[Federal Register Volume 75, Number 184 (Thursday, September 23, 2010)]
[Notices]
[Pages 57957-57958]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-23760]
[[Page 57957]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Call for Comments on the Existing National Standards for the
Culturally and Linguistically Appropriate Services in Health Care
AGENCY: Department of Health and Human Services, Office of the
Secretary, Office of the Assistant Secretary for Health, Office of
Minority Health.
ACTION: Notice.
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SUMMARY: The HHS Office of Minority Health (OMH) announces the launch
of an enhancement initiative of the existing National Standards for
Culturally and Linguistically Appropriate Services in Health Care (CLAS
Standards). The public comment period will begin September 20, 2010 and
conclude December 31, 2010. During this time three regional meetings on
the standards will be held throughout the country. Individuals and
organizations are encouraged to submit their comments on the 14
standards and their current application and use. The enhanced national
standards, as revised in accordance with public comment and subject
matter expertise, will be published for review in spring of 2011 with
the final versions being published in fall of 2011.
DATES: The initial comment and submission period is September 20
through December 31, 2010.
ADDRESSES: (1) Electronically through the public comment site http://clasenhancements.thinkculturalhealth.org.
(2) By mail, comments postmarked no later than December 31, 2010,
can be submitted to: CLAS Standards c/o HHS Office of Minority Health,
1101 Wootton Parkway, Suite 600, Rockville, Maryland 20852. Comments
sent by courier will be accepted until 5 p.m. EST on December 31.
(3) Individuals may register for one of the regional meetings by
using the online registration form at http://clasenhancements.thinkculturalhealth.org. To request a registration
form by mail, write to CLAS Standards Enhancement Initiative meeting,
c/o SRA International, Inc., 6003 Executive Blvd, Suite 400, Rockville,
MD 20852.
FOR FURTHER INFORMATION CONTACT: Guadalupe Pacheco, Office of Minority
Health, 1101 Wootton Parkway, Suite 600, Rockville, MD 20852, Attn:
CLAS, Telephone: (240) 453-6174; Fax: (240) 453-2883; E-mail:
[email protected].
Background: To help achieve its mission of ``improving the health
of racial and ethnic minority populations through the development of
effective health policies and programs that help to eliminate
disparities in health,'' the OMH published the National Standards for
Culturally and Linguistically Appropriate Services in Health Care (CLAS
Standards) in 2001. The CLAS Standards were developed on the basis of
an analytical review of key laws, regulations, contracts, and standards
used by Federal and State agencies and other national organizations,
with input from a national advisory committee of policymakers, health
care providers, and researchers. Open public hearings were held to
obtain input from communities throughout the nation. The CLAS Standards
represent the first national standards for cultural competence in
health care and offer comprehensive guidance on what constitutes
culturally competent service delivery. They consist of 14 guidelines,
recommendations, and mandates that serve to inform, guide, and
facilitate implementation of culturally and linguistically appropriate
services in health care. The CLAS Standards are organized by three
themes: Culturally Competent Care, Language Access Services, and
Organizational Supports. They recognize that culture and language are
central to the delivery of health services.
Disparities in health care have been documented in a number of
groundbreaking reports: Findings of the Supplement to Mental Health: A
Report of the Surgeon General (CMHS, 2001a) reveal that ``racial and
ethnic minorities bear a greater burden from unmet mental health needs
and thus suffer a greater loss to their overall health and
productivity.'' Findings from the 2000 Surgeon General's Report Oral
Health in America: A Report of the Surgeon General indicated
significant disparities ``between racial and socioeconomic groups in
regards to oral health and ensuing overall health issues'' (DHHS,
2000). The 2003 report from the Institute of Medicine, Unequal
Treatment: Confronting Racial and Ethnic Disparities in Healthcare
(Smedley, Stith & Nelson, 2003), and its supplementary paper
contributions such as Racial and Ethnic Disparities in Diagnosis and
Treatment: A Review of the Evidence and a Consideration of Causes
(Geiger, 2003) and The Civil Rights Dimension of Racial and Ethnic
Disparities in Health Status (Perez, 2003), brought to the forefront
that minorities receive lower quality health care even when
socioeconomic and access-related factors are controlled. The report
also showed that bias, stereotyping, prejudice, and clinical
uncertainty may contribute to racial and ethnic disparities in health
care (Smedley et al., 2003).
A significant body of research released since the 2003 IOM report
corroborates these findings. The National Healthcare Disparities Report
prepared by the Agency for Healthcare Research and Quality states that
``although varying in magnitude by condition and population,
disparities are observed in almost all aspects of health care'' (The
Agency for Healthcare Research and Quality, 2006). Inspired by the CLAS
Standards, national organizations including the American Medical
Association (AMA), American Association of Medical Colleges (AAMC), the
Joint Commission, the National Committee for Quality Assurance (NCQA),
the National Quality Forum (NQF) and others have released standards to
help support the provision of culturally and linguistically appropriate
care. Many of these standards promote the education and training of
health care providers in culturally appropriate care.
Increasingly, national experts are looking to cultural competency
training as a means to reduce disparities in health care. Evidence
suggests that the most effective cultural competence training helps
providers develop new knowledge, skills, and attitudes in order to
effectively treat minority and immigrant populations (Smedley et al.,
2003). The concepts of cultural and linguistic competency as well as
health disparities are featured prominently in the health care reform
legislation enacted and signed by President Barack Obama in March 2010.
References to the concepts of cultural and linguistic competency
illustrate how pervasive and important the constructs have become.
Public comment period: It has been nearly ten years since the
release of the landmark report regarding the CLAS Standards. In the
report, the HHS, OMH provided the framework for all health care
organizations to establish services and policies to best serve our
increasingly diverse communities. In the decade following the release
of the CLAS Standards, the field of cultural and linguistic competency
has seen tremendous growth. It has evolved from a fledgling concept to
a recognized intervention in the quest for health equity. The field of
cultural and linguistic competency is dynamic and as such requires
routine enhancement and nurturing. With this in mind, HHS, OMH has
begun to revisit the National CLAS Standards.
The OMH has determined that the appropriate next step is for the
CLAS
[[Page 57958]]
Standards to undergo a national process of public comment that will
result in a broader awareness of HHS interest in CLAS, significant
input from stakeholder groups on the existing CLAS Standards, as well
as a final revision of the CLAS Standards and accompanying commentary
supported by the expertise of a National Project Advisory Committee.
The final revisions will be published in the Federal Register as
recommended national standards for adoption or adaptation by
stakeholder organizations and agencies.
The publication of the CLAS Standards in the Federal Register, and
publicizing the availability of the complete report with commentary on
the Internet and through local, regional, and national organizations
will facilitate reaching as wide an audience of stakeholders as
possible. This period of dissemination and awareness-raising will
include three regional meetings to gather and solicit detailed input
from interested individuals and organizations that will complement and
enhance the public comments received by OMH through electronic and
written means.
Individuals and organizations desiring to provide input on the
standards are encouraged to send comments during the public comment
period which is from September 20 through December 31, 2010.
Individuals mailing comments are requested to include the following
information: Name, position, organization, mail, and e-mail addresses
and to identify specifically those portions of their comments that
pertain to: The wording or the content of individual standards, the
purpose of the standards and/or the intended audience for the national
standards.
Dates and locations of the meetings are as follows:
Baltimore, Maryland, Friday, October 22, 2010, The Hyatt Regency,
300 Light Street, Baltimore, MD 21202.
San Francisco, California, Thursday, November 4, 2010, The Stanford
Court, A Renaissance Hotel, 905 California Street, San Francisco, CA
94108.
Chicago, Illinois, Monday, November 15, 2010, The James Hotel, 55
East Ontario Street, Chicago, IL 60611-2727.
All meetings will convene at 9 a.m. and conclude at 3 p.m. On-site
registration will be available starting at 7:30 a.m.
Information about the CLAS Standards Enhancement Initiative is
available electronically at http://clasenhancements.thinkculturalhealth.org.
Dated: September 2, 2010.
Garth N. Graham,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 2010-23760 Filed 9-22-10; 8:45 am]
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