Regulatory guide · a review aid, not legal advice
Section 1557 and your health documents
What the 2024 Section 1557 rule asks of the documents a covered health program sends: the notice of availability, translation by qualified translators, and human review of machine translation.
Owner: Compliance · Checked against its sources on
Send a blank template, not a copy with a patient's or member's details.
In 30 seconds
- A covered entity must say that language help and auxiliary aids are free, in English and at least the 15 most common languages of people with limited English in its state.
- The notice goes with key documents, including denial notices, Explanations of Benefits, appeal-rights notices and consent forms.
- Machine-translated text that affects rights or benefits, or is technical, must be reviewed by a qualified human translator.
- Section 1557 sets no reading grade. It asks for meaningful access and effective communication.
Who it covers
Section 1557 of the Affordable Care Act bars discrimination in health programs and activities that receive federal financial assistance from HHS, programs HHS runs, and the federal and state exchanges. HHS’s 2024 final rule, at 45 CFR part 92, sets out what covered entities must do. Whether your organization is covered is a question for your counsel.
The notice of availability
A covered entity must tell people that language assistance and auxiliary aids and services are free. The notice must be in English and at least the 15 languages most commonly spoken by people with limited English proficiency in the state or states where it operates. It must also be available in alternate formats.
- Once a year to participants, beneficiaries, enrollees and applicants, and on request
- In a conspicuous place on the website
- In physical locations, in no smaller than 20-point sans serif font
- With the notice of nondiscrimination, the notice of privacy practices and application and intake forms
- With notices of denial or termination of eligibility, benefits or services, including Explanations of Benefits, and notices of appeal and grievance rights
- With communications about a person’s rights, eligibility, benefits or services that ask for a response
- With consent forms and instructions for medical procedures, and with public-health-emergency communications
Notice of availability
Language assistance and auxiliary aids and services are free.
English and at least the 15 languages most commonly spoken by people with limited English proficiency in your state, and in alternate formats.
Where it goes
- Once a yearTo participants, beneficiaries, enrollees and applicants, and on request
- On the websiteIn a conspicuous place
- In physical locationsNo smaller than 20-point sans serif
- With key documentsNotices, forms, denials and consent forms, as listed above
Translation by qualified translators
When translation is required, a covered entity must use a qualified translator. If it uses machine translation for text that is critical to a person’s rights, benefits or meaningful access, where accuracy is essential, or where the text is complex, non-literal or technical, a qualified human translator must review the translation.
Machine-translated text
Is the text any of these?
- Critical to a person’s rights, benefits or meaningful access
- Accuracy is essential
- Complex, non-literal or technical
YesA qualified human translator reviews the translation
Language-access self-audit: 12 questions, 10 minutes
What to check in each document
For each document on the list above, check that the notice of availability goes with it, that the English source is clear enough to translate, and that every translated version records who reviewed it.
- The notice of availability is attached and in the required languages
- The English source is in plain language before it goes to translation
- Machine-translated text that affects rights or benefits has a named human reviewer
- Alternate formats are offered and work
How HealthLiteracyCopilot helps
HealthLiteracyCopilot scores the English source before translation, translates with your glossary and protected terms, and sends a segment that could lose a dose to a human translator.
Your next step
Upload one Word document or PDF, up to 5 pages. It is scored against N-PLAT and rewritten in plain language, with the reason for each change.
Send a blank template, not a copy with a patient's or member's details.
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Sources
Questions
Does Section 1557 set a reading grade level?
No. It asks for meaningful access and effective communication. Grade-level targets come from state contracts, accreditors and your own policy.
Can we use machine translation?
The rule allows it, but text that is critical to rights, benefits or meaningful access, or that is technical, must be reviewed by a qualified human translator.
Is this legal advice?
No. It is a review aid. Confirm how the rule applies to your organization with your counsel.