuals may register for one of the regional meetings by using the online registration form at www.omhrc.gov/clas or by sending a registration request to: CLAS Standards meeting, c/o IQ Solutions, 11300 Rockville Pike, Suite 801, Rockville, MD 20852. Only preregistered individuals will be guaranteed access to the meeting; transportation, lodging and other costs are the responsibility of the participant. Recommended Standards for Culturally and Linguistically Appropriate Health Care Services Based on an analytical review of key laws, regulations, contracts, and standards currently in use by Federal and state agencies and other national organizations, these guidelines were developed with input from a national project advisory committee of policymakers, providers, and researchers. In the full report, available online at www.omhrc.gov/ clas, each standard is accompanied by commentary that addresses its relationship to existing laws and standards, and offers recommendations for implementation and oversight to providers, policymakers, and advocates. Preamble Culture and language have considerable impact on how patients access and respond to health care services. To ensure equal access to quality health care by diverse populations, health care organizations, and providers should: 1. Promote and support the attitudes, behaviors, knowledge, and skills necessary for staff to work respectfully and effectively with patients and each other in a culturally diverse work environment. 2. Have a comprehensive management strategy to address culturally and linguistically appropriate services, including strategic goals, plans, policies, procedures, and designated staff responsible for implementation. 3. Utilize formal mechanisms for community and consumer involvement in the design and execution of service delivery, including planning, policy making, operations, evaluation, training, and, as appropriate, treatment planning. 4. Develop and implement a strategy to recruit, retain, and promote qualified, diverse and culturally competent administrative, clinical, and support staff that are trained and qualified to address the needs of the racial and ethnic communities being served. 5. Require and arrange for ongoing education and training for administrative, clinical, and support staff in culturally and linguistically competent service delivery. 6. Provide all clients with limited English proficiency access to bilingual staff or interpretation services. [[Page 70044]] 7. Provide oral and written notices, including translated signage at key points of contact, to clients in their primary language informing them of their right to receive interpreter services free of charge. 8. Translate and make available signage and commonly used written patient educational material and other materials for members of the predominant language groups in service areas. 9. Ensure that interpreters and bilingual staff can demonstrate bilingual proficiency and receive traning that includes the skills and ethics of interpreting, and knowledge in both languages of the terms and concepts relevant to clinical or non-clinical encounters. Family or friends are not considered adequate substitutes because they usually lack these abilities. 10. Ensure that the client's primary spoken language and self- identified race/ethnicity are included in the health care organization's management information system as well as any patient records used by provider staff. 11. Use a variety of methods to collect and utilize accurate demographic, cultural, epidemiological and clinical outcome data for racial and ethnic groups in the service area, and become informed about the ethnic/cultural needs, resources, and assets of the surrounding community. 12. Undertake ongoing organizational self-assessments of cultural and linguistic competence, and integrate measures of access, satisfaction, quality, and outcomes for CLAS into other organizational internal audits and performance improvement programs. 13. Develop structures and procedures to address cross cultural ethnical and legal conflicts in health care delivery and complaints or grievances by patients and staff about unfair, culturally insensitive or discriminatory treatment, or difficulty in accessing services, or denial of services. 14. Prepare an annual progress report documenting the organization's progress with implementing CLAS standards, including information on programs, staffing, and resources. The complete report, along with supporting material, is available online at www.OMHRC.gov/clas. Dated: December 7, 1999. Nathan Stinson, Jr., Deputy Assistant Secretary for Minority Health. [FR Doc. 99-32419 Filed 12-14-99; 8:45 am] BILLING CODE 4160-17-M
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