[Federal Register Volume 64, Number 240 (Wednesday, December 15, 1999)]
[Notices]
[Pages 70042-70044]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-32419]


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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.

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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: 
[email protected] 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: 
[email protected].

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: [email protected] 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