Health Equity and Accountability Act of 2026

In this title, the definitions in section 3400 of the Public Health Service Act, as added by section 2004, shall apply.

(a) Purpose.— It is the purpose of this section—

(1) to improve Federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals with limited English proficiency;

(2) to require each Federal agency to examine the services it provides and develop and implement a system by which individuals with limited English proficiency can obtain culturally competent services and meaningful access to those services consistent with, and without substantially burdening, the fundamental mission of the agency;

(3) to require each Federal agency to translate any English language written material prepared for the general public into the top 15 non-English languages in the United States (according to the most recent data from the American Community Survey or its replacement) within established timelines described in subsection (b)(2)(C)(v);

(4) to require each Federal agency to ensure that recipients of Federal financial assistance provide meaningful access to applicants and beneficiaries who are individuals with limited English proficiency and culturally competent services to all individuals;

(5) to ensure that recipients of Federal financial assistance take reasonable steps, consistent with the guidelines set forth in the “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (67 Fed. Reg. 41455 (June 18, 2002)), to ensure culturally and linguistically appropriate access to their programs and activities by individuals with limited English proficiency; and

(6) to ensure compliance with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) and section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) (prohibiting health care providers and organizations from discriminating in the provision of services).

(b) Federally conducted programs and activities.—

(1) In general.— Not later than 120 days after the date of enactment of this Act, each Federal agency providing financial assistance to, or administering, a health program or activity described in section 2003(a) shall prepare a plan or update a plan to improve culturally and linguistically appropriate access to such program or activity with respect to individuals with limited English proficiency. Not later than 1 year after the date of enactment of this Act, each such Federal agency shall ensure that such plan is fully implemented.

(2) Plan requirement.— Each plan under paragraph (1) shall include—

(A) the steps the agency will take to ensure that individuals with limited English proficiency have access to each health program or activity supported or administered by the agency;

(B) the policies and procedures for identifying, assessing, and meeting the culturally and linguistically appropriate language needs of its beneficiaries, including those who are individuals with limited English proficiency, served by such a program or activity;

(C) the steps the agency will take for such program or activity to be culturally and linguistically appropriate by—

(i) providing a range of language assistance options;

(ii) giving notice to individuals with limited English proficiency of the right to competent language services;

(iii) training staff (at least annually);

(iv) monitoring and assessing the quality of the language services (at least annually); and

(v) translating any English language written material prepared for the general public into the top 15 non-English languages in the United States (according to the most recent data from the American Community Survey or its replacement) within established timelines that ensure that high-quality, culturally competent translated material is provided promptly within not more than 15 calendar days in general and within not more than 7 calendar days in the case of any national emergency or State disaster declaration;

(D) the steps the agency will take for such program or activity to provide reasonable accommodations necessary for all individuals, including individuals with limited English proficiency and other groups, to understand communications from the agency;

(E) the steps the agency will take to ensure that applications, forms, and other significant documents for such program or activity are competently translated into the primary language of a client that is an individual with limited English proficiency where such materials are needed to improve access of such client to such program or activity;

(F) the resources the agency will provide to improve cultural and linguistic appropriateness to assist recipients of Federal funds to improve access to health care-related programs and activities for individuals with limited English proficiency;

(G) the resources the agency will provide to ensure that competent language assistance is provided to patients that are individuals with limited English proficiency by interpreters or trained bilingual staff;

(H) the resources the agency will provide to ensure that family, particularly minor children, and friends are not used to provide interpretation services, except as permitted under section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116); and

(I) the steps the agency will take and resources the agency will provide to ensure that individuals know their rights, including the ability to and procedures to file a complaint.

(3) Submission of plan to DOJ.— Each agency that is required to prepare a plan under paragraph (1) shall—

(A) consult with populations who are directly impacted by policies in the plan and their representatives in the development of the plan; and

(B) when the plan is finalized, send a copy of the plan, and any subsequent material updates to such plan, to the Attorney General, who shall serve as the central repository of all such plans.

(a) Applicability.— This section shall apply to any health program or activity—

(1) of which any part is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance; or

(2) that is carried out (including indirectly through contracts, subcontracts, or other support) by an executive agency or any entity established under title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18001 et seq.) (or amendments made thereby).

(b) Standards.— Each program or activity described in subsection (a)—

(1) shall implement strategies to recruit, retain, and promote individuals at all levels to maintain a diverse staff and leadership that can provide culturally and linguistically appropriate health care to patient populations of the service area of the program or activity;

(2) shall educate and train governance, leadership, and workforce at all levels and across all disciplines of the program or activity in culturally and linguistically appropriate policies, and practices, and legal requirements on an ongoing basis at least yearly;

(3) shall offer and promptly provide language assistance, including trained and competent bilingual staff and interpreter services, to individuals with limited English proficiency or who have other communication needs, at no cost to the individual at all points of contact, and during all hours of operation, to facilitate timely access to health care services and health care-related services;

(4) shall for each language group consisting of individuals with limited English proficiency that constitutes 5 percent or 500 individuals, whichever is less, of the population of persons eligible to be served or likely to be affected or encountered in the service area of the program or activity, make available at a fifth grade reading level or at the reading level most appropriate for the individuals belonging to the relevant language group—

(A) easily understood patient-related materials, including print and multimedia materials, in the language of such language group;

(B) information or notices about termination of benefits in such language;

(C) signage; and

(D) any other documents or types of documents designated by the Secretary;

(5) shall develop and implement clear goals, policies, operational plans, and management, accountability, and oversight mechanisms in collaboration with the relevant communities served to provide culturally and linguistically appropriate services and infuse them throughout the planning and operations of the program or activity;

(6) shall conduct initial and ongoing, at least annually, organizational assessments of culturally and linguistically appropriate services-related activities and integrate valid linguistic, competence-related National Standards for Culturally and Linguistically Appropriate Services (CLAS) measures into the internal audits, performance improvement programs, patient satisfaction assessments, continuous quality improvement activities, and outcomes-based evaluations of the program or activity and develop ways to standardize assessments;

(7) shall ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note; Public Law 104–191), data on an individual required to be collected pursuant to section 3101 of the Public Health Service Act (42 U.S.C. 300kk), including the individual’s alternative format preferences and policy modification needs, are—

(A) collected in health records;

(B) integrated into the management information systems of the program or activity;

(C) reported in such a way as to be interoperable with health information systems at the Federal and State levels; and

(D) periodically updated;

(8) shall maintain a current demographic, cultural, and epidemiological profile of the community, conduct regular assessments of community health assets and needs, and use the results of such assessments to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the program or activity;

(9) shall develop participatory, collaborative partnerships with community-based organizations and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing, implementing, and evaluating policies and practices to ensure culturally and linguistically appropriate service-related activities;

(10) shall ensure that conflict and grievance resolution processes are culturally and linguistically appropriate and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients;

(11) shall annually—

(A) make available to the public—

(i) information about the progress and successful innovations of the program or activity in implementing the standards under this section; and

(ii) translated materials of such information that is culturally and linguistically appropriate to the communities served under this section; and

(B) provide public notice in such communities about the availability of such information; and

(12) shall, if requested, regularly make available to the head of each Federal entity from which Federal funds are provided, information about the progress and successful innovations of the program or activity in implementing the standards under this section as required by the head of such entity.

(c) Comments accepted through notice and comment rulemaking.— An executive agency carrying out a program or activity described in subsection (a)—

(1) shall ensure that comments with respect to such program or activity that are accepted through notice and comment rulemaking are accepted in all languages;

(2) may not require such comments to be submitted only in English; and

(3) shall ensure that any such comments that are not submitted in English are considered, during the agency’s review of such comments, equally as such comments that are submitted in English.

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following: