Effective July 18, 2016, all dentists who accept Medicaid, Medicare A, C and D and Medicare Advantage payments are responsible for following provisions under Section 1557 of the Affordable Care Act.   This law basically requires that patients who receive federal assistance cannot be denied health services or health coverage or discriminated against in other ways in health services or coverage because of their race, color, national origin, sex, age, or disability.  The rule requires every covered dental practice to take reasonable steps to provide meaningful access to individuals with Low English Proficiency (LEP) who are eligible to be served or likely to be encountered.

As of the effective date, you are required to do the following:

• Arrange for translator services if requested by a patient and necessary.  For Medicaid providers in Virginia, DentaQuest will reimburse for these services and they have a list of approved interpreter services on their website.  It is recommended that you contact DentaQuest if you would like information on the services and the process for reimbursement.  Some other plans may also pay for these services and, if the service is needed for a patient, the recommendation would be for you to contact the particular plan to inquire.
•  With certain exceptions, such as in an emergency when a qualified interpreter is not available, when a covered dental practice provides an interpreter or translator (including bilingual staff), the interpreter or translator must meet certain requirements.  These interpreters or translators may be business associates and will likely require HIPAA business associate agreements.
• The dentist must reasonably determine that the translator:
• Is proficient in writing and understanding both written English and the non-English language.
• Can translate effectively, accurately, and impartially to and from English and the non-English language, using any necessary specialized vocabulary, terminology and phraseology.
• Adheres to generally accepted translator ethics principles, including confidentiality.
• Depending on the circumstances, the dentist may provide on-site or remote interpretation. Remote interpretation may not be appropriate in situations where visual cues and other messages depend on physical as well as verbal communication to provide meaningful access to an individual with LEP. The final rule requires audio-visual communication to meet certain requirements, such as:
• Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communications.
• A sharply delineated image that is large enough to display the interpreter’s face and the participating individual’s face regardless of the individual’s body position.
• A clear, audible transmission of voices.
• Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the video remote interpreting.

The covered dental practice must pay, and cannot charge the patient, for this service. As mentioned above, Medicaid reimbursement is available for these services in Virginia.  Contact DentaQuest for information on the services and the reimbursement process. You are responsible for offering a qualified interpreter or translator when oral interpretation or translation is a reasonable step to provide meaningful access for a LEP individual in a language likely to be encountered or spoken by individuals eligible to be served by your practice.
If a bilingual adult comes with the individual with LEP, you may not rely on that adult to interpret, except in an emergency involving an imminent threat to someone’s safety or welfare, such as a dental emergency, where there’s no qualified interpreter immediately available, or where the individual with LEP specifically requests that the adult interpret, the adult agrees to interpret, and it’s appropriate to rely on the adult under the circumstances.

• Some plans (such as DentaQuest) may pay for these services so it is recommended that you contact the plan to inquire about these services and how the payment will be processed.

• Post a notice of nondiscrimination in your dental office and on your website.  This is required by October 16th. OCR has provided a sample Notice of Nondiscrimination, which is available at www.ADA.org/1557.
• Post taglines in your dental office and on your website indicating that the language assistance services are available at no charge.  These taglines must be made in the 15 most common languages spoken in the state and they must be printed on your most important publications and communications.  The 15 non-English languages for Virginia are: Spanish, Korean, Vietnamese, Chinese, Arabic, Tagalog, Persian, Amharic, Urdu, French, Russian, Hindi, German, Bengali, and Kru/Ibo/Yoruba.  This is also required by October 16th.  
The ADA provides a most critical resource: state-by-state ADA sample taglines https://success.ada.org/en/practice/operations/section-1557/~/link.aspx?_id=6FA08470962D4A66BEBAA86451248E3B&_z=z

The ADA has requested that the Office for Civil Rights extend the implementation deadline to allow sufficient time for ADA members to meet the requirements but this request was denied.  The ADA has also asked that the most burdensome regulations be limited to only those practices employing 25 or more staff. 

ADA Webinar on Section 1557 Requirements: http://cc.readytalk.com/play?id=3uv57u

More resources can be found on the ADA website by clicking here. 

The Health and Human Services Website also includes some resources for providers regarding these regulations.

• Click here for FAQs on the final rule
• Review the Civil Rights for Providers of Health Care and Human Services by clicking here.