[Federal Register Volume 75, Number 184 (Thursday, September 23, 2010)]
[Notices]
[Pages 57957-57958]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-23760]



[[Page 57957]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Call for Comments on the Existing National Standards for the 
Culturally and Linguistically Appropriate Services in Health Care

AGENCY: Department of Health and Human Services, Office of the 
Secretary, Office of the Assistant Secretary for Health, Office of 
Minority Health.

ACTION: Notice.

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SUMMARY: The HHS Office of Minority Health (OMH) announces the launch 
of an enhancement initiative of the existing National Standards for 
Culturally and Linguistically Appropriate Services in Health Care (CLAS 
Standards). The public comment period will begin September 20, 2010 and 
conclude December 31, 2010. During this time three regional meetings on 
the standards will be held throughout the country. Individuals and 
organizations are encouraged to submit their comments on the 14 
standards and their current application and use. The enhanced national 
standards, as revised in accordance with public comment and subject 
matter expertise, will be published for review in spring of 2011 with 
the final versions being published in fall of 2011.

DATES: The initial comment and submission period is September 20 
through December 31, 2010.

ADDRESSES: (1) Electronically through the public comment site http://clasenhancements.thinkculturalhealth.org.
    (2) By mail, comments postmarked no later than December 31, 2010, 
can be submitted to: CLAS Standards c/o HHS Office of Minority Health, 
1101 Wootton Parkway, Suite 600, Rockville, Maryland 20852. Comments 
sent by courier will be accepted until 5 p.m. EST on December 31.
    (3) Individuals may register for one of the regional meetings by 
using the online registration form at http://clasenhancements.thinkculturalhealth.org. To request a registration 
form by mail, write to CLAS Standards Enhancement Initiative meeting, 
c/o SRA International, Inc., 6003 Executive Blvd, Suite 400, Rockville, 
MD 20852.

FOR FURTHER INFORMATION CONTACT: Guadalupe Pacheco, Office of Minority 
Health, 1101 Wootton Parkway, Suite 600, Rockville, MD 20852, Attn: 
CLAS, Telephone: (240) 453-6174; Fax: (240) 453-2883; E-mail: 
[email protected].
    Background: To help achieve its mission of ``improving the health 
of racial and ethnic minority populations through the development of 
effective health policies and programs that help to eliminate 
disparities in health,'' the OMH published the National Standards for 
Culturally and Linguistically Appropriate Services in Health Care (CLAS 
Standards) in 2001. The CLAS Standards were developed on the basis of 
an analytical review of key laws, regulations, contracts, and standards 
used by Federal and State agencies and other national organizations, 
with input from a national advisory committee of policymakers, health 
care providers, and researchers. Open public hearings were held to 
obtain input from communities throughout the nation. The CLAS Standards 
represent the first national standards for cultural competence in 
health care and offer comprehensive guidance on what constitutes 
culturally competent service delivery. They consist of 14 guidelines, 
recommendations, and mandates that serve to inform, guide, and 
facilitate implementation of culturally and linguistically appropriate 
services in health care. The CLAS Standards are organized by three 
themes: Culturally Competent Care, Language Access Services, and 
Organizational Supports. They recognize that culture and language are 
central to the delivery of health services.
    Disparities in health care have been documented in a number of 
groundbreaking reports: Findings of the Supplement to Mental Health: A 
Report of the Surgeon General (CMHS, 2001a) reveal that ``racial and 
ethnic minorities bear a greater burden from unmet mental health needs 
and thus suffer a greater loss to their overall health and 
productivity.'' Findings from the 2000 Surgeon General's Report Oral 
Health in America: A Report of the Surgeon General indicated 
significant disparities ``between racial and socioeconomic groups in 
regards to oral health and ensuing overall health issues'' (DHHS, 
2000). The 2003 report from the Institute of Medicine, Unequal 
Treatment: Confronting Racial and Ethnic Disparities in Healthcare 
(Smedley, Stith & Nelson, 2003), and its supplementary paper 
contributions such as Racial and Ethnic Disparities in Diagnosis and 
Treatment: A Review of the Evidence and a Consideration of Causes 
(Geiger, 2003) and The Civil Rights Dimension of Racial and Ethnic 
Disparities in Health Status (Perez, 2003), brought to the forefront 
that minorities receive lower quality health care even when 
socioeconomic and access-related factors are controlled. The report 
also showed that bias, stereotyping, prejudice, and clinical 
uncertainty may contribute to racial and ethnic disparities in health 
care (Smedley et al., 2003).
    A significant body of research released since the 2003 IOM report 
corroborates these findings. The National Healthcare Disparities Report 
prepared by the Agency for Healthcare Research and Quality states that 
``although varying in magnitude by condition and population, 
disparities are observed in almost all aspects of health care'' (The 
Agency for Healthcare Research and Quality, 2006). Inspired by the CLAS 
Standards, national organizations including the American Medical 
Association (AMA), American Association of Medical Colleges (AAMC), the 
Joint Commission, the National Committee for Quality Assurance (NCQA), 
the National Quality Forum (NQF) and others have released standards to 
help support the provision of culturally and linguistically appropriate 
care. Many of these standards promote the education and training of 
health care providers in culturally appropriate care.
    Increasingly, national experts are looking to cultural competency 
training as a means to reduce disparities in health care. Evidence 
suggests that the most effective cultural competence training helps 
providers develop new knowledge, skills, and attitudes in order to 
effectively treat minority and immigrant populations (Smedley et al., 
2003). The concepts of cultural and linguistic competency as well as 
health disparities are featured prominently in the health care reform 
legislation enacted and signed by President Barack Obama in March 2010. 
References to the concepts of cultural and linguistic competency 
illustrate how pervasive and important the constructs have become.
    Public comment period: It has been nearly ten years since the 
release of the landmark report regarding the CLAS Standards. In the 
report, the HHS, OMH provided the framework for all health care 
organizations to establish services and policies to best serve our 
increasingly diverse communities. In the decade following the release 
of the CLAS Standards, the field of cultural and linguistic competency 
has seen tremendous growth. It has evolved from a fledgling concept to 
a recognized intervention in the quest for health equity. The field of 
cultural and linguistic competency is dynamic and as such requires 
routine enhancement and nurturing. With this in mind, HHS, OMH has 
begun to revisit the National CLAS Standards.
    The OMH has determined that the appropriate next step is for the 
CLAS

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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 existing CLAS Standards, as well 
as a final revision of the CLAS 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 OMH through electronic and 
written means.
    Individuals and organizations desiring to provide input on the 
standards are encouraged to send comments during the public comment 
period which is from September 20 through December 31, 2010. 
Individuals mailing comments are requested to include the following 
information: Name, position, organization, mail, and e-mail addresses 
and to identify specifically those portions of their comments that 
pertain to: The wording or the content of individual standards, the 
purpose of the standards and/or the intended audience for the national 
standards.
    Dates and locations of the meetings are as follows:
    Baltimore, Maryland, Friday, October 22, 2010, The Hyatt Regency, 
300 Light Street, Baltimore, MD 21202.
    San Francisco, California, Thursday, November 4, 2010, The Stanford 
Court, A Renaissance Hotel, 905 California Street, San Francisco, CA 
94108.
    Chicago, Illinois, Monday, November 15, 2010, The James Hotel, 55 
East Ontario Street, Chicago, IL 60611-2727.
    All meetings will convene at 9 a.m. and conclude at 3 p.m. On-site 
registration will be available starting at 7:30 a.m.
    Information about the CLAS Standards Enhancement Initiative is 
available electronically at http://clasenhancements.thinkculturalhealth.org.

    Dated: September 2, 2010.
Garth N. Graham,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 2010-23760 Filed 9-22-10; 8:45 am]
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