Chapter Four – Required and Additional Health Services, of the Health Resources and Services Administration (HRSA) Health Center Program Compliance Manual (Compliance Manual, Chapter Four) requires health centers that serve a substantial proportion of patients with Limited English Proficiency (LEP) to implement the following:

• Develop a plan and make arrangements for interpretation and translation that are appropriate for the needs of the patient population; and
• Provide guidance to staff members with respect to cultural sensitivities and bridging linguistic and cultural differences. 

Additionally, Chapter Seven – Coverage for Medical Emergencies During and After-Hours (Compliance Manual, Chapter Seven) requires health centers to ensure patients in the LEP patient population:

• Are informed of and able to access after-hours coverage; and
• Receive information regarding after-hours coverage in language, literacy levels and formats appropriate to the patient population.

Health centers can demonstrate compliance with ensuring access to the LEP patient population via the following methods: 

• Utilize bilingual staff, as appropriate.
• Provide documentation of the completion of cultural competency training for staff.
• Contract with an organization that provides translation services.
• Provide evidence of translated key documents provided to patients. 
• Ensure documented after-hours procedures include verbiage to support the following:
  • Information regarding after-hours coverage is provided in languages and literacy levels appropriate to the health center’s patient population.
  • The manner in which after-hours information is provided to patients, including those with LEP. 
  • The process for managing an after-hours call for an LEP patient. 

Health centers can conduct a self-assessment of compliance by answering the questions outlined in Chapter Four – Required and Additional Health Services, Elements b and c (Site Visit Protocol, Chapter Four), and Chapter Seven – Coverage for Medical Emergencies During and After Hours, Element c (Site Visit Protocol, Chapter 7),  in the HRSA Health Center Program Site Visit Protocol.