Health Equity and Accountability Act of 2026

“(a) In general.— In this title:

(1) Bilingual.— The term bilingual, with respect to an individual, means an individual who has a sufficient degree of proficiency in 2 languages.

(2) Community health worker.— The term community health worker means a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served that enables the worker to build trusted relationships, serve as a liaison between health and social services and the community, facilitate access to services, and improve the quality and cultural competence of service delivery.

(3) Cultural.— The term cultural means relating to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, age, and institutions of racial, ethnic, religious, or social groups, including lesbian, gay, bisexual, transgender, queer, and questioning individuals, and individuals with physical and mental disabilities.

(4) Culturally and linguistically appropriate.— The term culturally and linguistically appropriate means being respectful of and responsive to the cultural and linguistic needs of all individuals.

(5) Effective communication.— The term effective communication means an exchange of information between the provider of health care or health care-related services and the recipient of such services who is limited in English proficiency, or has a communication impairment such as a hearing, vision, speaking, or cognitive disability, that enables access to, understanding of, and benefit from, with consideration for the recipient’s health literacy, health care or health care-related services, and full participation in the development of the treatment plan of the recipient.

(6) Grievance resolution process.— The term grievance resolution process means all aspects of dispute resolution including filing complaints, grievance and appeal procedures, and court action.

(7) Health care group.— The term health care group means a group of physicians organized, at least in part, for the purposes of providing physician services under the Medicaid program under title XIX of the Social Security Act, the State Children’s Health Insurance Program under title XXI of such Act, or the Medicare program under title XVIII of such Act, including a provider of services under part B of such title XVIII, and may include a hospital, a hospice provider, a palliative care provider, and any other individual or entity furnishing services covered under any such program that is affiliated with the health care group.

(8) Health care.— The term health care includes all health care needed throughout the life cycle and the end of life.

(9) Health care services.— The term health care services means services that address physical and mental health conditions, as well as conditions impacted by social determinants of health, in all care settings throughout the life cycle and the end of life.

(10) Health care-related services.— The term health care-related services means human or social services programs or activities that provide access, referrals, or links to health care services.

(11) Health educator.— The term health educator includes a professional with a baccalaureate degree who is responsible for designing, implementing, and evaluating individual and population health promotion, health education (including education on end-of-life care options), end-of-life care, or chronic disease prevention programs.

(12) Indian; indian tribe.— The terms “Indian” and “Indian Tribe” have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act.

(13) Individual with a disability.— The term individual with a disability means any individual who has a disability as defined for the purpose of section 504 of the Rehabilitation Act of 1973.

(14) Individual with limited english proficiency.— The term individual with limited English proficiency means an individual who self-identifies on the Census as speaking English less than “very well”.

(15) Integrated health care delivery system.— The term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health, mental health, substance use disorder, hospice and palliative care, and related disciplines to improve the health outcomes of an individual and the community. Such providers may include hospitals, health, mental health, or substance use prevention and treatment clinics and providers, home health agencies, home- and community-based services providers, congregate settings (including any skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, shelters, and facilities providing services for older adults and individuals with disabilities), ambulatory surgery centers, rehabilitation centers, employed, independent, or contracted physicians, and oral health care providers.

(16) Interpreting; interpretation.— The terms “interpreting” and “interpretation” mean the transmission of a spoken, written, or signed message from one language or format into another, faithfully, accurately, and objectively.

(17) Language access.— The term language access means the provision of language services to an individual with limited English proficiency or an individual with communication disabilities designed to enhance that individual’s access to, understanding of, or benefit from health care services or health care-related services.

(18) Language assistance services.— The term language assistance services includes—

(A) oral language assistance, including interpretation in non-English languages provided in person or remotely by a qualified interpreter for an individual with limited English proficiency, and the use of qualified bilingual or multilingual staff to communicate directly with individuals with limited English proficiency;

(B) written translation, performed by a qualified translator, of written content in paper or electronic form into languages other than English; and

(C) taglines.

(19) Minority populations.— The term minority populations means individuals of racial and ethnic minority groups, individuals of sexual and gender minority groups, and individuals with a disability.

(20) Onsite interpretation.— The term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care services or health care-related services and the recipient of such services who is limited in English proficiency or has a communication impairment such as an impairment in hearing, vision, or learning.

(21) Qualified individual with a disability.— The term qualified individual with a disability means, with respect to a health program or activity, an individual with a disability who, with or without reasonable modifications to policies, practices, or procedures, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of aids, benefits, or services offered or provided by the health program or activity.

(22) Qualified interpreter for an individual with a disability.— The term qualified interpreter for an individual with a disability, with respect to an individual with a disability—

(A) means an interpreter for such individual who by means of a remote interpreting service or an onsite appearance—

(i) adheres to generally accepted interpreter ethics principles, including client confidentiality; and

(ii) is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology, and phraseology; and

(B) may include—

(i) sign language interpreters;

(ii) oral transliterators, which are individuals who represent or spell in the characters of another alphabet; and

(iii) cued language transliterators, which are individuals who represent or spell by using a small number of handshapes.

(23) Qualified interpreter for an individual with limited english proficiency.— The term qualified interpreter for an individual with limited English proficiency means an interpreter who by means of a remote interpreting service or an onsite appearance—

(A) adheres to generally accepted interpreter ethics principles, including client confidentiality;

(B) has demonstrated proficiency in speaking and understanding both spoken English and one or more other spoken languages; and

(C) is able to interpret effectively, accurately, and impartially, both receptively and expressly, to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology.

(24) Qualified translator.— The term qualified translator means a translator who—

(A) adheres to generally accepted translator ethics principles, including client confidentiality;

(B) has demonstrated proficiency in writing and understanding both written English and one or more other written non-English languages; and

(C) is able to translate effectively, accurately, and impartially to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology.

(25) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g).

(26) Secretary.— The term Secretary means the Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality.

(27) Sexual and gender minority group.— The term sexual and gender minority group includes lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expression, or reproductive development varies from traditional, societal, cultural, or physiological norms.

(28) Sight translation.— The term sight translation means the transmission of a written message in one language into a spoken or signed message in another language, or an alternative format in English or another language.

(29) State.— Notwithstanding section 2, the term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

(30) Telephonic interpretation.— The term telephonic interpretation (also known as “over the phone interpretation” or “OPI”) means, with respect to interpretation for an individual with limited English proficiency, a method of interpretation in which the interpreter is not in the physical presence of the provider of health care services or health care-related services and such individual receiving such services, but the interpreter is connected via telephone.

(31) Translation.— The term translation means the transmission of a written message in one language into a written or signed message in another language, and includes translation into another language or alternative format, such as large print font, Braille, audio recording, or CD.

(32) Underserved communities.— The term underserved communities means populations sharing particular characteristics, or geographic communities, who have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, such as—

(A) Black, Latino, Indigenous, and Native American persons, Asian Americans, Native Hawaiians and Pacific Islanders, Middle Easterners and North Africans, and other persons of color;

(B) members of religious minorities;

(C) lesbian, gay, bisexual, transgender, and queer persons;

(D) individuals with a disability;

(E) persons who live in rural areas;

(F) older adults; and

(G) persons otherwise adversely affected by persistent poverty or inequality.

(33) Video remote interpreting services.— The term video remote interpreting services means the provision, in health care services or health care-related services, through a qualified interpreter for an individual with limited English proficiency, of video remote interpreting services that are—

(A) in 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 communication; and

(B) in a sharply delineated image that is large enough to display.

(34) Vital document.— The term vital document includes applications for government programs that provide health care services, medical or financial consent forms, financial assistance documents, letters containing important information regarding patient instructions (such as prescriptions, referrals to other providers, and discharge plans) and participation in a program (such as a Medicaid managed care program), notices pertaining to the reduction, denial, or termination of services or benefits, notices of the right to appeal such actions, and notices advising individuals with limited English proficiency with communication disabilities of the availability of free language services, alternative formats, and other outreach materials.

(b) Reference.— In any reference in this title to a regulatory provision applicable to a “handicapped individual”, the term handicapped individual in such provision shall have the same meaning as the term individual with a disability as defined in subsection (a).

(a) Establishment.— The Secretary shall establish and support a center to be known as the “Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care” (referred to in this section as the “Center”) to carry out each of the following activities:

(1) Interpretation services.—

(A) In general.— The Center shall provide resources via the internet to identify and link health care providers to competent and qualified interpreter and translation services.

(B) Training.— For purposes of providing the services described in subparagraph (A), the Center shall adopt a language access plan that includes training requirements for Center staff to provide such services.

(2) Translation of written material.—

(A) Vital documents.— The Center shall provide, directly or through contract, to providers of health care services and health care-related services, at no cost to such providers and in a timely and reasonable manner, vital documents—

(i) which may be submitted by an entity described in subparagraph (C) for translation into non-English languages, or alternative formats, at a fifth-grade reading level; and

(ii) from competent translation services, the quality of which shall be monitored and reported publicly.

(B) Forms.— For each form developed or revised by the Secretary that will be used by individuals with limited English proficiency in health care or health care-related settings, the Center shall, not later than 45 calendar days of the Secretary receiving final approval of the form from the Office of Management and Budget—

(i) translate the form, at a minimum, 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; and

(ii) post all translated forms on the Center’s website.

(C) Entities.—

(i) In general.— An entity described in this subparagraph is—

(I) an entity that operates a health program or activity, any part of which receives Federal financial assistance;

(II) an entity established under title I of the Patient Protection and Affordable Care Act that administers a health program or activity; or

(III) the Department of Health and Human Services.

(ii) Health program or activity.— For purposes of clause (i), the term health program or activity has the meaning given such term in section 92.4 of title 45, Code of Federal Regulations, as in effect on July 5, 2024.

(3) Toll-free customer service telephone number.— The Center shall provide, through a toll-free number, a customer service line for individuals with limited English proficiency that is linked to the toll-free telephone number 1–800–MEDICARE and a toll-free telephone hotline provided for pursuant to section 1311(d)(4)(B) of the Patient Protection and Affordable Care Act by an Exchange established under title I of such Act—

(A) to obtain information about federally conducted or funded health programs, including the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children’s Health Insurance Program under title XXI of such Act, and coverage available through an Exchange established under title I of the Patient Protection and Affordable Care Act, and other sources of free or reduced care including federally qualified health centers, entities receiving assistance under title X, and public health departments;

(B) to obtain assistance with applying for or accessing these programs and understanding Federal notices written in English; and

(C) to learn how to access language services.

(4) Health information clearinghouse.—

(A) In general.— The Center shall develop and maintain, and make available on the internet and in print, an information clearinghouse that includes the information described in subparagraphs (B) through (G)—

(i) to facilitate the provision of language services by providers of health care services and health care-related services to reduce medical errors;

(ii) to improve health outcomes, to improve cultural competence, and to reduce health care costs caused by miscommunication with individuals with limited English proficiency; and

(iii) to reduce or eliminate the duplication of efforts to translate materials.

(B) Document templates.— The Center shall collect and evaluate for accuracy, develop, and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care, including templates for each of the following:

(i) Administrative and legal documents, including—

(I) intake forms;

(II) forms related to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children’s Health Insurance Program under title XXI of such Act, including eligibility information for such programs;

(III) forms informing patients of the compliance and consent requirements pursuant to the regulations under section 264(c) of the Health Insurance Portability and Accountability Act of 1996; and

(IV) documents concerning informed consent, advanced directives, and waivers of rights.

(ii) Clinical information, such as how to take medications, how to prevent transmission of a contagious disease, and other prevention and treatment instructions.

(iii) Public health, patient education, and outreach materials, such as immunization notices, health warnings, or screening notices.

(iv) Additional health or health care-related materials as determined appropriate by the Director of the Center.

(C) Structure of forms.— In operating the clearinghouse, the Center shall—

(i) ensure that the documents posted in English and non-English languages are culturally and linguistically appropriate;

(ii) allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally and linguistically appropriate for the target populations;

(iii) allow health care providers to customize the documents for their use;

(iv) facilitate access to such documents;

(v) provide technical assistance with respect to the access and use of such information; and

(vi) carry out any other activities the Secretary determines to be useful to fulfill the purposes of the clearinghouse.

(D) Language assistance programs.— The Center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for individuals with limited English proficiency, including case studies using de-identified patient information, program summaries, and program evaluations.

(E) Culturally and linguistically appropriate materials.— The Center shall provide, at no cost, to all health care providers and all providers of health care-related services, information relating to culturally and linguistically appropriate health care for minority populations residing in the United States, including—

(i) tenets of culturally and linguistically appropriate care;

(ii) culturally and linguistically appropriate self-assessment tools;

(iii) culturally and linguistically appropriate training tools;

(iv) strategic plans to increase cultural and linguistic appropriateness in different types of providers of health care services and health care-related services, including regional collaborations among health care organizations for health care services and health care-related services; and

(v) culturally and linguistically appropriate information for educators, practitioners, students, and researchers.

(F) Translation glossaries.— The Center shall—

(i) develop and publish on its website translation glossaries that provide standardized translations of commonly used terms and phrases utilized in documents translated by the Center; and

(ii) make such glossaries available—

(I) free of charge;

(II) in each language in which the Center translates forms under paragraph (2)(B);

(III) in alternative formats in accordance with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.); and

(IV) in paper format upon request.

(G) Information about progress.— The Center shall—

(i) regularly collect and make publicly available information about the progress of entities receiving grants under section 3402 regarding successful innovations in implementing the requirements of this subsection; and

(ii) provide public notice in the entities’ communities about the availability of such information.

(b) Director.— The Center shall be headed by a Director who shall be appointed by, and who shall report to, the Director of the Agency for Healthcare Research and Quality.

(c) Availability of language access.— The Director of the Center shall collaborate with the Deputy Assistant Secretary for Minority Health, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration to notify health care providers and health care organizations about the availability of language access services by the Center.

(d) Education.— The Secretary, directly or through contract, shall undertake a national education campaign to inform providers, individuals with limited English proficiency, individuals with hearing or vision impairments, health professionals, graduate schools, community health centers, social service providers, and community-based organizations about—

(1) Federal and State laws and guidelines governing access to language services;

(2) the value of using trained and competent interpreters and the risks associated with using family members, friends, minors, and untrained bilingual staff;

(3) funding sources for developing and implementing language services; and

(4) promising practices to effectively provide language services.

(e) Authorization of appropriations.— There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.

(a) In general.—

(1) Grants.— The Secretary shall award grants to eligible entities to enable such entities to design, implement, and evaluate innovative, cost-effective programs to improve culturally and linguistically appropriate access to health care services for individuals with limited English proficiency and communication disabilities.

(2) Coordination.— In making grants under this section, and in the design and implementation of the program established under this section, the Secretary shall coordinate with, and ensure the participation of, other agencies including the Health Resources and Services Administration, the National Institute on Minority Health and Health Disparities, the Tribal Affairs component of the Office of Intergovernmental and External Affairs of the Department of Health and Human Services, and the Office of Minority Health.

(b) Eligibility.— To be eligible to receive a grant under subsection (a), an entity shall be—

(1) a city, county, Indian Tribe, State, or subdivision thereof;

(2) an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;

(3) a community health, mental health, or substance use disorder center or clinic;

(4) a solo or group physician practice;

(5) an integrated health care delivery system;

(6) a public hospital;

(7) a health care group, university, or college; or

(8) any other entity designated by the Secretary.

(c) Application.— An eligible entity seeking a grant under this section shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such additional information as the Secretary may reasonably require.

(d) Use of funds.— An entity shall use funds received through a grant under this section to—

(1) develop, implement, and evaluate models of providing competent interpretation services through onsite interpretation, telephonic interpretation, or video remote interpreting services;

(2) implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the entity;

(3) develop and maintain a needs assessment that identifies the current demographic, cultural, and epidemiological profile of the community to accurately plan for and implement language services needed in the service area of the entity;

(4) develop a strategic plan to implement language services;

(5) develop participatory, collaborative partnerships with communities encompassing the patient populations of individuals with limited English proficiency served by the grant to gain input in designing and implementing language services;

(6) develop and implement grievance resolution processes that are culturally and linguistically appropriate and capable of identifying, preventing, and resolving complaints by individuals with limited English proficiency;

(7) develop short-term medical and mental health interpretation training courses and incentives for bilingual health care staff who are asked to provide interpretation services in the workplace;

(8) develop formal training programs, including continued professional development and education programs as well as supervision, for individuals interested in becoming dedicated health care interpreters and culturally and linguistically appropriate providers;

(9) provide staff language training instruction, which shall include information on the practical limitations of such instruction for nonnative speakers;

(10) develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bilingual provider;

(11) develop other language assistance services as determined appropriate by the Secretary;

(12) develop, implement, and evaluate models of improving cultural competence, including cultural competence programs for community health workers;

(13) 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 and any applicable State privacy laws, data on the individual patient or recipient’s race, ethnicity, and primary language are collected (and periodically updated) in health records and integrated into the organization’s information management systems or any similar system used to store and retrieve data; and

(14) ensure that culturally competent care and language assistance are available to individuals with limited English proficiency.

(e) Priority.— In awarding grants under this section, the Secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience in improving language access.

(f) Evaluation.—

(1) By grantees.— An entity that receives a grant under this section shall submit to the Secretary an evaluation that describes, in the manner and to the extent required by the Secretary, the activities carried out with funds received under the grant, and how such activities improved access to health care services and health care-related services and the quality of health care for individuals with limited English proficiency. Such evaluation shall be collected and disseminated through the Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care established under section 3401. The Director of the Agency for Healthcare Research and Quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request.

(2) By secretary.— The Director of the Agency for Healthcare Research and Quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section.

(g) Authorization of appropriations.— There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.

(a) In general.— The Secretary shall expand research concerning language access in the provision of health care services.

(b) Eligibility.— The Secretary may conduct the research described in subsection (a) or enter into contracts with other individuals or organizations to conduct such research.

(c) Use of funds.— Research conducted under this section shall be designed to do one or more of the following:

(1) To identify the barriers to mental and behavioral services that are faced by individuals with limited English proficiency.

(2) To identify health care providers’ and health administrators’ knowledge and awareness of the barriers to quality health care services that are faced by individuals with limited English proficiency and communication disabilities.

(3) To identify optimal approaches for delivering language access.

(4) To identify best practices for data collection, including—

(A) the collection by providers of health care services and health care-related services of data on the race, ethnicity, age, disability, and primary language of recipients of such services, taking into account existing research conducted by the Government or private sector;

(B) the development and implementation of data collection and reporting systems; and

(C) effective privacy safeguards for collected data.

(5) To develop a minimum data collection set for primary language.

(6) To evaluate the most effective ways in which the Secretary can create or coordinate, and subsidize or otherwise fund, telephonic interpretation services for health care providers, taking into consideration, among other factors, the flexibility necessary for such a system to accommodate variations in—

(A) provider type;

(B) languages needed and their frequency of use;

(C) type of encounter;

(D) time of encounter, including whether the encounter occurs during regular business hours and after hours; and

(E) location of encounter.

(d) Authorization of appropriations.— There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.”.

(a) Grants authorized.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall award 1 grant in accordance with this section to each of 3 States (to be selected by the Secretary) to assist each such State in designing, implementing, and evaluating a statewide program to provide onsite interpreter services under the State Medicaid plan.

(b) Grant period.— A grant awarded under this section is authorized for the period of 3 fiscal years beginning on October 1, 2026, and ending on September 30, 2029.

(c) Preference.— In awarding a grant under this section, the Secretary shall give preference to a State—

(1) that has a high proportion of qualified LEP enrollees, as determined by the Secretary;

(2) that has a large number of qualified LEP enrollees, as determined by the Secretary;

(3) that has a high growth rate of the population of individuals with limited English proficiency, as determined by the Secretary; and

(4) that has a population of qualified LEP enrollees that is linguistically diverse, requiring interpreter services in at least 200 non-English languages.

(d) Use of funds.— A State receiving a grant under this section shall use the grant funds to—

(1) ensure that all health care providers in the State participating in the State Medicaid plan have access to onsite interpreter services, for the purpose of enabling effective communication between such providers and qualified LEP enrollees during the furnishing of items and services and administrative interactions;

(2) establish, expand, procure, or contract for—

(A) a statewide health care information technology system that is designed to achieve efficiencies and economies of scale with respect to onsite interpreter services provided to health care providers in the State participating in the State Medicaid plan; and

(B) an entity to administer such system, the duties of which shall include—

(i) procuring and scheduling interpreter services for qualified LEP enrollees;

(ii) procuring and scheduling interpreter services for individuals with limited English proficiency seeking to enroll in the State Medicaid plan;

(iii) ensuring that interpreters receive payment for interpreter services rendered under the system; and

(iv) consulting regularly with organizations representing LEP consumers, interpreters, and health care providers; and

(3) develop mechanisms to establish, improve, and strengthen the competency of the medical interpretation workforce that serves qualified LEP enrollees in the State, including a national certification process that is valid, credible, and vendor-neutral.

(e) Application.— To receive a grant under this section, a State shall submit an application at such time and containing such information as the Secretary may require, which shall include the following:

(1) A description of the language access needs of individuals in the State enrolled in the State Medicaid plan.

(2) A description of the extent to which the program will—

(A) use the grant funds for the purposes described in subsection (d);

(B) meet the health care needs of rural populations of the State; and

(C) collect information that accurately tracks the language services requested by consumers as compared to the language services provided by health care providers in the State participating in the State Medicaid plan.

(3) A description of how the program will be evaluated, including a proposal for collaboration with organizations representing interpreters, consumers, and individuals with limited English proficiency.

(f) Definitions.— In this section:

(1) Qualified lep enrollee.— The term qualified LEP enrollee means an individual—

(A) who is limited English proficient; and

(B) who is enrolled in a State Medicaid plan.

(2) State.— The term State has the meaning given the term in section 1101(a)(1) of the Social Security Act (42 U.S.C. 1301(a)(1)), for purposes of title XIX of such Act (42 U.S.C. 1396 et seq.).

(3) State medicaid plan.— The term State Medicaid plan means a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or a waiver of such a plan.

(4) United states.— The term United States has the meaning given the term in section 1101(a)(2) of the Social Security Act (42 U.S.C. 1301(a)(2)), for purposes of title XIX of such Act (42 U.S.C. 1396 et seq.).

(g) Continuation past demonstration.— Any State receiving a grant under this section must agree to directly pay for language services in Medicaid for all Medicaid providers by the end of the grant period.

(h) Funding.—

(1) Authorization of appropriations.— There is authorized to be appropriated $5,000,000 to carry out this section.

(2) Availability of funds.— Amounts appropriated pursuant to the authorization in paragraph (1) are authorized to remain available without fiscal year limitation.

(3) Increased federal financial participation.— Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)(E)) is amended by inserting “(or, in the case of a State that was awarded a grant under section 2005 of the Health Equity and Accountability Act of 2026, 100 percent for each quarter occurring during the grant period specified in subsection (b) of such section)” after “75 percent”.

(i) Limitation.— No Federal funds awarded under this section may be used to provide interpreter services from a location outside the United States.

(a) Direct graduate medical education.— Section 1886(h)(4) of the Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at the end the following new subparagraph:

“(L) Treatment of culturally and linguistically appropriate training.— In determining a hospital’s number of full-time equivalent residents for purposes of this subsection, all the time that is spent by an intern or resident in an approved medical residency training program for education and training in culturally and linguistically appropriate service delivery, which shall include all medically underserved populations (as defined in section 330(b)(3) of the Public Health Service Act), shall be counted toward the determination of full-time equivalency.”.

(b) Indirect medical education.— Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following new clause:

“(xiv) The provisions of subparagraph (L) of subsection (h)(4) shall apply under this subparagraph in the same manner as they apply under such subsection.”.

(c) Effective date.— The amendments made by subsections (a) and (b) shall apply with respect to payments made to hospitals on or after the date that is 1 year after the date of the enactment of this Act.

(a) Language access grants for Medicare providers.—

(1) Establishment.—

(A) In general.— Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services (in this subsection referred to as the “Secretary”), acting through the Centers for Medicare & Medicaid Services and in consultation with the Center for Medicare and Medicaid Innovation (as referred to in section 1115A of the Social Security Act (42 U.S.C. 1315a)), shall establish a demonstration program under which the Secretary shall award grants to eligible Medicare service providers to provide culturally and linguistically appropriate services to Medicare beneficiaries who are limited English proficient, including beneficiaries who live in ethnically, racially, geographically, socioeconomically diverse and underserved communities.

(B) Application of innovation rules.— The demonstration project under subparagraph (A) shall be conducted in a manner that is consistent with the applicable provisions of subsections (b), (c), and (d) of section 1115A of the Social Security Act (42 U.S.C. 1315a).

(C) Number of grants.— To the extent practicable, the Secretary shall award not less than 24 grants under this subsection.

(D) Grant period.— Except as provided in paragraph (2)(D), each grant awarded under this subsection shall be for a 3-year period.

(2) Eligibility requirements.— To be eligible for a grant under this subsection, an entity must meet the following requirements:

(A) Medicare provider.— The entity must be—

(i) a provider of services under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.);

(ii) a provider of services under part B of such title (42 U.S.C. 1395j et seq.);

(iii) a Medicare Advantage organization offering a Medicare Advantage plan under part C of such title (42 U.S.C. 1395w–21 et seq.); or

(iv) a PDP sponsor offering a prescription drug plan under part D of such title (42 U.S.C. 1395w–101 et seq.).

(B) Underserved communities.— The entity must serve a community that, with respect to necessary language services for improving access and utilization of health care among individuals who are limited English proficient, is disproportionally underserved.

(C) Application.— The entity must prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.

(D) Reporting.— In the case of a grantee that received a grant under this subsection in a previous year, such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph (9) for such year. If a grantee fails to meet the requirements of such paragraph for the first year of a grant, the Secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program.

(3) Distribution.— To the extent feasible, the Secretary shall award—

(A) at least 10 grants to providers of services described in paragraph (2)(A)(i);

(B) at least 10 grants to service providers described in paragraph (2)(A)(ii);

(C) at least 10 grants to organizations described in paragraph (2)(A)(iii); and

(D) at least 10 grants to sponsors described in paragraph (2)(A)(iv).

(4) Considerations in awarding grants.—

(A) Variation among grantees.— In awarding grants under this subsection, the Secretary shall select grantees to ensure the following:

(i) The grantees provide many different types of language services.

(ii) The grantees serve Medicare beneficiaries who speak different languages, and who, as a population, have differing needs for language services.

(iii) The grantees serve Medicare beneficiaries in both urban and rural settings.

(iv) The grantees represent each Centers for Medicare & Medicaid Services region, as defined by the Secretary.

(v) The grantees serve Medicare beneficiaries in at least 2 large metropolitan statistical areas with diverse populations, including diversity in race, ethnicity, sexual orientation, gender identity, disability status, and socioeconomic status.

(B) Priority for partnerships with community organizations and agencies.— In awarding grants under this subsection, the Secretary shall give priority to eligible entities that have a partnership with 1 or more of the following entities that have experience in providing language services:

(i) A community organization.

(ii) A consortium of community organizations, State agencies, and local agencies.

(5) Use of funds for competent language services.—

(A) In general.— Subject to subparagraph (E), a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to Medicare beneficiaries who are individuals who are limited English proficient to supplement existing Medicare requirements.

(B) Competent language services defined.— For purposes of this subsection, the term competent language services means—

(i) interpreter and translation services that—

(I) subject to the exceptions under subparagraph (C)—

(aa) if the grantee operates in a State that has statewide health care interpreter standards, meet the State standards currently in effect; or

(bb) if the grantee operates in a State that does not have statewide health care interpreter standards, utilize competent interpreters who follow the National Council on Interpreting in Health Care’s Code of Ethics and Standards of Practice and comply with the requirements of section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) as published in the Federal Register on May 18, 2016, 81 Fed. Reg. 31375; and

(II) in the case of interpreter services, are provided through—

(aa) onsite interpretation;

(bb) telephonic interpretation; or

(cc) video interpretation; and

(ii) the direct provision of health care or health care-related services by a competent bilingual health care provider.

(C) Exceptions.—

(i) In general.— The requirements of subparagraph (B)(i)(I) do not apply, with respect to interpreter and translation services and a grantee—

(I) in the case of a Medicare beneficiary who is limited English proficient, if—

(aa) such beneficiary has been informed, in the beneficiary’s primary language, of the availability of free interpreter and translation services and the beneficiary instead requests that a family member, friend, or other person provide such services; and

(bb) the grantee documents such request in the beneficiary’s medical record; or

(II) subject to clause (ii), in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient.

(ii) Clarification.— Clause (i)(II) shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to patients who are individuals who are limited English proficient from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay.

(D) Medicare advantage organizations and pdp sponsors.— A grantee that is a Medicare Advantage organization or a prescription drug plan sponsor must provide at least 50 percent of the grant funds that the grantee receives under this subsection directly to the entity’s network providers (including all health providers and pharmacists) for the purpose of providing support for such providers to provide competent language services to Medicare beneficiaries who are individuals who are limited English proficient.

(E) Administrative and reporting costs.— A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph (9).

(6) Determination of amount of grant payments.—

(A) In general.— Payments to grantees under this subsection shall be calculated based on the estimated numbers of Medicare beneficiaries who are limited English proficient in a grantee’s service area utilizing—

(i) data on the numbers of English learners who speak English less than “very well” from the most recently available data from the Bureau of the Census or other State-based study the Secretary determines is likely to yield accurate data regarding the number of such individuals in such service area; or

(ii) data provided by the grantee, if the grantee routinely collects data on the primary language of the Medicare beneficiaries that the grantee serves and the Secretary determines that the data is accurate and shows a greater number of individuals who are limited English proficient than would be estimated using the data under clause (i).

(B) Discretion of secretary.— Subject to subparagraph (C), the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the Secretary, based on changes in the data under subparagraph (A) with respect to the service area of a grantee for the year.

(C) Limitation on amount.— The amount of a grant made under this subsection to a grantee may not exceed $500,000 for the period under paragraph (1)(D).

(7) Assurances.— Grantees under this subsection shall, as a condition of receiving a grant under this subsection—

(A) ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery;

(B) ensure the linguistic competence of bilingual providers;

(C) offer and provide appropriate language services at no additional charge to each patient who is limited English proficient for all points of contact between the patient and the grantee, in a timely manner during all hours of operation;

(D) not less frequently that annually, notify Medicare beneficiaries of their right to receive language services in their primary language without charge;

(E) post signage in the primary languages commonly used by the patient population in the service area of the organization; and

(F) ensure that—

(i) primary language data are collected for recipients of language services and such data are consistent with standards developed under title XXXIV of the Public Health Service Act, as added by section 2002 of this Act, to the extent such standards are available upon the initiation of the demonstration program; and

(ii) consistent with the privacy protections provided under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), if the recipient of language services is a minor or is incapacitated, primary language data must also be collected on the parent or legal guardian of such recipient.

(8) No cost sharing.— Medicare beneficiaries who are limited English proficient shall not have to pay cost sharing or co-payments for competent language services provided under this demonstration program.

(9) Reporting requirements for grantees.— Not later than the end of each calendar year, a grantee that receives funds under this subsection in such year shall submit to the Secretary a report that includes the following information:

(A) The number of Medicare beneficiaries to whom competent language services are provided, disaggregated by age and entitlement basis (on the basis of age, disability, or determination of end stage renal disease).

(B) The primary languages of those Medicare beneficiaries.

(C) The types of language services provided to such beneficiaries.

(D) Whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies.

(E) The types of interpretation services provided to such beneficiaries, and the approximate length of time such service is provided to such beneficiaries.

(F) The costs of providing competent language services.

(G) An account of the training or accreditation of bilingual staff, interpreters, and translators providing services funded by the grant under this subsection.

(10) Evaluation and report to congress.— Not later than 1 year after the completion of a 3-year grant under this subsection, the Secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the Congress a report that includes the following:

(A) An analysis of the patient outcomes and the costs of furnishing care to the Medicare beneficiaries who are individuals who are limited English proficient participating in the project as compared to such outcomes and costs for such Medicare beneficiaries not participating, based on the data provided under paragraph (9) and any other information available to the Secretary.

(B) The effect of delivering language services on—

(i) Medicare beneficiary access to care and utilization of services;

(ii) the efficiency and cost-effectiveness of health care delivery;

(iii) patient satisfaction with respect to both health service delivery and language assistance;

(iv) health outcomes; and

(v) the provision of culturally appropriate services provided to such beneficiaries.

(C) The extent to which bilingual staff, interpreters, and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider, service, or other category as determined by the Secretary to ensure the provision of high-quality interpretation, translation, or other language services to Medicare beneficiaries if such services are expanded pursuant to section 1115A(c) of the Social Security Act (42 U.S.C. 1315a(c)).

(D) Recommendations, if any, regarding the extension of such project to the entire Medicare Program, subject to the provisions of such section 1115A(c).

(11) Appropriations.— There is appropriated to carry out this subsection, in equal parts from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), $16,000,000 for each fiscal year of the demonstration program.

(12) Limited english proficient defined.— In this subsection, the term limited English proficient means individuals who self-identify on the Census as speaking English less than “very well”.

(b) Language assistance services under the Medicare program.—

(1) Inclusion as rural health clinic services.— Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A) in subsection (aa)(1)—

(i) in subparagraph (C), by striking “and” at the end;

(ii) in subparagraph (D), by inserting “and” after the comma at the end; and

(iii) by inserting after subparagraph (D) the following new subparagraph:

“(E) language assistance services as defined in subsection (ooo),”; and

(B) by adding at the end the following new subsection:

“(ooo) Language assistance services and related terms.— The term language assistance services means language access or language assistance services (as those terms are defined in section 3400 of the Public Health Service Act) furnished by a qualified interpreter for an individual with limited English proficiency or a qualified translator (as those terms are defined in such section 3400) to an individual with limited English proficiency (as defined in such section 3400).”.

(2) Coverage.— Section 1832(a)(2) of the Social Security Act (42 U.S.C. 1395k(a)(2)) is amended—

(A) in subparagraph (I), by striking “and” at the end;

(B) in subparagraph (J), by striking the period at the end and inserting “; and”; and

(C) by adding at the end the following new subparagraph:

“(K) language assistance services (as defined in section 1861(ooo)).”.

(3) Payment.— Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended—

(A) in paragraph (9), by striking “and” at the end;

(B) in paragraph (10), by striking the period at the end and inserting “; and”; and

(C) by inserting after paragraph (10) the following new paragraph:

“(11) in the case of language assistance services (as defined in section 1861(ooo)), 100 percent of the reasonable charges for such services, as determined in consultation with the Medicare Payment Advisory Commission.”.

(4) Waiver of budget neutrality.— For the 3-year period beginning on the date of enactment of this section, the budget neutrality provision of section 1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not apply with respect to language assistance services (as defined in section 1861(ooo) of such Act).

(c) Medicare parts C and D; Medicare Advantage plans and prescription drug plans reporting requirement.— Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:

“(6) Reporting requirements relating to effective language services.— A contract under this part shall require a Medicare Advantage organization (and, through application of section 1860D–12(b)(3)(D), a contract under section 1860D–12 shall require a PDP sponsor) to annually submit (for each year of the contract) a report that contains information on the internal policies and procedures of the organization (or sponsor) related to recruitment and retention efforts directed to workforce diversity and linguistically and culturally appropriate provision of services in each of the following contexts:

(A) The collection of data in a manner that meets the requirements of title I of the Health Equity and Accountability Act of 2026, regarding the enrollee population.

(B) Education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population.

(C) Evaluation of the language services programs and services offered by the organization (or sponsor) with respect to the enrollee population, such as through analysis of complaints or satisfaction survey results.

(D) Methods by which the plan provides to the Secretary information regarding the ethnic diversity of the enrollee population.

(E) The periodic provision of educational information to plan enrollees on the language services and programs offered by the organization (or sponsor).”.

(d) Improving language services in Medicaid and CHIP.—

(1) Payments to states.— Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)(E)), as amended by section 2005(h)(3), is further amended by—

(A) striking “75” and inserting “95”;

(B) striking “translation or interpretation services” and inserting “language assistance services”; and

(C) striking “children of families” and inserting “individuals”.

(2) State plan requirements.— Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking “and (30)” and inserting “(30), and (32)”.

(3) Definition of medical assistance.— Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—

(A) in paragraph (31), by striking “and” at the end;

(B) by redesignating paragraph (32) as paragraph (33); and

(C) by inserting after paragraph (31) the following new paragraph:

“(32) language assistance services, as such term is defined in section 1861(nnn), provided in a timely manner to individuals with limited English proficiency as defined in section 3400 of the Public Health Service Act; and”.

(4) Use of deductions and cost sharing.— Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—

(A) in subparagraph (I), by striking “or” at the end;

(B) in subparagraph (J), by striking “; and” and inserting “, or”; and

(C) by adding at the end the following new subparagraph:

“(K) language assistance services described in section 1905(a)(32); and”.

(5) CHIP coverage requirements.— Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—

(A) in subsection (a), in the matter before paragraph (1), by striking “(5), (6), (7) and (8)” and inserting “(5) through (13)”;

(B) in subsection (c), by adding at the end the following new paragraph:

“(13) Language assistance services.— The child health assistance provided to a targeted low-income child shall include coverage of language assistance services, as such term is defined in section 1861(nnn), provided in a timely manner to individuals with limited English proficiency (as defined in section 3400 of the Public Health Service Act).”; and

(C) in subsection (e)(2)—

(i) in the heading, by striking “PREVENTIVE” and inserting “CERTAIN”; and

(ii) by inserting “language assistance services described in subsection (c)(13),” before “or for pregnancy-related assistance”.

(6) Definition of child health assistance.— Section 2110(a)(27) of the Social Security Act (42 U.S.C. 1397jj(a)(27)) is amended by striking “transportation, translation, and outreach services” and inserting “transportation services, language assistance services as described in section 2103(c)(13), and outreach services”.

(7) State data collection.— Pursuant to the reporting requirement described in section 2107(b)(1) of the Social Security Act (42 U.S.C. 1397gg(b)(1)), the Secretary of Health and Human Services shall require that States collect data on—

(A) the primary language of individuals receiving child health assistance under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); and

(B) in the case of such individuals who are minors or incapacitated, the primary language of the individual’s parent or guardian.

(8) CHIP payments to states.— Section 2105 of the Social Security Act (42 U.S.C. 1397ee) is amended—

(A) in subsection (a)(1)—

(i) in the matter preceding subparagraph (A), by striking “75” and inserting “95”; and

(ii) in subparagraph (D)(iv), by striking “translation or interpretation services” and inserting “language assistance services”; and

(B) in subsection (c)(2)(A), by inserting before the period at the end the following: “, except that expenditures pursuant to clause (iv) of subparagraph (D) of such paragraph shall not count towards this total”.

(e) Funding language assistance services furnished by providers of health care and health care-Related services that serve high rates of uninsured LEP individuals.—

(1) Payment of costs.—

(A) In general.— Subject to subparagraph (B), the Secretary shall make payments (on a quarterly basis) directly to eligible entities to support the provision of language assistance services to individuals with limited English proficiency in an amount equal to an eligible entity’s eligible costs for providing such services for the quarter.

(B) Funding.— Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary such sums as may be necessary for each of fiscal years 2027 through 2031.

(C) Relation to medicaid dsh.— Payments under this subsection shall not offset or reduce payments under section 1923 of the Social Security Act (42 U.S.C. 1396r–4), nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language assistance services for the purposes of this subsection.

(2) Methodology for payment of claims.—

(A) In general.— The Secretary shall establish a methodology to determine the average per person cost of language assistance services.

(B) Different entities.— In establishing such methodology, the Secretary may establish different methodologies for different types of eligible entities.

(C) No individual claims.— The Secretary may not require eligible entities to submit individual claims for language assistance services for individual patients as a requirement for payment under this subsection.

(3) Data collection instrument.— For purposes of this subsection, the Secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the Secretary or relevant accrediting organizations regarding the number of individuals to whom language access is provided.

(4) Guidelines.— Not later than 6 months after the date of enactment of this Act, the Secretary shall establish and distribute guidelines concerning the implementation of this subsection.

(5) Reporting requirements.—

(A) Report to secretary.— Entities receiving payment under this subsection shall provide the Secretary with a quarterly report on how the entity used such funds. Such report shall contain aggregate (and may not contain individualized) data collected using the instrument under paragraph (3) and shall otherwise be in a form and manner determined by the Secretary.

(B) Report to congress.— Not later than 2 years after the date of enactment of this Act, and every 2 years thereafter, the Secretary shall submit a report to Congress concerning the implementation of this subsection.

(6) Definitions.— In this subsection:

(A) Eligible costs.— The term eligible costs means, with respect to an eligible entity that provides language assistance services to limited English proficient individuals, the product of—

(i) the average per person cost of language assistance services, determined according to the methodology devised under paragraph (2); and

(ii) the number of individuals with limited English proficiency who are provided language assistance services by the entity and for whom no reimbursement is available for such services under the amendments made by subsection (a), (b), (c), or (d), or by private health insurance.

(B) Eligible entity.— The term eligible entity means an entity that—

(i) is a Medicaid provider that is—

(I) a physician;

(II) a hospital with a low-income utilization rate (as defined in section 1923(b)(3) of the Social Security Act (42 U.S.C. 1396r–4(b)(3))) of greater than 25 percent;

(III) a Federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)));

(IV) provider of long-term services and supports;

(V) a hospice provider; or

(VI) a palliative care provider;

(ii) not later than 6 months after the date of the enactment of this Act, provides language assistance services to not less than 8 percent of the entity’s total number of patients; and

(iii) prepares and submits an application to the Secretary, at such time, in such manner, and accompanied by such information as the Secretary may require, to ascertain the entity’s eligibility for funding under this subsection.

(C) Language assistance services.— The term language assistance services has the meaning given such term in section 1861(nnn) of the Social Security Act, as added by subsection (b).

(f) Application of civil rights act of 1964, section 1557 of the affordable care act, and other laws.— Nothing in this section shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of the Affordable Care Act (42 U.S.C. 18116), or other laws that protect the civil rights of individuals.

(g) Effective date.—

(1) In general.— Except as otherwise provided and subject to paragraph (2), the amendments made by this section shall take effect on January 1, 2027.

(2) Exception if state legislation required.— In the case of a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or a State plan for child health assistance under title XXI of such Act (42 U.S.C. 1397aa et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, such State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

(a) In general.— The Secretary, in consultation with the Director of the National Institute on Minority Health and Health Disparities and the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to improve health care for patient populations that have low health literacy.

(b) Eligibility.— To be eligible to receive a grant under subsection (a), an entity shall—

(1) be a hospital, health center or clinic, health plan, or other health entity (including a nonprofit minority health organization or association); and

(2) prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may reasonably require.

(c) Use of funds.—

(1) Agency for healthcare research and quality.— A grant under subsection (a) that is awarded through the Director of the Agency for Healthcare Research and Quality shall be used—

(A) to define and increase the understanding of health literacy across all areas of health care, including end of life care;

(B) to investigate the correlation between low health literacy and health and health care;

(C) to clarify which aspects of health literacy have an effect on health outcomes; and

(D) for any other activity determined appropriate by the Director.

(2) Health resources and services administration.— A grant under subsection (a) that is awarded through the Administrator of the Health Resources and Services Administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include—

(A) the development of new disease management and end of life care programs for patients with low health literacy;

(B) the tailoring of disease management programs and end of life care addressing mental, physical, oral, and behavioral health conditions for patients with low health literacy;

(C) the translation of written health materials for patients with low health literacy;

(D) the identification, implementation, and testing of low health literacy screening tools;

(E) the conduct of educational campaigns for patients and providers about low health literacy;

(F) the conduct of educational campaigns concerning health directed specifically at patients with mental disabilities, including those with cognitive and intellectual disabilities, designed to reduce the incidence of low health literacy among these populations, which shall have instructional materials in the plain language standards promulgated under the Plain Writing Act of 2010 (5 U.S.C. 301 note) for Federal agencies; and

(G) other activities determined appropriate by the Administrator.

(d) Definitions.— In this section:

(1) Low health literacy.— The term low health literacy means the inability of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions, and engage with and self-advocate within health care systems, including through completing documents and exercising patient rights.

(2) Secretary.— The term Secretary means the Secretary of Health and Human Services—

(A) acting through the Director of the Agency for Healthcare Research and Quality, with respect to grants under subsection (c)(1); and

(B) acting through the Administrator of the Health Resources and Services Administration with respect to grants under subsection (c)(2).

(e) Authorization of appropriations.— There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.

(a) Covered entity; health program or activity.— In this section:

(1) Covered entity.— The term covered entity means an entity described in clause (i) of section 3401(a)(2)(C) of the Public Health Service Act, as added by section 2004.

(2) Health program or activity.— The term health program or activity has the meaning given such term in clause (ii) of such section 3401(a)(2)(C).

(b) Requirements.— A covered entity, in order to ensure the right of individuals with limited English proficiency to receive access to high-quality health care through the health program or activity, shall—

(1) ensure that appropriate clinical and support staff receive ongoing education and training in culturally and linguistically appropriate service delivery at least annually;

(2) offer and provide appropriate language assistance services at no additional charge to each patient that is an individual with limited English proficiency at all points of contact, in a timely manner during all hours of operation;

(3) notify patients of their right to receive language services in their primary language; and

(4) utilize only qualified interpreters for an individual with limited English proficiency or qualified translators, except as provided in subsection (c).

(c) Exemptions.— The requirements of subsection (b)(4) shall not apply as follows:

(1) When a patient requests the use of family, friends, or other persons untrained in interpretation or translation if each of the following conditions are met:

(A) The interpreter requested by the patient is over the age of 18.

(B) The covered entity informs the patient in the primary language of the patient that he or she has the option of having the entity provide to the patient an interpreter and translation services without charge.

(C) The covered entity informs the patient that the entity may not require an individual with a limited English proficiency to use a family member or friend as an interpreter.

(D) The covered entity evaluates whether the person the patient wishes to use as an interpreter is competent. If the covered entity has reason to believe that such person is not competent as an interpreter, the entity provides its own interpreter to protect the covered entity from liability if the patient’s interpreter is later found not competent.

(E) If the covered entity has reason to believe that there is a conflict of interest between the interpreter and patient, the covered entity may not use the patient’s interpreter.

(F) The covered entity has the patient sign a waiver, witnessed by at least 1 individual not related to the patient, that includes the information stated in subparagraphs (A) through (E) and is translated into the patient’s primary language.

(2) When a medical emergency exists and the delay directly associated with obtaining competent interpreter or translation services would jeopardize the health of the patient, but only until a competent interpreter or translation service is available.

(d) Rule of construction.— Subsection (c)(2) shall not be construed to mean that emergency rooms or similar entities that regularly provide health care services in medical emergencies are exempt from legal or regulatory requirements related to competent interpreter services.

(a) Report.— Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of Health and Human Services shall seek to enter into a contract with the National Academy of Medicine for the preparation and publication of a report that describes Federal efforts to ensure that all individuals with limited English proficiency have meaningful access to health care services and health care-related services that are culturally and linguistically appropriate. Such report shall include—

(1) a description and evaluation of the activities carried out under this Act;

(2) a description and analysis of best practices, model programs, guidelines, and other effective strategies for providing access to culturally and linguistically appropriate health care services;

(3) recommendations on the development and implementation of policies and practices by providers of health care services and health care-related services for individuals with limited English proficiency, including people with cognitive, hearing, vision, or print impairments;

(4) recommend guidelines or standards for health literacy and plain language, informed consent, discharge instructions, and written communications, and for improvement of health care access;

(5) a description of the effect of providing language services on quality of health care and access to care; and

(6) a description of the costs associated with or savings related to the provision of language services.

(b) Authorization of appropriations.— There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.

(a) Grants authorized.— The Secretary of Education is authorized to provide grants to eligible entities for the provision of English as a second language (in this section referred to as “ESL”) instruction to individuals with limited English proficiency, including health care-related English instruction, and shall determine, after consultation with appropriate stakeholders, the mechanism for administering and distributing such grants.

(b) Eligible entity.— In this section, the term eligible entity means—

(1) a State; or

(2) a community-based organization that predominantly employs and serves racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))).

(c) Application.— An eligible entity that desires to receive a grant under this section shall apply by submitting to the Secretary of Education an application at such time, in such manner, and containing such information as the Secretary may require.

(d) Use of grant.— An eligible entity shall use grant funds provided under this section to—

(1) develop and implement a plan for assuring the availability of ESL instruction, free of charge, to the community served by the eligible entity, that effectively integrates information about the nature of the United States health care system, how to access care, and any special language skills that may be required for individuals with limited English proficiency to access and regularly negotiate the health care system effectively;

(2) develop a plan for making ESL instruction available free to charge to individuals with limited English proficiency in the community served by the eligible entity who are seeking instruction, including, where appropriate, through the use of public-private partnerships; and

(3) provide ESL instruction to individuals with limited English proficiency in the community served by the eligible entity.

(e) Supplement, not supplant.— An eligible entity awarded a grant under this section shall use funds made available under this section to supplement, and not supplant, other Federal, State, and local funds that would otherwise be expended to carry out activities under this section.

(f) Duties of the secretary.— The Secretary of Education shall—

(1) collect and make publicly available annual data on how much Federal, State, and local governments spend annually on ESL instruction;

(2) collect data from eligible entities awarded a grant under this section to identify the unmet needs of individuals with limited English proficiency for appropriate ESL instruction, including—

(A) the preferred written and spoken language of such individuals;

(B) the availability of enrollment in ESL instruction programs in the communities served by each eligible entity awarded a grant under this section, including the extent of waiting lists for ESL instruction, how many programs maintain waiting lists, and, for programs that do not have waiting lists, the reasons why such a list is unnecessary or otherwise not maintained;

(C) the availability of programs to geographically isolated communities;

(D) the impact of course enrollment policies, including open enrollment, on the availability of ESL instruction;

(E) the number of individuals with limited English proficiency and the number of individuals enrolled in ESL instruction programs in the communities served by each eligible entity awarded a grant under this section;

(F) the effectiveness of the ESL instruction provided through grants awarded under this section in meeting the needs of individuals receiving such instruction; and

(G) an assessment of the need for programs that integrate job training and ESL instruction, to assist individuals with limited English proficiency in obtaining better jobs;

(3) determine the cost and most appropriate methods of making ESL instruction available to all individuals with limited English proficiency in the United States who are seeking instruction; and

(4) not later than 1 year after the date of enactment of this Act, issue a report to Congress that—

(A) assesses the information collected in paragraphs (1), (2), and (3) and makes recommendations on steps that should be taken to realize the goal of making ESL instruction available to all individuals with limited English proficiency in the United States who are seeking instruction; and

(B) evaluates the impact of the grant program authorized under this section on the accessibility of, and ability to effectively negotiate, the health care system for individuals with limited English proficiency who have received ESL instruction funded by a grant under this section.

(g) Authorization of appropriations.— There are authorized to be appropriated to the Secretary of Education $250,000,000 for each of fiscal years 2027 through 2031 to carry out this section.

(a) General provisions.—

(1) Immunity.— A person injured by a violation of this title (including an amendment made by this title) by a State may bring a civil action in the appropriate Federal court for such injury in accordance with this section.

(2) Remedies.— In a civil action under this section for a violation of this title, such remedies shall be available as would be available in a civil action for such violation against any party other than a State.

(b) Rule of construction.— Nothing in this title may be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) or any other Federal statute.

(a) Essential benefits.— Section 1302(b)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended by adding at the end the following:

“(K) Language access services, including oral interpretation and written translations.”.

(b) Employer-Sponsored minimum essential coverage.—

(1) In general.— Section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by redesignating clauses (iii) and (iv) as clauses (iv) and (v), respectively, and by inserting after clause (ii) the following new clause:

“(iii) Coverage must include language access and services.— Except as provided in clause (iv), an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the plan does not provide coverage for language access services, including oral interpretation and written translations.”.

(2) Conforming amendments.—

(A) Section 36B(c)(2)(C) of such Code is amended by striking “clause (iii)” each place it appears in clauses (i) and (ii) and inserting “clause (iv)”.

(B) Section 36B(c)(2)(C)(iv) of such Code, as redesignated by this subsection, is amended by striking “(i) and (ii)” and inserting “(i), (ii), and (iii)”.

(c) Quality reporting.— Section 2717(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is amended—

(1) by striking “and” at the end of subparagraph (C);

(2) by striking the period at the end of subparagraph (D) and inserting “; and”; and

(3) by adding at the end the following new subparagraph:

“(E) reduce health disparities through the provision of language access services, including oral interpretation and written translations.”.

(d) Regulations regarding internal claims and appeals and external review processes for health plans and health insurance issuers.— The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall amend the regulations in section 54.9815–2719(e) of title 26, Code of Federal Regulations (or successor regulations), section 2590.715–2719(e) of title 29, Code of Federal Regulations (or successor regulations), and section 147.136(e) of title 45, Code of Federal Regulations (or successor regulations), respectively, to require group health plans and health insurance issuers offering group or individual health insurance coverage to which such sections apply—

(1) to provide oral interpretation services without any threshold requirements;

(2) to provide in the English versions of all notices a statement prominently displayed in not less than 15 non-English languages clearly indicating how to access the language services provided by the plan or issuer; and

(3) with respect to the requirements for providing relevant notices in a culturally and linguistically appropriate manner in the applicable non-English languages, to apply a threshold that 5 percent of the population, or not less than 500 individuals, in the county is literate only in the same non-English language in order for the language to be considered an applicable non-English language.

(e) Data collection and reporting.— The Secretary of Health and Human Services shall—

(1) amend the single streamlined application form developed pursuant to section 1413 of the Patient Protection and Affordable Care Act (42 U.S.C. 18083) to collect the preferred spoken and written language for each household member applying for coverage under a qualified health plan through an Exchange under title I of such Act (42 U.S.C. 18001 et seq.);

(2) require navigators, certified application counselors, and other individuals assisting with enrollment to collect and report requests for language assistance; and

(3) require the toll-free telephone hotlines established pursuant to section 1311(d)(4)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(d)(4)(B)) to submit an annual report documenting the number of language assistance requests, the types of languages requested, the range and average wait time for a consumer to speak with an interpreter, the number of complaints and any steps the hotline, and any entity contracting with the Secretary to provide language services, have taken to actively address some of the consumer complaints.

(f) Effective date.— The amendments made by this section shall not apply to plans beginning prior to the date of the enactment of this Act.

Section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254b(b)(3)) is amended to read as follows:

“(3) Medically underserved population.— The term medically underserved population means—

(A) the population of an urban or rural area designated by the Secretary as—

(i) an area with a shortage of personal health services; or

(ii) a population group having a shortage of such services; or

(B) a population of individuals, not confined to a particular urban or rural area, who are designated by the Secretary as having a shortage of personal health services due to a specific demographic trait.”.

(a) Ensuring meaningful access.—

(1) In general.— Not later than 1 year after the date of the enactment of this Act, the head of each agency shall ensure that individuals with LEP can meaningfully access the federally conducted programs and activities of the agency, including by—

(A) consistent with any applicable Language Access Technical Standards established by the agency under subsection (c)—

(i) translating each vital document or content created for the public into—

(I) any languages the agency frequently encounters; and

(II) the dominant languages spoken in the United States based on current U.S. Census data; and

(ii) adding multilingual functionality to agency digital and information technology systems to identify and track the spoken and written language needs of people who engage with the agency and to provide documents and content in other languages;

(B) providing oral interpretation, sight translation, and telephonic or remote interpretation services to such individuals;

(C) recognizing, as an alternative to using qualified interpreters or translators, the use of demonstrably bilingual staff of the agency that have been assessed and are qualified to deliver accurate and effective communication as an appropriate method of providing language assistance;

(D) acknowledging that, when qualified, such staff may offer service that is faster, more effective, and more cost-efficient than the use of qualified interpreters or translators;

(E) notifying the public of the availability of language assistance, including interpreters, translated documents and digital content, and bilingual staff, through the use of multilingual notices, taglines, signage or demonstrably equivalent alternatives included on documents and digital content the agency creates for the public and in agency buildings and offices; and

(F) training employees of the agency who interact with the public on any policy or procedure established by the agency to implement the language access plan established by the agency under subsection (b).

(2) Public complaint and tracking system.—

(A) Complaints.— The Attorney General shall establish and maintain a publicly accessible system for individuals to submit complaints to the Attorney General regarding barriers to receiving meaningful access, as described under paragraph (1), from an agency.

(B) Response.— The head of the agency with respect to which the complaint was made shall respond to each complaint that was made not later than 60 days after receipt of the complaint from the Attorney General.

(C) Reports.— The Attorney General shall publish on the website of the Department of Justice an annual report summarizing the complaints made under subparagraph (A), disaggregated by the agency that is the subject of the complaint, the language with respect to which the agency failed to provide access, and the program or activity to which the person is guaranteed meaningful access under paragraph (1).

(b) Language access plan.—

(1) Establishment.— Not later than 1 year after the date of the enactment of this Act, the head of each agency shall establish a language access plan to implement subsection (a) that—

(A) is practical and effective, readily implemented, and responsive to the particular circumstances and mission of the agency;

(B) is consistent with the Language Access Technical Standards issued under subsection (c);

(C) is consistent with the standards set forth—

(i) in the initial LEP Guidance of the agency;

(ii) in the policy guidance document entitled “Enforcement of Title VI of the Civil Rights Act of 1964—National Origin Discrimination Against Persons With Limited English Proficiency” 65 Fed. Reg. 50, 123 (Aug. 16, 2000); and

(iii) in the Attorney General’s memorandum to the heads of Department components issued on November 21, 2022, entitled “Strengthening the Federal Government’s Commitment to Language Access”;

(D) identifies which populations containing individuals with LEP are likely to seek access to the services and programs of the agency, including language populations that are emerging, have been historically isolated, are of lesser diffusion, and do not have a commonly used written format;

(E) describes how multilingual communications will be meaningfully provided to the populations identified pursuant under subparagraph (D), including whether such communications will be provided through oral, visual, or community-based modes of communication as appropriate;

(F) in the case that the agency provides assistance during emergency response situations (such as disasters, public health crises, and other urgent circumstances) specifies how multilingual communications will be meaningfully provided to such populations during such situations regardless of whether an official state of emergency has been declared; and

(G) sets procedures for the agency with respect to monitoring, evaluating, and improving the performance of the agency in implementing the plan, including—

(i) regular assessments of the language access needs of the agency and the effectiveness of the language access provided by the agency;

(ii) measurable performance indicators addressing timeliness, accuracy, and quality of language assistance services;

(iii) mechanisms for collecting and reviewing data on service usage, complaints, and identified barriers;

(iv) periodic internal reviews conducted by the civil rights office of the agency; and

(v) processes for corrective action and continuous improvement when deficiencies or gaps in meaningful access are identified.

(2) Notice and comment.— The head of each agency shall publish a proposal for the plan required to be established under paragraph (1) in the Federal Register for a 60-day public comment period to ensure that stakeholders, including individuals with LEP and organizations representing such individuals, have an adequate opportunity to provide input on how the head of such agency carries out the provisions of this section.

(3) Federal Register.— After considering any comments received during the period described under paragraph (2) with respect to plan published under such paragraph, the head of an agency shall—

(A) update such plan on the basis of such comments as the head of the agency determines appropriate; and

(B) publish a finalized version of the plan in the Federal Register.

(4) Submission to the Attorney General and to congress.— Not later than 30 days after the head of an agency establishes the language access plan required by paragraph (1), the head of such agency shall submit such plan to—

(A) the Attorney General; and

(B) the Chair and Ranking Minority Member of—

(i) the Committee on the Judiciary of the House of Representatives;

(ii) the Committee on the Judiciary of the Senate;

(iii) the Committee on Oversight and Government Reform of the House of Representatives; and

(iv) the Committee on Homeland Security and Governmental Affairs of the Senate.

(5) Central repository.— The Department of Justice shall establish and maintain a publicly available website with the domain name “LEP.gov” to serve as the central repository for each plan submitted to the Attorney General under paragraph (4)(A).

(c) Language access technical standards.—

(1) Establishment of standard.— Not later than 1 year after the date of the enactment of this Act, the head of each agency, in consultation with the Attorney General, the National Institute of Standards and Technology, and stakeholders and advocates from non-English-speaking communities, shall establish standards to be known as Language Access Technical Standards to—

(A) ensure meaningful access to federally conducted programs and activities under subsection (a); and

(B) be used as a measure of progress to evaluate the effectiveness and accuracy of language access for federally conducted programs and activities carried out by each agency.

(2) General accessibility requirements.— The Language Access Technical Standards shall at a minimum, with respect to the systems and services of the agency—

(A) allow individuals with LEP to access any written content provided by the agency in the language of their choice among the agency’s supported languages;

(B) ensure the functionality, quality, and timeliness of the system and services for all languages;

(C) implement user-friendly interfaces that account for varying literacy and digital skills; and

(D) be culturally determined.

(3) Undue burden exception.—

(A) Written request.— In the case that the head of an agency determines that compliance with a specific requirement included in the Language Access Technical Standards established under this subsection would impose an undue burden on the agency, the head of the agency shall submit to the Attorney General a written request to waive such requirement for the agency that identifies—

(i) the specific requirement that would impose such undue burden;

(ii) the nature of the burden; and

(iii) any alternative to fulfilling the requirement and why each such alternative is not feasible.

(B) Attorney General review.—

(i) In general.— Not later than 30 days after receiving a request under subparagraph (A), the Attorney General shall grant or deny the request.

(ii) Determination criteria.— In determining whether to grant or deny a request under paragraph (2), the Attorney General an agency shall consider whether—

(I) individuals with limited English proficiency are likely to interact with the agency; and

(II) a failure to provide meaningful language access is likely to result in significant harm, denial of benefits, or diminished civil rights protections.

(C) Expiration.— A grant of a waiver under this subsection shall expire two years after such grant.

(D) Record.— The Attorney General shall maintain a publicly accessible record of all written requests received under subparagraph (A) in the central repository established under subsection (b)(5).

(4) Public participation and comment.— Before establishing Language Access Technical Standards, or updating any such standards, the head of an agency shall provide opportunity for public comment and engage communities representing individuals with LEP, including community and cultural organizations that work with individuals with LEP, and providers of professional language services.

(5) Updates.— The Language Access Technical Standards shall be reviewed at least once every 3 years, and updated as necessary following such review.

(6) Adoption.— The head of each agency shall certify compliance with the Language Access Technical Standards annually to the Attorney General.

(7) Scope.— The Language Access Technical Standards shall apply to all agency programs, activities, and communications, including—

(A) in-person, telephonic, and virtual interactions;

(B) paper and digital content and documents;

(C) websites, portals, and mobile applications; and

(D) artificial intelligence-assisted and machine translation language assistance services, including automated translation, transcription, and interpretation technologies.

(d) AI and automated language assistance services.—

(1) Limitation.— The head of an agency—

(A) may not fully replace any qualified language assistance services of the agency with artificial intelligence or machine translation services; and

(B) shall require a qualified human translator or interpreter to verify any use of such service or machine translation by the agency.

(2) Requirements.— The head of each agency shall ensure that any artificial intelligence-assisted language assistance services used by the agency—

(A) do not replace any qualified translators and interpreters;

(B) publicly disclose on an annual basis on www.LEP.gov data sources, limitations, confidence levels, and error rates of the service;

(C) comply with section 552a of title 5, United States Code (commonly referred to as the Privacy Act of 1974), the Federal Information Security Modernization Act of 2014, and the E–Government Act of 2002, and protect personal and sensitive information from disclosure;

(D) are tested to prevent discrimination based on language, culture, ethnicity, or other protected characteristics, with mitigation strategies documented;

(E) are reviewed and validated by qualified translators and interpreters to ensure proper cultural context, idiomatic accuracy, and clarity of the translation or interpretation; and

(F) are continuously monitored by the agency for performance, with errors reported and corrective actions for user-reported inaccuracies in translation and interpretation implemented.

(3) Best practices.— Not later than 1 year after the date of the enactment of this Act, the Attorney General shall issue guidance on best practices for the use of artificial intelligence in language assistance services, including validation, monitoring, and accountability measures for such artificial intelligence.

(4) Audit requirement.—

(A) In general.— The Inspector General of each agency shall conduct, at least once every two years after the date of the enactment of this Act, an audit of all artificial intelligence-assisted language systems to assess accuracy, fairness, cultural relevance, and compliance with the Language Access Technical Standards established under subsection (c).

(B) Report.— An Inspector General shall submit to the Attorney General a report on an audit conducted under subparagraph (A), not later than 90 days after such audit is completed.

(C) Public transparency.— The Attorney General shall make publicly available a summary of the report submitted under subparagraph (B).

(5) NIST.— The National Institute of Standards and Technology shall provide technical expertise, validation protocols, and standardization tools for artificial intelligence-assisted language assistance services.

(e) Interagency coordination.—

(1) Interagency Language Access Standard Council.— The Administrator of General Services shall convene an Interagency Language Access Standards Council to coordinate updates, best practices, and research on emerging technologies.

(2) Language Access Working Group.—

(A) In general.— There is established an Language Access Working Group to—

(i) serve as a central resource for providing support and technical assistance to agencies in implementing the language access plan of the agency; and

(ii) directly engage with community groups, individuals with LEP, and other stakeholders to ensure adherence with this section.

(B) Membership.— The members of the Group shall be comprised of one Language Access Coordinator from each agency and the Attorney General.

(C) Head of group.— The Attorney General shall serve as the head of the Group.

(f) Establishment of Language Access Coordinator position.—

(1) Position.— There is established in each agency a position to be known as the Language Access Coordinator.

(2) Designation.— The head of each agency shall designate an officer or employee of the agency to serve as the Language Access Coordinator for the agency.

(3) Duties.— The Language Access Coordinator shall—

(A) serve as point of contact for each language access effort of the agency;

(B) shall ensure that each agency component that frequently interacts with individuals with LEP provides, if feasible, mandatory annual training to managers, personnel who frequently communicate with individuals with LEP, and personnel who arrange for language support, on this section, the language access plan of the agency, and agency procedures for identifying language access needs, providing language assistance services, working with interpreters and translators, requesting document translations, and tracking the use of language access services;

(C) determine annually whether additional federally conducted programs and activities should be made accessible for individuals with LEP and notify agency components of their responsibility to provide such access; and

(D) beginning on the date that is 3 years after the date of the enactment of this Act, evaluate the language access plan of the agency, including a review of the costs of language assistance services, and propose changes to agency components, as appropriate, to refine such plan.

(g) Noncompliance.— Noncompliance with the requirements of this section—

(1) shall be treated as discrimination under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), thereby granting the Department of Justice enforcement authority, including the authority to conduct an investigation, commence an administrative action, and seek civil remedies; and

(2) may trigger administrative, civil, or injunctive remedies by aggrieved parties or the Attorney General.

(h) Definitions.— In this section:

(1) Agency.— The term agency has the meaning given that term in section 551 of title 5, United States Code.

(2) Individual with LEP.— The term individual with LEP means an individual for whom English is not a primary language and who has a limited ability to read, speak, write, or understand the English language (including an individual who is able to speak or understand the English language, but has a limited ability to read or write the English language).

(3) Language assistance services.— The term language assistance services means oral and written language assistance services used to provide individuals with LEP meaningful access to, and an equal opportunity to participate fully in, the services, activities, and other programs administered by the Federal Government.

(4) Meaningful access.— The term meaningful access means access that—

(A) results in accurate, timely, and effective communication at no cost to the individual with LEP; and

(B) is comparable to the access provided to individuals who are proficient in English.

(5) Primary language.— The term primary language means the language in which an individual most effectively communicates.

(6) Program or activity.— The term program or activity means all the operations of an agency that involve contact with the public, the administration of Federal benefits, or communication with members of the public or program participants.

(7) Qualified interpreter or translator.— The term qualified interpreter or translator means—

(A) an individual who—

(i) is capable of effective, accurate, and impartial rendition of spoken or signed communication from one language to another between people who speak, sign, read, or write in a different language, both receptively and expressively, using any necessary specialized vocabulary and with appropriate cultural relevance, either simultaneously or consecutively;

(ii) demonstrates to the Language Access Coordinator of the agency proficiency in and ability to listen to a spoken language, seeing or feeling a signed or manual language, or reading something written in one language and expressing what is being conveyed by that language accurately and with appropriate cultural relevance into another language, either simultaneously or consecutively, including with respect to any specialized term, concept, or any particularized vocabulary or phraseology particular to the program or service concerned that is being conveyed; and

(iii) understands and adheres to the roles of interpreters or translators, including any confidentiality, ethics, and impartiality rules.

(8) Vital document.— The term vital document means any written material containing information critical for—

(A) accessing or understanding a Federal program or activity or required by law; or

(B) obtaining any aid, benefit, service, or training, such as—

(i) an application for a benefit or service;

(ii) a consent or complaint form;

(iii) a notice of rights and responsibilities; or

(iv) a letter or notice that requires a response from a beneficiary, applicant, participant, or employee.

(a) Definitions.— In this section:

(1) AANHPI.— The term AANHPI means Asian American, Native Hawaiian, and Pacific Islander.

(2) Secretary.— Except as otherwise specified, the term Secretary means the Secretary of Health and Human Services.

(b) Findings.— Congress finds the following:

(1) The AANHPI community is among the fastest growing population groups in the United States. It is a diverse population representing more than 70 distinct ethnicities, and speaking more than 100 languages and dialects.

(2) There is a growing mental health crisis in the United States, particularly for AANHPI individuals. AANHPI individuals with mental health challenges have the lowest rates of mental health service utilization compared to other racial or ethnic populations. In 2023, only 35 percent of Asian adults with a mental health challenge received treatment in the past year. Although suicide is the eleventh leading cause of death, it is the leading cause of death for AANHPI youth. From 2018 to 2023, AANHPI youth between the ages of 10 to 24 years were the only racial or ethnic population in this age category where suicide was the leading cause of death.

(3) Such mental health disparities within the AANHPI community may be attributed to systemic barriers to accessing mental health services, including stigma attached to mental health, limited availability of and access to culturally and linguistically appropriate services, and insufficient research.

(4) Insufficient research on AANHPI communities often leads to an inaccurate representation of their experiences and needs. It is imperative to disaggregate AANHPI population data to better understand the range of mental health issues for each subpopulation so that specific culturally and linguistically appropriate solutions can be developed.

(5) Critical investments are necessary to reduce stigma and improve mental health within AANHPI communities, including increasing culturally and linguistically appropriate outreach education and mental health services, improving representation of AANHPI individuals among the behavioral health workforce, and strengthening disaggregated data collection in research.

(c) National AANHPI behavioral health outreach and education strategy.— Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following new section:

“554. National AANHPI behavioral health outreach and education strategy.—

(a) In general.— The Secretary, acting through the Assistant Secretary, shall, in coordination with the Director of the Office of Minority Health, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention, and in consultation with advocacy and behavioral health organizations serving populations of Asian American, Native Hawaiian, and Pacific Islander individuals or communities, develop and implement a national outreach and education strategy to promote behavioral health and reduce stigma associated with mental health and substance use disorders within the Asian American, Native Hawaiian, and Pacific Islander population. Such strategy shall—

(1) be designed to meet the diverse cultural and language needs and preferences of the various Asian American, Native Hawaiian, and Pacific Islander populations;

(2) be developmentally and age appropriate;

(3) increase awareness of symptoms of mental illnesses common within subgroups of such population, taking into account differences within subgroups, such as gender, gender identity, age, sexual orientation, culture, or ethnicity;

(4) provide information, in a publicly accessible manner, on evidence-based, culturally and linguistically appropriate, and adapted interventions and treatments;

(5) ensure full participation of, and engage, both consumers and community members in the development and implementation of materials; and

(6) seek to broaden the perspective among both individuals in Asian American, Native Hawaiian, and Pacific Islander communities and stakeholders serving such communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health.

(b) Reports.— Beginning not later than 1 year after the date of the enactment of the Health Equity and Accountability Act of 2026 and annually thereafter, the Secretary, acting through the Assistant Secretary, shall submit to Congress, and make publicly available, a report on the extent to which the strategy developed and implemented under subsection (a) increased awareness among the Asian American, Native Hawaiian, and Pacific Islander population of mental health and substance use disorders.

(c) Authorization of appropriations.— There is authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2026 through 2030.”.

(d) Systematic review of and report on the AANHPI youth behavioral health crisis.—

(1) Systematic review.—

(A) In general.— The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, in coordination with the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, and the Director of the Office of Minority Health, shall conduct a systematic review of behavioral health among AANHPI youth.

(B) Elements.— Such systematic review required under subparagraph (A) shall include an assessment of—

(i) the prevalence, risk factors, and root causes of mental health challenges, substance misuse, and mental health and substance use disorders among AANHPI youth;

(ii) the prevalence and methods of attempted suicide, nonfatal substance use overdose, and death by suicide or substance use overdose among AANHPI youth; and

(iii) AANHPI youth that received treatment for mental health and substance use disorders.

(2) Report.— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives, and make publicly available, a report on the findings of the systematic review conducted under paragraph (1), including—

(A) identification of the barriers to accessing behavioral health prevention, treatment, and recovery services for AANHPI youth;

(B) identification of root causes of mental health challenges and substance misuse among AANHPI youth;

(C) recommendations for evidence-based actions to be taken by the Secretary to improve behavioral health among AANHPI youth;

(D) recommendations for legislative or administrative action to improve the behavioral health of AANHPI youth experiencing depression, suicide, and overdose, and to reduce the prevalence of depression, suicide, overdose, and other behavioral health conditions among AANHPI youth; and

(E) such other recommendations as the Secretary determines appropriate.

(3) Data.— Any data included in the systematic review or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.

(4) Authorization of appropriations.— For purposes of carrying out this subsection, there is authorized to be appropriated $1,500,000 for fiscal year 2027.

(e) Systematic review of and report on strategies on the AANHPI behavioral health workforce shortage.—

(1) Systematic review.—

(A) In general.— The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, in coordination with the Administrator of the Health Resources and Services Administration, the Secretary of Labor, and the Director of the Office of Minority Health, shall conduct a systematic review of strategies for increasing the behavioral health workforce that identify as AANHPI.

(B) Elements.— Such systematic review required under subparagraph (A) shall include an assessment of—

(i) the total number of behavioral health workers in the United States who identify as AANHPI;

(ii) with respect to each such worker, information regarding the current type of license, geographic area of practice, and type of employer (such as hospital, Federally qualified health center, school, or private practice);

(iii) information regarding the cultural and linguistic capabilities of such workers, including languages spoken proficiently;

(iv) the relevant barriers to enrollment in behavioral health professional education programs and entering the behavioral health workforce for AANHPI individuals; and

(v) the total number of behavioral health workers who identify as AANHPI and who participate in Federal programs that seek to increase, train, and support the behavioral health workforce.

(2) Report.— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives, and make publicly available, a report on the findings of the systematic review conducted under paragraph (1), including—

(A) identification of AANHPI behavioral health workers’ knowledge and awareness of the barriers to quality behavioral health care services faced by AANHPI individuals, including stigma, limited English proficiency, and lack of health insurance coverage;

(B) recommendations for actions to be taken by the Secretary to increase the number of AANHPI behavioral health workers;

(C) recommendations for legislative or administrative action to improve the enrollment of AANHPI individuals in behavioral health workforce education and training programs; and

(D) such other recommendations as the Secretary determines appropriate.

(3) Data.— Any data included in the systematic review or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.

(4) Definition.— In this section the term behavioral health worker means any individual licensed or certified to provide mental health or substance use disorder services, including in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, peer support, and substance use disorder counseling.

(5) Authorization of appropriations.— For purposes of carrying out this subsection, there is authorized to be appropriated $1,500,000 for fiscal year 2027.