Week 3 – Discussion Board 1

[Art Liebl]

In at least 250 words talk about if you think present day legislation is enough. Do you see executive order 13166 being applied in your state? Respond to two fellow students by Monday.

[Lesly Betancur]

In my opinion, no present-day legislation is not enough, the foundation is there but it is not enough. While laws like Executive Order 13166 exist, enforcement is weak, implementations are inconsistent, funding is limited, modernized tech tools are needed, and many agencies don’t fully meet the needs of today’s diverse multilingual populations. Demographics are constantly shifting and coverage for diverse languages limits its effectiveness, so more action is needed to ensure true language access.

Yes, Rhode Island has implemented policies and procedures that align with the objectives of Executive Order 13166, “Improving Access to Services for Persons with Limited English Proficiency,” signed in 2000. This executive order mandates that federal agencies and recipients of federal funding take reasonable steps to provide meaningful access to their services for individuals with limited English proficiency (LEP). Rhode Island has created policies, language access plans, and local laws like R.I. Gen. Law § 23-17-54 to enforce these requirements. Rhode Island General Law § 23-17-54 requires all hospitals and emergency care facilities to provide qualified interpreters for non-English-speaking patients. Hospitals must post multilingual notices informing patients of their right to interpreter services, and the receipt of such services does not affect immigrant status benefits. Other RI federal agencies are proactive as well, such as the Rhode Island Judiciary (courts), Rhode Island Department of Education (RIDE)(schools), and Rhode Island Division of Motor Vehicles (DMV) has made progress in offering translation and interpretation services. These initiatives demonstrate Rhode Island’s commitment to ensuring that LEP individuals have meaningful access to essential services, in compliance with both federal and state laws.

[Cristina Restrepo]

Lesly, I really like how well you explained the many ways Rhode Island is implementing and adhering to order 13166 which calls to improve access to services for individuals with limited English proficiency. You really showed how compromised the state is with its LEP community, however, I also agree with you in that there is still many challenges to be addressed such as limited funding, technological tools needed, as well as diverse language interpretation among others. I hope our state representatives act to resolve these issues to better serve our LEP community.

[Leonisa Avelino]

Hi Leslie, I like the detailed examples you provided about Rhode Island’s efforts. It’s encouraging to see that state-level initiatives, like R.I. Gen. Law § 23-17-54 and the policies adopted by agencies like RIDE and the DMV, are moving in the right direction. Still, as you mentioned, demographics are always shifting, so these systems need to be constantly reassessed and improved to stay effective.

[Cristina Restrepo]

I believe present day legislation is not enough as current laws still face some challenges some of them being the lack of universal certification standards for medical interpreters, reimbursement of services and ongoing need for accessible qualified interpreters in various languages. While order 13166, Massachusetts Emergency Room Interpreter Bill and ClAS Standards provide a good foundation, they do not fully address the challenges and gaps that LEP individuals face today.

The most outstanding challenges are the reimbursement of services as it can be a significant barrier especially for Medicaid/Medicare recipients. Also, there are no universal federal standards for certifying medical interpreters, which raises concerns about the quality and consistency of interpreter services. Another issue that needs to be addressed is the lack of medical interpretation in languages other than the most commonly spoken. Despite the legal requirements in place today, there is insufficient access to qualified interpreters, particularly in regions with diverse language population.

When it comes to order 13166, it is already being implemented in the state of Rhode Island to ensure access to federal programs and services for individuals with limited English proficiency. This means that any health facility that receives federal funding must provide competent and qualified interpreter services to those who need it. Also, the state of Rhode Island has developed a Limited English Proficiency Plan to ensure accessible transportation planning and public notification. This plan focuses on the provision of multilingual publications, translation, and interpretation services to meet the needs of limited English proficiency individuals.

[Leonisa Avelino]

Hi Christina,

You made some excellent points about the ongoing gaps in language access, especially in healthcare. I agree that the lack of universal certification for medical interpreters and the challenges around reimbursement make it hard to ensure quality services. Even with strong policies like Executive Order 13166, we still see barriers, particularly for less commonly spoken languages. Rhode Island’s LEP Plan is a great step, but more nationwide consistency is definitely needed.

[Lesly Betancur]

Cristina, you made important points about the gaps in current legislation for medical interpretation. While policies like Executive Order 13166, the Massachusetts ER Interpreter Bill, and CLAS Standards offer a solid start, they don’t fully address the ongoing challenges especially around reimbursement, certification, and language diversity. The lack of federal certification standards affects the quality of care, and without proper reimbursement, especially in Medicaid/Medicare, providers may struggle to offer consistent services. Also, many less commonly spoken languages remain underserved, leaving parts of the population without adequate access. As a RI native, it’s encouraging to hear about Rhode Island’s proactive efforts, including its LEP Plan and compliance with federal requirements. RI is a great example of how states can take initiative.

[Leonisa Avelino]

In my opinion, present-day legislation like Executive Order 13166 lays a vital foundation for ensuring language access in healthcare and other federally funded services. In Massachusetts, this executive order is effectively implemented, and its impact is clear in the state’s strong language access policy. For instance, Massachusetts has supplemented the federal requirements with additional measures, such as the Massachusetts Emergency Room Interpreter Bill, which specifically mandates interpreter services in acute care settings. This combination of federal and state legislation is designed to ensure that individuals with Limited English Proficiency receive the care they need without language barriers.
However, while these laws are a step in the right direction, there is still room for improvement. Legislation can provide the framework for equal access, but its effectiveness depends on strict enforcement and consistent compliance by organizations. In many cases, the practical implementation of these rules may fall short, particularly in settings with limited resources or where there is insufficient training on cultural competence and language services. Additionally, as Massachusetts’ population becomes even more diverse, the evolving needs of Limited English Proficiency communities may call for update and improvement to the current law.
Overall, while I see Executive Order 13166 actively applied in Massachusetts, it’s important to continue reviewing and enhancing these policies to ensure they fully meet the dynamic needs of all community members.

[Lesly Betancur]

Leonisa, I agree with you. while Executive Order 13166 does lay a vital foundation and Massachusetts’ additional efforts, like the Emergency Room Interpreter Bill, clearly demonstrate a strong commitment to language access. Still, as you mentioned, the real challenge lies in consistent enforcement and adapting to a changing population. Continued evaluation and investment in cultural competence and training are essential to making these policies truly effective in practice.

[Milleny Arantess]

Hi Leonisa,
I agree with you and the fact that Executive Order 13166 lays a vital foundation for the healthcare field. I also agree that it’s something that needs to be reinforced at all times and updated so that it matches the current state of the U.S.

[Joseph Matthews]

In my opinion, Executive Order 13166 and the current HIPAA, Federal and State regulations, although quite thorough, are not enough as this social need and the statutory tools (i.e., rules and regulations) governing same are always changing in an environment that is dynamic and constantly evolving. This does not mean that I see these statutory guidelines as being weak with structural shortfalls. Having been exposed to many years with commercial contracts (such as oil & gas and banking) – which have to be in continuous compliance with federal guidelines – I have found the HIPAA Privacy Rule (PR) and Executive Order 13166 to amply cover the main points – even to the degree of fine minutia. The content of these regulations and legislation in general can get very technical and even a bit confusing as, for instance, in the case on page 18 of chapter 3 which addresses Group Health Plan disclosures to Plan Sponsors (see the middle paragraph, with focus on the second and third bullet points).

On the other hand – I see the big challenge that these large amount of requirements place on the health care providers, especially when it comes to LEPs, which can number into the hundred as pertains to languages, dialects and cultures. In sum, I do understand that if one wants to achieve minimum results – one has to aim high – which this legislation clearly does. As I have been living overseas since the 1970s, I cannot opine on any specific state law as pertains to the above.

[Milleny Arantess]

Hi Joesph,
I love how you bring your own experiences with federal laws and regulations into the conversation. It teaches me a lot, and I agree with you in the fact that Executive Order 13166 does do an amazing job of covering the most critical points, but as you said the medical interpreting field is very complex and hard to create specific and extraordinary laws for.

[Yona Souza]

Joseph, I find your opinion to be very on-point regarding the present-day situation in the United States. No, these legislations aren’t enough, however, as you mentioned, there is a big challenge within this whole concept because of all the multiple cultures and languages they have to account for.

[Joseph Matthews]

I find Cristina’s point to be quite on-the-mark about the insufficient access to qualified interpreters in general. I feel this is due to the ever-increasing mobility of the world’s population on one hand and the number of LEPs in the U.S. vis-a-vs even what it was just 10-15 years ago on the other. Imagine a health care provider in Casper, Wyoming that has three LEPs being attending to, one who speaks Farsi, one being the Portuguese dialect spoken in Gao, India and the other is Vietnamese? This is what I meant in my writre-up that the requirements the legislation puts on the health provider as pertains to LEPs to be no small task. Resources are finite in any organization, public or private and a balance has to found.

[Cristina Restrepo]

Hello Joseph, you bring a great point about finding balance when it comes to resources available to increase access of services for LEP individuals, specifically to qualified medical interpreters. I agree with your point of view, as there are many languages being spoken in a particular area and it is impossible to have medical interpreters for every language spoken, however, there should definitely be interpreting services for the most common languages spoken within a particular community.

[Joseph Matthews]

Thank you, Lesly for pointing out a clear example of how this federal legislation has filtered down into a corresponding state regulation as, in your case, that of the Rhode Island. As I am not in the U.S. – your example shows how both federal and state levels operate in sync with each other while avoiding potential areas of conflict as we see in the section on State Law – specifically statutory preemptions and exceptions on page 19 of chapter 3.

[Milleny Arantess]

I think that present day legislation is not enough. Although we are where we are today because of the legislation that paved the way and because of the one that we currently work by it still isn’t good enough when we think of how the world is ever changing. The world is ever changing but I’m only going to be talking about the U.S. In the U.S we have new cultures and languages arrisin everyday from people moving here from other countries and from parents raising their kids to know and understand their native culture. There is always going to be a necessity for interpreters that speak more languages, more security, more funding, more enforcing of the legislation, and a lot more overall.
I do see that Massachusetts applies executive order 13166. Whenever I go to appointments I am always offered an interpreter for my parents who don’t speak English that well. The interpreters are always respectful and always do a good job. Massachusetts also implemented their own law, The Massachusetts Emergency Room Interpreter Bill. This bill states that every hospital must provide an interpreter in the emergency room free of charge. This bill also makes it so hospitals can’t make family or friends interpret for the patient. But, like I stated before even though these laws currently exist, and they are good laws, there is always a way to make it even better so that it can provide for the current crazy state of the U.S.

[Yona Souza]

Hi Milleny, I agree with your opinion based on this topic, and I love that you fully give your opinion based on lived experience. You touched on an interesting point regarding the importance of having the Massachusetts Emergency Room Bill well-regulated because it allows the family of LEP individuals to be free from the burden of interpreting to a loved one while going through so many emotions and chaos in an emergency situation.

[Yona Souza]

Although the state of Massachusetts has done a great job at enforcing legislation regarding language access for individuals with limited proficiency, I believe that it’s still not enough. There are more than 7,000 languages spoken worldwide, and many people who migrate to the United States may face difficulties gaining access to the right resources in the healthcare field because providers struggle to connect with an available interpreter who speaks that specific language. Of course, Spanish, Portuguese, and Mandarin LEPs are a large community in the United States. They are considered easier to find an interpreter for, because such languages are more common here in the northeast area, present day legislation still doesn’t successfully mediate the needs of LEP individuals, especially for speakers whose language is not so common in a specific area. I believe that current legislation fails to embrace so many different cultures. An example of this is: that you may speak Spanish, but that doesn’t necessarily mean that you’re from Spain. Because there are millions of different cultures and also different ways to communicate, finding the right resource and interpreter plays a critical role in order to successfully solve this issue. I have witnessed many cases in which I went to the hospital with my parents and instead of my parents receiving the right resource which would be a Portuguese interpreter who speaks Brazilian Portuguese, we received an interpreter who spoke Portuguese from Portugal, which of course was still helpful. However, millions of words are completely different in these two languages, and instead of the interpretation being there as an asset, it became a language barrier because it was more difficult to understand their Portugal- Portuguese accent, and words that we never heard before.

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