SB188 - Establishes procedures to assist certain persons with limited English proficiency in accessing health care in certain circumstances. (BDR 40-41)

- 83rd Session (2025) Senate Bill No. 188–Senator Doñate CHAPTER.......... AN ACT relating to health care; requiring certain health facilities and providers of health care to take reasonable steps to provide a person with limited English proficiency with language assistance under certain circumstances; prescribing requirements governing the use of interpreters and translators to comply with that requirement; authorizing the discipline of certain health facilities and providers of health care for certain violations; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing federal regulations require certain health care entities to take reasonable steps to provide meaningful access to persons with limited English proficiency who are eligible to be served or likely to be directly affected by a health program or activity of the entity. (45 C.F.R. § 92.201(a)) The Director of the Office for Civil Rights of the United States Department of Health and Human Services has provided additional guidance by defining meaningful access to mean ensuring that language barriers do not prevent a person from obtaining necessary health services and care. (Melanie Fontes Rainer, Director, Office for Civil Rights U.S. Dep’t. of Health and Human Services (Dec. 5, 2024), Dear Colleague Letter Regarding Language Access Provisions of the Final Rule Implementing Section 1557 of the Affordable Care Act, retrieved from http://www.hhs.gov/sites/default/files/ocr-dcl- section-1557-language-access.pdf) Existing federal regulations prescribe various requirements and procedures governing the use of interpreters and translators to comply with those requirements. (45 C.F.R. § 92.201) Sections 5-8 and 16-20 of this bill codify similar provisions into state law, thereby requiring certain health facilities and providers of health care to take reasonable steps to ensure that language barriers do not prevent a person with limited English proficiency from obtaining necessary access to health care. Sections 5, 16 and 20 prescribe certain factors for determining whether an action is necessary for a health facility or provider of health care to be in compliance with that requirement. Sections 5 and 16 require that a service to provide language assistance be available free of charge, be accurate in translation or interpretation, be provided in a timely manner and protect the ability of the person with limited English proficiency to make independent decisions. Sections 5 and 16 require that a qualified translator review a machine-translated document under certain circumstances. Sections 5 and 16 require a health facility or provider of health care to use a qualified interpreter or translator to provide interpreting or translating services, and sections 8 and 19 establish the qualifications to serve as an interpreter or translator. Sections 6 and 17 prohibit the use of an unqualified interpreter, except in certain circumstances. Sections 6 and 17 also prohibit a health facility or provider of health care from requiring a person with limited English proficiency to provide his or her own interpreter or pay the cost of an interpreter. Sections 7 and 18 prescribe requirements governing the use of a remote interpreter. Sections 3, 4 and 15 of this bill define certain terms, and section 2 of this bill establishes the applicability of the definitions set forth in sections 3 and 4. Sections 9 and 10 of this bill make conforming changes to establish the applicability of certain provisions. – 2 – - 83rd Session (2025) Sections 11-13, 20 and 21 of this bill prescribe various mechanisms for the enforcement of sections 5-8 and 16-19, including the imposition of administrative sanctions against a health facility that fails to comply with those provisions and professional discipline against a provider of health care who fails to comply with those provisions. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 449 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 8, inclusive, of this act. Sec. 2. As used in sections 2 to 8, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 and 4 of this act have the definitions ascribed to them in those sections. Sec. 3. “Health facility” means a medical facility, a facility for the dependent that is a provider of services under Medicaid or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed. Sec. 4. “Person with limited English proficiency” means a person who speaks a language other than English and who cannot readily understand or communicate in the English language. Sec. 5. 1. A health facility shall take reasonable steps to ensure that language barriers do not prevent a person with limited English proficiency from obtaining necessary health care. 2. In determining whether a particular action is necessary to comply with subsection 1, a health facility shall, and in determining whether a health facility is in compliance with subsection 1, the Division shall: (a) Evaluate, and give substantial weight to, the nature and importance of the services or programs provided by the health facility and the relevant communications to the person with limited English proficiency; and (b) Consider any other relevant factors, including, without limitation, the effectiveness of any procedure for providing language access through written documents. 3. A service to provide language assistance to ensure compliance with subsection 1 must: (a) Be provided free of charge to the person with limited English proficiency; – 3 – - 83rd Session (2025) (b) Be accurate in translation or interpretation and provided in a timely manner; and (c) Protect the privacy and ability of the person with limited English proficiency to make independent decisions. 4. Except as otherwise provided in section 6 of this act, if a health facility determines pursuant to subsection 2 that interpretation services or translation services are necessary to ensure compliance with subsection 1, the health facility shall utilize an interpreter or translator who is qualified pursuant to section 8 of this act to provide those services. 5. A health facility shall ensure that a translator who is qualified pursuant to section 8 of this act reviews a machine- translated document if the document: (a) Relates to the rights of a person with limited English proficiency, the goods or services provided by the health facility or the ability of a person with limited English proficiency to obtain necessary health care; (b) Must be accurately translated to ensure compliance with subsection 1 or protect the health and well-being of a person with limited English proficiency; or (c) Is complex, nonliteral or technical. Sec. 6. 1. A health facility shall not: (a) Require a person with limited English proficiency to provide his or her own interpreter or pay the cost of an interpreter; (b) Utilize an adult who is not qualified as an interpreter pursuant to section 8 of this act to interpret or facilitate communication for a person with limited English proficiency except where authorized pursuant to subsection 2 or 3; (c) Utilize a child who is less than 18 years of age to interpret or facilitate communication for a person with limited English proficiency except where authorized pursuant to subsection 2; or (d) Utilize an employee, a contractor or a volunteer of the health facility who is not an interpreter or a translator qualified pursuant to section 8 of this act to interpret or facilitate communication for a person with limited English proficiency. 2. A health facility may utilize an adult who is not qualified as an interpreter pursuant to section 8 of this act or a child who is less than 18 years of age to interpret or facilitate communication for a person with limited English proficiency on a temporary, emergency basis if: (a) There is an imminent threat to the safety or welfare of any person or the public; – 4 – - 83rd Session (2025) (b) An interpreter who is qualified pursuant to section 8 of this act is not immediately available; (c) The health facility is attempting to find an interpreter who is qualified pursuant to section 8 of this act; and (d) An interpreter who is qualified pursuant to section 8 of this act later confirms or supplements the initial communications with the interpreter utilized pursuant to this section. 3. A health facility may utilize an adult who is not qualified as an interpreter pursuant to section 8 of this act to interpret or facilitate communication for a person with limited English proficiency if the person with limited English proficiency requests for the adult to interpret or facilitate communication for him or her. Such a request must be: (a) Made without the adult present to an interpreter who is qualified pursuant to section 8 of this act; (b) Agreed to by the adult; (c) Documented in the record of the person with limited English proficiency; and (d) Deemed appropriate under the circumstances by the person providing the program or service on behalf of the health facility. Sec. 7. 1. A health facility may use a remote interpreter to provide interpreting services necessary to comply with section 5 of this act if the health facility utilizes audio-visual communication technology or audio communication technology that includes, without limitation, synchronous interaction with audio and, if applicable, video over a high-speed, wide-bandwidth connection or wireless connection that, to the extent possible: (a) Does not produce a lag or irregular pauses in communication or, if applicable, images; (b) Provides transmission of voice that is clear and audible; and (c) If applicable, produces a high-quality video image that is not blurry or grainy and is large enough to display the face of the interpreter and person with limited English proficiency, regardless of body position. 2. A health facility shall provide training to an employee, a contractor or a volunteer who is involved in using audio-visual communication technology or audio communication technology to facilitate the use of a remote interpreter. Such training must be adequate to ensure that the employee, contractor or volunteer operates the technology efficiently and effectively. – 5 – - 83rd Session (2025) Sec. 8. An interpreter or translator is qualified to provide interpretation or translation services pursuant to sections 2 to 8, inclusive, of this act if the interpreter or translator: 1. Has demonstrated proficiency in and understanding of spoken or written, as applicable: (a) English and at least one other language; or (b) At least two languages that are not English if he or she is a relay interpreter or translator; and 2. Has demonstrated proficiency in interpreting or translating, as applicable, effectively, accurately and impartially, including, without limitation, using specialized vocabulary or terms without change, omission or addition. Sec. 9. NRS 449.029 is hereby amended to read as follows: 449.029 As used in NRS 449.029 to 449.240, inclusive, and sections 2 to 8, inclusive, of this act, unless the context otherwise requires, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a program of hospice care described in NRS 449.196. Sec. 10. NRS 449.0301 is hereby amended to read as follows: 449.0301 The provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to 8, inclusive, of this act do not apply to: 1. Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility shall comply with all regulations relative to sanitation and safety applicable to other facilities of a similar category. 2. Foster homes as defined in NRS 424.014. 3. Any medical facility, facility for the dependent or facility which is otherwise required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed that is operated and maintained by the United States Government or an agency thereof. Sec. 11. NRS 449.160 is hereby amended to read as follows: 449.160 1. The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to 8, inclusive, of this act upon any of the following grounds: (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and sections 2 to 8, inclusive, of this act, or 449A.100 to 449A.124, inclusive, and 449A.270 to 449A.286, inclusive, or of any other law – 6 – - 83rd Session (2025) of this State or of the standards, rules and regulations adopted thereunder. (b) Aiding, abetting or permitting the commission of any illegal act. (c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued. (d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility. (e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or 439A.102 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and sections 2 to 8, inclusive, of this act and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required, including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is owned by the licensee without approval pursuant to NRS 439A.102. (f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486. (g) Violation of the provisions of NRS 458.112. (h) Failure to comply with the provisions of NRS 449A.170 to 449A.192, inclusive, and any regulation adopted pursuant thereto. (i) Violation of the provisions of NRS 629.260. 2. In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility f [Text truncated for display. Full text available on LegiScan.]