Language access programs and their imperatives took some big hits last year, including significant organizational funding reductions and grant revocations for non-profits, health care providers, and local and state governments that depend upon providing access to their programs for Limited English Proficient (LEP) people through effective language assistance through the use of qualified interpreters and translators, appropriate staff training, translated documents, and more. In short, while an organization’s funding pie retains its circular shape, its filling has been significantly reduced so that a slice of that pie is nowhere near as robust and satisfying as it was in 2024. The funding reductions have resulted in organization wide service cutbacks and layoffs.
However, two 2025 developments suggest that the critical need for language services is widely understood and will be evaluated perhaps more closely and diligently than ever before.
Let’s begin with CMS, the Centers for Medicare and Medicaid Services and part of the US Department of Health and Human Services. CMS’s jurisdiction is vast and includes oversight of Medicare and Medicaid recipient health care providers, payment for services rendered and enforcement of various federal requirements, including the Affordable Care Act (ACA), which remains the law and includes the ACA’s civil rights provisions in Section 1557.
In the last quarter of 2025, CMS made several announcements about Medicare and Medicaid program requirements for 2026. They include the 2026 Conditions of Participation (CoP) for Hospitals, the mandates hospitals must follow to receive reimbursements for services rendered. Excessive and repeat CoP penalties can threaten a hospital’s ongoing participation in Medicare and Medicaid, both of which are substantial sources of revenue for health care providers. The new CoPs prominently restrict the provision of healthcare for transgender children to address the “Rise of Chemical and Surgical Interventions for Children as Part of Sex-Rejecting Procedures for Gender Dysphoria, See: Federal Register /Vol. 90, No. 242 / Friday, December 19, 2025, 42 CFR Part 482.
By contrast, CMS announced that it is retaining the ACA’s patient care, patient safety, and health disparities initiatives. These include the ACA’s readmission penalties. The American Hospital Association describes the readmission penalties this way:
“The Affordable Care Act (ACA) required the Centers for Medicare & Medicaid Services (CMS) to penalize hospitals for “excess” readmissions when compared to “expected” levels of readmissions. Since the start of the program on Oct. 1, 2012, hospitals have experienced nearly $1.9 billion of penalties, including $528 million in fiscal year (FY) 2017. In FY 2013, payment penalties were based on hospital readmissions rates within 30 days for heart attack, heart failure and pneumonia. In FY 2015, CMS added readmissions for patients undergoing elective hip or knee replacement and patients with chronic obstructive pulmonary disease. CMS will add readmissions for coronary artery bypass procedures in FY 2017 and likely will add other measures in the future.”
Hospitals are penalized for excessive readmissions within 30 days of hospital discharge. It is axiomatic that non-existent or ineffective language assistance is likely to result in LEP and deaf patients returning to the hospital within 30 days of discharge for treatment of the same medical condition for which they were originally hospitalized.
For example, see, Association Between Limited English Proficiency and Revisits and Readmissions After Hospitalization for Patients With Acute and Chronic Conditions in Toronto, Ontario, Canada: JAMA. 2019;322(16):1605–1607. doi:10.1001/jama.2019.13066; Learning About 30-Day Readmissions From Patients With Repeated Hospitalizations, The American Journal of Managed Care: June 2014, Volume 20, Issue 6, “Patients with frequent admissions represented a small proportion of all adult medical patients but accounted for the majority of 30-day readmissions. Therefore, a focus on these patients is an important component of efforts to reduce hospital readmissions. Patients with a pattern of repeated admissions differ from other patients in significant ways that suggest different approaches to care management, transitional care, and community-based services may be needed;”
Research Snapshot: The Impact of Language Barriers on Hospital Choice, Northwestern University Feinberg School of Medicine, 2024; September 24, 2024: “New research shows that patients with limited English proficiency (LEP) may seek out care at lower-quality hospitals despite an increased travel distance and higher hospital readmission rates: Hospitalized individuals with LEP experience disproportionately worse healthcare outcomes compared to their English-proficient counterparts. These outcome disparities can be attributed to multi-level social determinants of health, including unaddressed language barriers, poor health insurance coverage, and disparities in the quality of hospitals where LEP patients are more likely to receive care; and Quality Improvement Intervention to Reduce Thirty-Day Hospital Readmission Rates Among Patients With Systemic Lupus Erythematosus, Vol. 74, No. 1, January 2022, pp 126–130DOI 10.1002/acr.24435© 2021, American College of Rheumatology.
In addition, the ACA’s requirements for the study and alleviation of heath disparities, and focus on patient-centered care, and patient safety remain in place. Other patient care focused mandates include Patient Rights, Safety & Quality, highlighted by emergency preparedness, infection control, performance improvements, and Organizational Standards.
Further regulatory and guidance announcements from CMS are due to be published this year. The patent centered care and patient safety orientations are the law. Patients and families may address any complaints to https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html.
The Joint Commission (TJC) is an independent, nonprofit organization that evaluates and accredits health care organizations and programs in the United States. Its primary purpose is to ensure that health care organizations comply with TJC’s standards for patient care and safety through evaluation processes. These evaluations include on-site surveys, during which surveyors assess various aspects of health care delivery, including patient care, medication management, infection control and overall organizational performance.
TJC collaborates with CMS to accredit federally funded health care providers and to verify they are complying with CMS regulations, which include effective language access requirements, and TJC standards. For more than 10 years, TJC has recognized the importance of effective communications with LEP people and individuals with communication disabilities. According to TJC in 2015 and 2021:
“Because communication is a cornerstone of patient safety and quality care, every patient has the right to receive information in a manner he or she understands. Effective communication allows patients to participate more fully in their care. When a patient understands what is being said about his or her care, treatment, and services, that patient is more likely to fulfill critical health care responsibilities.”
The Joint Commission, “Overcoming the challenges of providing care to limited English proficient patients,” Issue 13, 2021 (update, orig. published 2015).
In June 2025, TJC cut their accreditation standards in half to streamline the accreditation process and reduce the compliance “burden on hospitals.” According to Becker’s Clinical Leadership, June 30, 2025,
“The Joint Commission is transforming its accreditation process by reducing the number of requirements by 50% — from 1,551 to 774 standards — in its most significant rewrite since Medicare was established in 1965.
The overhaul, first shared with Becker’s, underscores the organization’s effort to reduce the regulatory burden on hospitals and healthcare organizations, uphold public trust and help organizations achieve the highest level of safety and quality, according to Jonathan Perlin, MD, PhD, president and CEO of The Joint Commission Enterprise.”
In the fall of 2025, TJC announced that it was shifting its existing effective communication standards to a more prominent place in the Joint Commission Requirements for Hospital Programs Accreditation Participation. The effective communication standards are now part of TJC’s National Performance Goals (NPG). According to TJC:
“NPGs are 14 high-priority topics that are measurable, actionable, and organized to make it easier for hospitals to track progress and improve outcomes on key areas of patient safety and quality care. By focusing on what matters most, NPGs help hospitals deliver safer, more effective care to every patient.
NPGs Incorporate existing Joint Commission requirements—there are no new requirements added; Elevate critical issues that go beyond minimum regulations; Provide clear goals that hospitals can work toward to improve safety and quality; and Support better care by aligning with real-world challenges hospitals face.”
As TJC announced in Fall 2025, “To reiterate, while these requirements have been relocated from the RI [Rights and Responsibilities of the Individual Patient], to the NPG chapter, no new concepts have been introduced. “
Language access standards can now be found in two National Performance Goals, 04.01.01 and 07.01.01:
“The hospital identifies health care disparities in its patient population by stratifying quality and safety data using the sociodemographic characteristics of the hospital’s patients.
Note 1: Hospitals may focus on areas with known health care disparities identified in the scientific literature (for example, organ transplantation, maternal care, diabetes management) or select measures that affect all patients (for example, experience of care and communication).
Note 2: Hospitals determine which sociodemographic characteristics to use for stratification analyses. Examples of sociodemographic characteristics may include the following: Age; Gender; Preferred language; Race and ethnicity; Veterans; Patients in rural communities; and Physical, mental, and cognitive disabilities
NPG.07.01.01: Element(s) of Performance for NPG.07.01.01
The hospital respects the patient’s right to receive information in a manner the patient understands.
The hospital respects the patient’s right to and need for effective communication. The hospital provides interpreting and translation services, as necessary.
Note: For hospitals that elect Joint Commission’s Primary Care Medical Home option: Language Note: For hospitals that elect Joint Commission’s Primary Care Medical Home option: Language interpreting options may include trained bilingual staff, contract interpreting services, or employed language interpreters. These options may be provided in person or via telephone or video. The documents translated, and the languages into which they are translated, are dependent on the primary care medical home’s patient population.
The hospital communicates with the patient who has vision, speech, hearing, or cognitive impairments in a manner that meets the patient’s needs.
NPG 07.04.01 The hospital treats the patient in a dignified and respectful manner.”
Working together with CMS’s CoPs, TJC will continue to focus on language access and its impact on patient care from a patient safety perspective, as well as health equity, similar to CMS heath disparities standards. Complaints about TJC-accredited provers can be addressed through this link: https://www.jointcommission.org/en-us/contact-us/report-a-patient-safety-event
2026 will soon reveal the extent of enforcement and ensuring compliance by these two organizations. CMS and TJC may be new language access players to many. However, they provide additional recourse for patients and families concerned that deaf or LEP family member patients simply did not understand the medical care they received, including informed consent. Of course, it is legally axiomatic that consent obtained without objective understanding by a patient, as provided by effective communications, is a legal nullity and major liability risk for health care providers (including bodily touching without permission or criminal assault and battery) not using qualified language access professionals.
The 2026 retention of language access and language-related standards by a federal agency and a private accrediting body is undisputably significant, not only recognizing ongoing ACA legal requirements but also heightened attention to effective language access.
© Bruce L. Adelson 2026 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 an Adjunct Assistant Professor of Family Medicine at the Georgetown University School of Medicine and Adjunct Professor of Law at the 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.