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Happy Birthday CLAS Standards! The National Standards for Culturally and Linguistically Appropriate Services known widely by the acronym CLAS, are 25-years old this year. When the Office of  Minority Health (OMH) developed and implemented CLAS in 2000, the new guidelines promoting culturally appropriate access to health care by LEP individuals and people with disabilities, began changing the approach of many in health care to examine health outcomes and access for their entire communities and service areas to better reach and care for people who for potentially exclusionary effects of income, language proficiency, disability, or cultural differences simply do not visit their local health system. “To improve health outside their walls, hospitals and care systems must engage in multisectoral partnerships with community-based groups, health departments and public health organizations.”

See: Association for Community Health Improvement. (2013, December). Trends in hospital-based population health infrastructure: Results from an Association for Community Health Improvement and American Hospital Association survey. Chicago: Health Research & Educational Trust, and “Published research from organizations like the Institute of Medicine (www.iom.edu), the Agency for Healthcare Research and Quality (www.ahrq.gov), the Centers for Disease Control and Prevention (www.cdc.gov),  the Health Resources and Services Administration (www.hrsa.gov),  and the Robert Wood Johnson Foundation (www.rwjf.org) has shown that not only do people from different backgrounds have unequal access to care, but they also have disparities in health outcomes and in healthcare itself.” A Failure to Communicate – Caring for Patients with Limited English Proficiency – Dr. Robert Like, MD

In sum, OMH defines CLAS as:

“What is CLAS?

CLAS is a way to improve the quality of services provided to all individuals, which could ultimately help reduce health disparities. CLAS is about respect and responsiveness: Respect the whole individual and Respond to the individual’s health needs and preferences.

Health disparities in our nation are well documented. Providing CLAS is one strategy to help eliminate health disparities. By tailoring services to an individual’s culture and language needs, health professionals can help bring about positive health outcomes.

The provision of health services that are respectful of and responsive to the health beliefs, practices, and needs of patients can help close the gap in health outcomes.” https://thinkculturalhealth.hhs.gov/clas/what-is-clas

According to the June, 2025 “Think Cultural Health newsletter,” HHS’s Office of  Minority Health commemorated CLAS’s 25^th birthday:

“2025 marks the 25^th anniversary of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. For a quarter-century, these standards have guided health organizations’ efforts to deliver care that is responsive to the cultural beliefs and communication needs of all patients. CLAS is a way to improve the quality of services, which will ultimately help reduce health disparities…

To further promote CLAS, OMH launched Think Cultural Health (TCH) in 2004, a website with free e-learning programs and resources about CLAS. Now in its 20^th year, TCH has educated more than a million health professionals, equipping them to bridge cultural and communication gaps in health care.

OMH invites health care professionals to explore Think Cultural Health’s training and resources. Visit TCH today and share these valuable tools with your networks to promote respectful, responsive care for all.”

CLAS implementation varies by state. The standards are neither laws nor regulations. However, they have proven to be quite valuable in providing health care and guideposts for culturally and linguistically appropriate care.

The Principal CLAS Standard is: “Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. “The remaining CLAS Standards are divided into three categories: (1) governance, leadership, and workforce; (2) communication and language assistance; and (3) engagement, continuous improvement, and accountability. to broadly requiring training for any health license renewal regulated by a state board.” See: The Network for Public Health Law, 2023

According to The Network for Public Health Law:

“There are some common themes among state laws requiring cultural competency training. In most cases, CLAS training must be completed as a part of the renewal process for licensed health care providers, or training must be provided as part of continuing education courses or in curriculum for colleges that train health care providers. The type of provider training included in these laws also varies widely, ranging from narrowly requiring CLAS training for public health dental hygienists to broadly requiring training for any health license renewal regulated by a state board.”

CLAS is also used by the Joint Commission in its health care accreditation process to evaluate hospitals’ compliance with language access laws and the standards’ recommendations for culturally appropriate health care to help ensure patient safety and better patient care options.

The Centers for Medicare and Medicaid Services (CMS) also utilizes CLAS to determine that recipients of Medicare and Medicaid funding are providing, accessible, population based-care. CMS uses a five-priority model, that includes the following two essentials: “Priority 4: Promote Language Access, Health Literacy, and the Provision of Person-Centered Services and Priority 5: Increase Access to  Health Care Services for Individuals Living With a Disability.”

In addition, over the past 25 years, CLAS has been part of the standard of  care in various U.S. locations for evaluating legally whether negligent medical was provided, for  example, to LEP patients and if so, was the deficiency in care deliberate or intentional. For example, see: STATE OF NEW MEXICO, COUNTY OF SANTA FE, FIRST JUDICIAL DISTRICT COURT:

SCOTT FUQUA, wrongful death personal representative of the ESTATE OF LARRY WILLIAMS, and LENORA WILLIAMS v. SAN JUAN REGIONAL MEDICAL CENTER, INC., and GRAHAM TULL, M.D., Case No. D-101-CV-2021-00146 (2023)

CLAS encompasses 15 standards. The language of many if not most of these standards almost duplicate verbatim statutory and regulatory language contained in Title VI of the 1964 Civil Rights Act and the Americans with Disabilities Act of 1990.

Principal Standard

1. Provide effective, understandable, and respectful quality care and services that respond to cultural health beliefs and practices, languages, health literacy, and other communication needs.

Governance, Leadership and Workforce

2. Advance and sustain organizational governance and leadership that promotes CLAS through policy, practices, and allocated resources.
3. Recruit, promote, equip, and support a governance, leadership, and workforce that respond to the digital, cultural and language needs of the population.
4. Educate and train governance, leadership, and workforce regularly on CLAS practices and resources.

Communication and Language Assistance

5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals, in writing and orally, of the availability of language assistance services in English and other languages that serve their linguistic needs.
7. Ensure the competence of individuals providing language assistance through training and certification, when available, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided and discouraged.
8. Provide easy-to-understand digital and print materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability

9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.

• Conduct ongoing assessments of the organization’s integration of CLAS-related activities and measures into quality improvement activities.
• Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health outcomes and to inform service delivery.
• Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic needs of populations in the service area.
• Partner with the community to design, implement, and evaluate cultural and linguistically appropriate practices and impact.
• Create culturally and linguistically appropriate processes to identify, prevent, and resolve conflicts, complaints, or grievances.
• Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public

https://thinkculturalhealth.hhs.gov/clas/standards

So, Happy Birthday CLAS Standards! Keep up the good work and we will continue celebrating your role in enhancing and improving access to medical care.

© Bruce L. Adelson 2025 All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.  Mr. Adelson is a faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness.

Mr. Adelson’s blogs are a Bromberg exclusive.