[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.
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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]
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