Section 1557 Language Access for Rare Languages: Hospital Compliance & Audit Risk
Under Section 1557 of the Affordable Care Act, hospitals and healthcare providers are legally required to provide language access services to patients with limited English proficiency (LEP). When it comes to widely spoken languages like Spanish or Mandarin, language access is relatively straightforward, but when a patient speaks a rare language like Inuktitut or Nahuatl, a whole slough of operational challenges and compliance risks come up.
For rare languages, it can be hard enough to identify the language a patient speaks, let alone where to find an available, qualified interpreter who works in that language. But Section 1557 makes it clear that the onus is on the healthcare provider to offer meaningful access to interpreters and other linguistic aids, no matter how uncommon the language is.
At Avantpage, we work with medical interpreters and translators in more than 150 different languages, ensuring that LEP patients can access information about their healthcare regardless of how rare their target language is. In this blog post, we’ll take a close look at strategies that healthcare providers can take to establish strong language access practices for rare languages, mitigating audit risk and guaranteeing compliance with regulations like Section 1557.
Understanding Section 1557 & Language Access Requirements
Section 1557 requires any health program that receives funding from the Department of Health and Human Services—i.e., hospitals that accept Medicare payments, health insurance marketplaces, etc.—to provide meaningful access to individuals with LEP.
This means that these programs must take reasonable steps to ensure that people with LEP can effectively understand and use their services. Such steps include, but are not limited to, things like medical interpreting services during medical appointments and written translations of important paperwork like consent forms and discharge papers.
Failure to provide linguistic assistance services to patients with LEP can result in noncompliance with Section 1557, triggering audits, complaints from patients and their families, and costly civil rights violations. It’s important to note that Section 1557 does not make any exception for rare languages—no matter how hard it is to find a qualified medical interpreter or translator for a given language, health programs covered under Section 1557 must be prepared to provide adequate language access services to all patients with LEP.
Fines for noncompliance can be costly—if a patient complains to the Office of Civil Rights (OCR) and the subsequent investigation determines that the practice indeed neglected to provide language access services, fines can go up to $55,000 for the first violation and up to $110,000 for additional violations, according to the Vermont Medical Society.
The Challenge of Rare Languages in Healthcare
Rare languages are languages that are not widely spoken and as such, have limited resources available. It’s not surprising that language services for rare languages tend to lag behind more common languages—one study found that nearly a third of hospitals in the United States only have online patient portals in English. Of the ones that offer multiple languages, the vast majority only have portals in English, Spanish, and a third language, meaning most portals do not support even moderately uncommon languages.
Due to the lower number of speakers, it can be harder to find translators and interpreters who work in these languages. Oftentimes, providing interpretation to speakers of rare languages entails the use of relay interpreting—for example, if a Nahuatl-English interpreter is not available, a Nahuatl-Spanish interpreter and Spanish-English interpreter might work together to “relay” the messages between the patient and doctor.
Additionally, rare languages may have less standardization, resulting in high dialectal variation that can also present unique challenges. In such cases, two speakers of what is labeled the same “language” may struggle to fully understand one another—for example, a Mixtec-speaking patient from Oaxaca may use vocabulary and grammatical forms that differ from those of a Mixtec interpreter from Puebla, requiring additional clarification to ensure accurate and culturally appropriate communication.
These factors make it much harder to provide thorough language access services to speakers of rare languages. As a result, compliance risks arise: If it’s harder to find interpreters and translators, it can result in delays in care and informed consent or complaints from patients and their families to the OCR. OCR and HHS investigations can lead to costly fines and legal battles, while patient complaints can harm your organization’s reputation. Even worse, miscommunication can lead to misdiagnosis or other negative health outcomes.
Strategies to Mitigate Risk
Rare languages present unique challenges and risks for language access in the healthcare industry—but there are steps that you can take to mitigate these risks and provide language access services that are on par with those of more common languages. Here are a few different strategies we recommend to hospitals and health insurance providers to mitigate the compliance risks associated with rare languages:
Rare language identification and inventory: Develop and maintain a detailed language inventory based on patient intake data, encounter history, and community demographics so you know exactly which rare languages your population speaks. This allows you to anticipate demand, identify gaps in interpreter or translator availability, and proactively build resources rather than reacting in crisis mode.
Tiered language access approach: Adopt a risk-based, tiered model in which machine translation (MT) with machine translation post-editing (MTPE) is used for low-risk or informational content, while qualified human translators handle high-risk materials such as consent forms, discharge instructions, and legal notices. This approach aligns the level of linguistic review with the clinical and legal stakes of the communication.
Secure, compliant translation platforms: Use HIPAA-compliant technology platforms that provide encrypted file transfer, role-based access controls, and documented workflows to protect protected health information (PHI). Built-in audit trails and reporting features ensure you can demonstrate compliance during investigations or regulatory reviews.
Vendor partnership and training: Partner with a language services provider like Avantpage that offers end-to-end support, including rare-language staffing, secure technology solutions, workflow design, and documentation protocols. Ongoing training and process consultation help ensure your internal teams understand when to escalate content for higher levels of linguistic review and how to maintain audit-ready records.
Rare Language Audit & Documentation Best Practices
Clear documentation is key for all language access services, but it’s particularly important for rare languages, as these languages present higher risk of auditing and investigation by the OCR.
Hospitals and health insurance providers must be able to demonstrate that language assistance was provided consistently, appropriately, and in accordance with established workflows—here are some best practices that we recommend for organizations to be prepared for an audit:
Maintain records of language requests: Keep track of all of the language services requests and projects that your organization has to process—note the languages used, the kind of content being translated or interpreted (i.e., did discharge papers need to be translated into a rare language, or did someone use interpreting services during a medical appointment?) and the scope and workflow involved (i.e., MTPE, human translators, in-person interpreting services, etc.).
Track frequency of rare language communications: By keeping track of all the language requests your organization fulfills, you can take note of the frequency of requests for rare languages and the scope of the typical rare language request.
Document grievances and corrective action: Be sure to keep a record of any grievances you receive, particularly for rare languages. Investigate all grievances thoroughly and take action to correct errors whenever possible—in your records, take note of any corrective action that was taken.
Train staff who manage rare language interactions: Any staff who interact with patients or are involved in contacting language service vendors should be thoroughly trained in managing interactions with LEP patients who speak rare languages. This ensures that they know the standard procedures for identifying the language that the patient speaks and receiving the interpretation services necessary.
Mitigating Rare Language Risk with Avantpage
At Avantpage, we provide medical interpreting and translation services to patients in more than 150 different languages. When you work with us, you can tap into a wide network of native speakers of rare languages who can help you connect with LEP patients in languages from Azerbaijani to Zulu.
We help hospitals and health insurance providers achieve compliance with regulations like Section 1557 by implementing highly efficient translation and interpretation workflows—for example, our on-demand interpretation platform, AvantInterpret, allows you to get connected to a medical interpreter in a matter of seconds. Meanwhile, MTPE workflows speed up the translation process without sacrificing the overall quality of the final product.
Our goal is to make sure that your patients feel free to express and advocate for themselves in their native language. When your patients can communicate freely with their doctors, that reduces risk and increases your operational efficiency—it’s a win-win for both the patient and your organization.
Frequently Asked Questions
Failing to provide access for rare languages exposes hospitals to:
OCR audits or HHS investigations for Section 1557 violations.
Civil rights complaints and grievances from patients denied meaningful access.
Operational risks like miscommunication, delayed care, or clinical errors.
Financial and reputational risks including penalties and remediation costs. Avantpage partners with hospitals to proactively mitigate these risks through robust MTPE and human translation solutions.
Not all rare languages carry the same operational or audit risk. Hospitals should combine patient demographics, historical translation requests, and regional language prevalence to create a rare language risk inventory. Avantpage offers consulting services to help organizations map their patient population, prioritize languages for MTPE workflows, and ensure resources are allocated where audit risk is highest.
While critical compliance steps are consistent—like secure platforms, qualified linguists, and audit documentation—Avantpage builds scalable MTPE frameworks that adapt to multiple rare languages without sacrificing quality. This ensures hospitals can manage dozens of low-prevalence languages efficiently while maintaining Section 1557 compliance.
Hospitals often underestimate the time, staffing, and risk exposure of on-the-fly translations. Misinterpretation can lead to care delays, grievance complaints, and even legal exposure. Avantpage reduces these hidden costs by implementing ready-to-deploy rare language solutions, combining MT, MTPE, and human translation, all documented for audit readiness.
Reduce Risk with Ready-to-Deploy Rare Language Access Solutions
If you’re not prepared, rare languages can represent real compliance, operational, and patient safety risks. Under Section 1557, hospitals need structured, defensible language access processes that reduce liability while ensuring equitable, high-quality care for every patient.
Avantpage can help you rise above that challenge—our language services empower care teams and patients alike to communicate freely and efficiently no matter the language. Whether you need to interpret a Kurdish-speaking patient’s medical appointment or translate consent forms into Burmese, we have an expert linguist who can help. You can trust Avantpage to help you find a tried and true solution for all your rare language needs—contact us today at [email protected] or (530) 750-2040 to learn more today.