HHS OCR and HRSA Partner to Assist HRSA-funded Health Centers in Puerto Rico through Effective Communication Dear Colleague Letter


Contact: HHS Office for Civil Rights


August 30, 2016

HHS OCR and HRSA Partner to Assist HRSA-funded Health Centers in Puerto Rico through Effective Communication Dear Colleague Letter

On August 30, 2016, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) and the Health Resources and Services Administration (HRSA) in Region II (Eastern & Caribbean Region-New York) signed a joint letter to increase awareness of the important issues affecting the provision of medical services to deaf and hard of hearing individuals; specifically, the letter focuses on the provision of auxiliary aids and services to ensure effective communication at HRSA-funded health centers in Puerto Rico.

Section 504 of the Rehabilitation Act of 1973 (Section 504) and Section 1557 of the Patient Protection and Affordable Care Act of 2010 (Section 1557) are Federal laws that require hospitals, health care providers, clinics, medical practices and other entities who receive funds from HHS to provide services to persons with disabilities in a non-discriminatory manner.  This requirement includes providing appropriate auxiliary aids and services to deaf and hard of hearing patients and their family members when necessary to ensure effective communication with service providers.

OCR and HRSA entered into a collaborative partnership to assist HRSA-funded health centers and health care providers to understand their obligations under Section 504 and Section 1557. HRSA-funded health care centers located in Puerto Rico are essential resources for thousands of individuals seeking medical services and it is critical that the appropriate auxiliary aids and services are provided for deaf and hard of hearing individuals and their families.

Effective communication is crucial in health care settings, and failure to effectively communicate may lead to a misunderstanding of patient’s symptoms, an inappropriate diagnosis, and/or delayed or improper medical treatment.  Although family members play a vital role in a patient’s care and their participation is often critical to ensuring health care services are accessed and understood, Section 504 places responsibility for providing effective communication, including the use of qualified interpreters, directly on health care providers.  The joint letter addresses ways in which health care providers can ensure medical information is both effectively and accurately communicated for the patients and their family members.

For over 50 years, HRSA-funded health centers have provided high quality preventive and primary health care to patients regardless of their ability to pay.  Approximately 1 in 14 people in the U.S. relies on a HRSA-funded health center for medical care.  Over 1,300 of these health centers operate approximately 9,000 service delivery sites in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the Pacific Basin, providing care for nearly 23 million patients annually.  OCR enforces Section 504 and Section 1557 for health care centers and health care providers who receive funds from HHS.

The Joint Letter may be found in English and in Spanish on OCR's website at: http://www.hhs.gov/civil-rights/for-individuals/special-topics/hospitals-effective-communication/disability-resources-effective-communication/index.html.

Visit OCR’s website to learn more about efforts in support of ensuring effective communication for deaf or hard of hearing individuals:

To learn more about non-discrimination and health information privacy laws, your civil rights, and privacy rights in health care and human service settings, and to find information on filing a complaint, visit us at www.hhs.gov/ocr.

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Content created by Office for Civil Rights (OCR)
Content last reviewed on September 26, 2016