How to offer bilingual and Spanish-language therapy

This guide is for OT, PT and SLP practices serving children or adults who speak Spanish or another language. Name exactly what you offer: a clinician who treats in that language, a qualified interpreter, or translated forms. Practices billing Medicaid or Medicare must take reasonable steps to give free, qualified language help.⁠^1,2

The guide uses ASHA’s terms: language-matched care, when clinician and person share a language, and cross-linguistic care, when an interpreter bridges the gap.⁠³ Spanish leads the title because ASHA, citing the 2022 American Community Survey, reports that 22% of the U.S. population speaks a language other than English at home and that Spanish is the most common of those languages, at 61%.⁠³ The steps apply to any language.

What counts as a bilingual or Spanish-language therapy service?

A service is bilingual when the person can get the care itself in their language, from a clinician who shares it or through a qualified interpreter; a bilingual front desk or a translated page helps people reach that care but is not the care. ASHA states that any clinician, monolingual or multilingual, can deliver cross-linguistic services with the necessary language assistance.⁠⁹ The Section 1557 rule defines qualified bilingual staff, qualified interpreters and qualified translators as separate roles, each with its own test.⁠⁴

Write down which of the four you have, for which language, at which location and on which days, before any of it appears on a website, flyer or listing.

Who can call themselves a bilingual speech-language pathologist?

An SLP who can do the clinical work in the language, not only hold a conversation in it. ASHA’s term is multilingual service provider: an audiologist, SLP or assistant who uses more than one language in service delivery, with a deep understanding of each language’s vocabulary, meaning, pronunciation, grammar and social use during clinical management, plus the knowledge and skills the service requires.⁠⁹ ASHA calls “near-native” proficiency the term previously used, and it does not accredit or approve training programs for multilingual providers.⁠⁹

Titles are a state matter: ASHA notes that laws for multilingual providers, including the titles used to identify them, vary by state, so check with your licensing board before printing “bilingual SLP.”⁠⁹ Proficiency can also be partial: ASHA suggests providers describe the clinical interactions they carry out comfortably in each language, such as counseling a care partner in Mandarin while preferring English for swallowing treatment.⁠⁹ “Ana evaluates and treats in Spanish” and “Ana speaks conversational Spanish with families” are different claims, and ASHA’s Code of Ethics forbids misrepresenting competence.⁠^9,10

Can an occupational or physical therapist advertise as bilingual?

Yes, when the word describes what the therapist actually does with patients in that language. APTA’s Code of Ethics for the Physical Therapy Profession, in effect since January 1, 2026, requires truthful and accurate information about services and practice within the limits of the therapist’s competence.⁠¹¹ AOTA’s 2025 Occupational Therapy Code of Ethics lists veracity among its guiding principles.⁠¹² Describe the work: “Daniel, PT, evaluates, treats and teaches home exercise programs in Spanish” tells an adult patient more than “bilingual PT,” and “Our pediatric OT works with parents in Spanish” tells a family what to expect.

Which language-access decisions should a practice settle first?

Five, and each produces a record someone else can check. Each record also feeds the language-access plan later in this guide.

The privacy row has a federal answer. HHS treats a bilingual employee, a contract interpreter on staff or a volunteer as workforce, and says an ongoing contract with an interpreter service should meet the Privacy Rule’s business associate agreement requirements; a family member the patient picks as interpreter for an encounter is not a business associate.⁠¹³

Which language-access laws apply to an OT, PT or SLP practice?

If the practice receives federal financial assistance from HHS, Section 1557 of the Affordable Care Act and Title VI of the Civil Rights Act apply, and HHS’s language-access page says both require language access services free of charge.⁠¹⁴ The Section 1557 rule’s definition of a health program names health clinics, physicians’ practices and community-based health care providers.⁠⁴

HHS’s Title VI guidance counts “physicians and other providers who receive Federal financial assistance from HHS” as recipients and weighs reasonable steps by four factors: how many people with limited English the practice serves or is likely to meet, how often, how important the service is, and the resources and costs; what is reasonable for a large provider may not be for a small one.⁠¹⁵

A practice with no federal funds, such as one that is entirely self-pay or commercial, may fall outside these federal rules but not outside state law: ASHA reports that as of 2019 every state and the District of Columbia had at least three laws addressing language access, and they differ.⁠¹⁶ The Section 1557 rule does not override state or local laws that give more protection.⁠⁴ Sign language interpreting also falls under disability law: HHS notes that the ADA and Section 504 have their own interpreter requirements for people who are deaf or hard of hearing, which the specialty guide covers.⁠¹³

Does billing Medicare or Medicaid make a practice a covered entity?

For Medicaid and CHIP, yes; for Medicare Part B, yes under HHS’s current interpretation. HHS’s civil rights FAQ says Medicaid and CHIP are federal financial assistance, and the same page still gives the longstanding answer that Medicare Part B is not.⁠⁵ The 2024 final rule reversed that position: HHS finalized its interpretation that Part B funding is federal financial assistance for Title VI, Section 504, the Age Act and Section 1557, and gave entities whose only federal program was Part B until May 6, 2025, to comply.⁠² That date has passed, so a private practice whose only federal payer is Medicare should plan as a covered entity.

Medicaid managed care plans have duties of their own: they make interpretation available to enrollees free of charge, and their provider directories list each provider’s languages and whether a skilled medical interpreter is available at the office.⁠¹⁷ What you report to a plan about languages reaches its members, so it needs the accuracy of your website.

What changed in federal language-access rules in 2025 and 2026?

Three things changed, and the Section 1557 language-access provisions remain in force through all of them. An executive order dated March 1, 2025, designated English as the official language; ASHA’s reading is that it does not undo language-access obligations tied to federal funding.⁠¹⁶ A federal court vacated the 2024 rule’s gender-identity provisions, and HHS’s June 2, 2026, notice states that its other provisions remain in force; the language-access sections are not among those vacated.⁠¹⁸ On July 24, 2026, HHS removed the disparate-impact provision of its Title VI regulations, 45 CFR 80.3(b)(2), the regulation its still-posted Title VI language-access guidance names as its legal authority.⁠^15,19

For a covered practice, the Section 1557 rule’s text is now the plainest statement of what is required, so the next section works from it; ask a health care attorney how the 2026 Title VI change affects you.

What does the Section 1557 rule require for patients with limited English?

Reasonable steps to give each person with limited English proficiency meaningful access, including companions, with language help that is free, accurate, timely and private.⁠¹ In practice that comes down to six duties.

1. Offer a qualified interpreter. When interpretation is needed, the practice offers a qualified interpreter, in person or remotely, and may not require the person to bring or pay for their own.⁠¹
2. Use qualified translators. Written translation is done by a qualified translator, and machine translation of critical, technical or accuracy-dependent text is reviewed by one.⁠¹
3. Write the procedures down. They say how staff identify limited English proficiency and reach interpreters and translators, name the qualified bilingual staff, and list translated materials with languages and dates.⁠⁴
4. Train the staff who use them. Relevant employees are trained on the policies and procedures.⁠⁴
5. Post the notice of free language help. It goes in English and at least the 15 languages most spoken by people with limited English proficiency in the state, on the website, in the office in type no smaller than 20-point sans serif, and in documents such as intake forms and billing communications.⁠⁴
6. Check remote interpreting. Video interpreting needs real-time, clear video with an image large enough to show the interpreter’s face and the patient’s, and staff trained to set it up.⁠¹

Small practices are not exempt: only a Section 1557 Coordinator and written grievance procedures depend on size, required at fifteen or more employees.⁠⁴ The deadlines have passed: the rule took effect July 5, 2024, and written procedures and the notice were due within one year.⁠⁴ A person may still decline language help.⁠¹

Can a parent, child or bilingual receptionist interpret for a patient?

A minor child only in an emergency, an accompanying adult only at the patient’s private request, and a receptionist only if qualified. The rule bars relying on a minor child to interpret except as a temporary measure in an emergency involving an imminent threat to someone’s safety or welfare, while a qualified interpreter is found.⁠¹ An accompanying adult may interpret outside an emergency only when the patient asks for it in private, with a qualified interpreter present and the companion out of the room, the adult agrees, the request is documented, and the arrangement is appropriate.⁠¹ Staff may communicate with patients in another language only if they are qualified interpreters, qualified translators or qualified bilingual staff, which means designated by the practice and shown to be proficient, specialized vocabulary included.⁠^1,4

The clinical reasons point the same way. HHS notes that when medical decisions or consent are at issue, friends and family may not be able to make sure the person understands.⁠²⁰ ASHA cautions that minors may lack the emotional maturity for the role, and that a dialect mismatch, even between Spanish speakers from different countries, may produce inaccurate interpretation.⁠¹⁶ The shortcut on offer is an older sibling in pediatric practice and a spouse or adult child in adult practice; neither is a plan.

Who pays for interpreters in a therapy practice?

The practice does. A covered practice may not require a patient to pay for their own interpreter, and HHS calls competent interpreter services at no cost to the person the provider’s responsibility; its Title VI fact sheet says the same of language help generally where the obligation exists.⁠^1,20,21

Medicaid help varies by state. CMS says states are not required to reimburse providers for language services and may treat the cost as part of the regular visit rate, in which case Medicaid providers still provide the services and bear the cost.⁠⁶ States may instead claim federal funds, including a 75% Medicaid match for interpretation for children of families whose primary language is not English and their family members.⁠⁶ Where a state pays, CMS says interpreters are not paid separately: the qualified provider bills, claiming oral interpretation with the code CMS gives as T-1013 alongside the visit’s CPT code.⁠⁶

Ask your state Medicaid agency and each managed care plan whether they pay for interpreters, what documentation they need, and whether the plan arranges interpreters for network providers; record each answer with the day and who gave it. Commercial plans rarely help: ASHA reports that most third-party payers do not pay for interpreter services.⁠¹⁶ Budget interpretation as a variable cost per visit, as the startup costs guide does, and keep it off the patient’s bill.

Billing materials and good faith estimates are among the communications that carry the notice of free language help.⁠⁴ The insurance and fees guide covers what to explain about payment.

How should SLPs assess a child or adult who speaks two languages?

In every language the person uses, with tools that fit the person, asking first whether a pattern is a difference or a disorder. ASHA states that being multilingual is not a communication disorder, that signs of a disorder appear across all of a person’s languages though the symptoms differ, and that patterns caused by one language’s influence on another do not indicate a disorder.⁠³ Cultural responsiveness, in ASHA’s words, requires distinguishing a communication difference from a communication disorder, and an accent or dialect is rule-based variation, not an articulation disorder.⁠²²

• Case history in each language. ASHA’s language history covers how and when each language was learned, where each is used, and the person’s language of choice with health providers; ethnographic interviewing lets the family say what they think is relevant.⁠^3,22
• Samples in all languages. ASHA directs clinicians to collect speech and language samples in every language the person uses, with an interpreter if needed.⁠³ A 2024 meta-analysis of 35 studies found bilingual children with developmental language disorder scored 0.78 standard deviations lower on language sample measures than bilingual peers with typical language, and called for more research on classification accuracy.⁠²³
• Standardized scores only when valid. ASHA says scores are not valid or reported for a person outside the test’s normative sample, and translating a test without validation studies to reach a standard score is not appropriate.⁠³
• Dynamic assessment. A test–teach–retest method that does not rely on monolingual norms.⁠³

For adults with aphasia, ASHA asks the SLP to weigh when each language was acquired, how it was used before the injury and which the person needs daily, to gather data in all of them, and to treat in the person’s languages, by a bilingual SLP or with an interpreter.⁠²⁴ For swallowing, ASHA says clinicians use the person’s preferred languages for home and work.⁠³

Who evaluates matters. ASHA expects a multilingual SLP to select, administer and interpret procedures that separate heritage-language influence from a disorder; an SLP working with an interpreter stays responsible for planning the session, choosing materials and administering the assessment.⁠^9,16 Build the routing rule from the decision table on that.

Does learning two languages cause speech or language delays?

No. The family page linked from ASHA’s Practice Portal states that using multiple languages does not confuse children or cause speech or language delays, and that a communication issue shows up in all of a child’s languages.⁠²⁵ The research supports that at the strength it has. A systematic review of 66 studies found limited evidence that bilingual children develop speech more slowly than monolingual peers, found qualitative differences and more variation, and warned that bilingual children with speech sound disorders are likely to be under-referred.⁠²⁶ A small study of eight French-English bilingual children with language impairment found they did not show more profound grammatical deficits than monolingual peers with the same impairment.⁠²⁷

Both errors are costly: calling a second-language pattern a disorder, and waiting because a real delay is blamed on bilingualism. ASHA notes that children from minoritized backgrounds who speak nonmainstream English dialects are less likely than similar White peers to receive needed services.⁠²² Treatment evidence is thinner: a 2023 systematic review of 14 papers on bilingual children with developmental language disorder found most showed evidence for vocabulary intervention, with cross-language generalization evident mainly for vocabulary.⁠²⁸ ASHA asks clinicians to advocate for multilingualism with families told to avoid a language, so a home program should never tell parents to drop theirs.⁠³

How do OTs and PTs handle language in evaluations and home programs?

With an interpreter or a language-matched clinician for anything the person must understand, home programs translated by a qualified translator, and both recorded in the chart. Section 1557 covers the practice’s health programs as a whole, not one discipline.⁠⁴ APTA’s code requires physical therapists and assistants to address barriers to communication and comprehension with patients and caregivers, and APTA counts language among the situations cultural competence covers.⁠^11,29 AOTA’s 2025 code lists justice among its guiding principles and equity among its core values.⁠¹²

• History. A pediatric OT’s questions about feeding and dressing, or an adult PT’s about falls and work, go through a qualified interpreter or a language-matched clinician, not a relative.⁠¹
• Standardized tests. Before giving a motor or functional test through an interpreter, check whether its manual permits translated instructions and whether its norms fit the person, and record any change in the report.
• Consent and precautions. ASHA rules out sight translation for informed consent and other legal documents.⁠¹⁶
• Home programs. Exercise precautions and hip or spine restrictions are text where accuracy is essential, so a machine translation needs review by a qualified human translator; then ask the patient or caregiver to show the exercise back through the interpreter.⁠¹

How do you work with a medical interpreter during therapy sessions?

Plan the session with the interpreter, run it in short turns, and debrief afterward. ASHA’s framework for SLPs and audiologists is briefing, interaction and debriefing, with additional time scheduled in each session for all three.⁠¹⁶ The same three steps fit an OT or PT session.

• Before the session. Share goals, names, technical terms and test prompts in advance so nothing is sight-translated, and agree on consecutive interpreting, which ASHA notes is used more in spoken-language assessment and treatment.⁠¹⁶
• During the session. Speak to the patient, one idea at a time; on video, keep both faces visible, as the rule requires.⁠¹
• After the session. Ask the interpreter what was hard to render, and note responses that may reflect the interpretation rather than the patient.
• Continuity and records. ASHA encourages using the same interpreter across encounters, and says reports and insurance claims should note when an interpreter was used, its effect on the findings, and any translated materials.⁠¹⁶

Use a script so the front desk handles every language request the same way.

How do you market Spanish-language therapy services truthfully?

State the resource, the people and the limits, in both languages, and keep every version current. The FTC’s rules apply in any language: advertising must be truthful and not deceptive, claims need evidence, and the FTC reads both what an ad says outright and what it implies or leaves out.⁠⁷ Where an FTC rule requires a disclosure, it appears in the language of the ad’s audience.⁠⁸ Every state also has consumer protection laws for ads.⁠⁷

The professional codes agree: ASHA’s forbids misrepresentation in advertising, APTA’s requires truthful and accurate information about services, and AOTA’s names veracity as a guiding principle.⁠^10,11,12 Implied claims count too: a Spanish home page showing every clinician’s photo suggests all of them speak Spanish, so label who does.

Should a practice translate its website into Spanish?

Translate the pages a family needs to reach care, through a qualified translator, and keep them as current as the English: how to book and ask for an interpreter, what a first visit involves, fees and insurance, and the service pages for services actually offered in the language. For a covered practice, the notice of free language help belongs in a conspicuous place on the website.⁠⁴ Machine translation alone is not enough for text that is critical to access, where accuracy is essential, or that is technical; a qualified human translator reviews it.⁠¹

Mark each translated page with the date of the English version it matches, and update both when fees or services change; a Spanish page with last year’s fees misleads just as an outdated English page does. The website content checklist and the guides to pediatric and adult service pages cover the pages themselves.

What goes in a language-access plan for a small therapy practice?

A plan says who needs help and in which languages, how staff get an interpreter or translator, who the qualified bilingual staff are, which documents exist in which languages, how staff are trained and how the plan is checked. HHS’s Title VI guidance offers five steps: identify people who need language help, set out the language assistance measures, train staff, give notice and monitor and update the plan.⁠¹⁵ For a covered practice, the Section 1557 rule turns the core of it into written procedures with required contents.⁠⁴

Fill each line with what is true now; an empty line is an open decision with an owner. To see whether the plan works, count each month the inquiries by preferred language, the share of each that books an evaluation, the days from first contact to first visit by language, and interpreter late arrivals. A gap between languages is the finding.

How should intake and scheduling handle a language request?

Ask about language at first contact, record spoken and written preferences separately, and book the interpreter or the language-matched clinician together with the appointment. ASHA’s language-access planning includes questions about languages and communication preferences on intake forms and record fields that capture language preferences.⁠¹⁶

• First contact. Offer a language choice on the phone line and the web form; the accessible inquiry forms guide covers the form and the intake call script the conversation.
• Who needs it. Record the language of each person involved. A parent may need an interpreter when the child does not, and an adult patient’s caregiver may need one when the patient does not; the Section 1557 rule covers companions with limited English proficiency too.⁠¹
• One booking. Reserve the interpreter or the language-matched clinician with the appointment, and send reminders in the preferred written language using the new patient email templates.
• Waitlists. Record the language need on the waitlist so an opening with a language-matched clinician goes to the family who needs it.
• Reply times. Hold inquiries in every language to the same reply standard, and measure it by language; if callers in one language book less often, the guide to why callers do not book helps find the step that lost them.

ASHA lists adjusting scheduling for cultural and individual values that affect availability among the considerations of culturally responsive service.⁠²²

What does a language-access setup look like in a mixed practice?

Like a short list of true statements, matched by bookings that keep them true. The example below is hypothetical.

How should a DrSensory listing describe language services?

In the description, in the clinic’s own words, matching the website. The claim guide explains that the languages a clinic ticks are stored with the listing but not shown on the public profile, so a paid listing’s description is where families find them, and it suggests keeping the About text within 1,200 characters.

Every clinic has a basic listing at no cost, and claiming is free. A paid listing adds the description, logo, up to five photos, hours, specialties, ages and conditions treated, the website link, reviews with public replies, and family inquiries that come to the clinic, for $29.99 a month or $349.99 a year for the first location and $9.99 a month or $99.99 a year for each additional one, with no contract (pricing). One listing covers one address, so name a Spanish-speaking clinician only on the listing for the location where they work. DrSensory does not verify clinical quality or promise rankings, so the accuracy of the language line rests with the clinic.

The directory profile guide covers the rest of the description.

Sources

1. eCFR. 45 CFR 92.201, Meaningful access for individuals with limited English proficiency (current text). Checked October 23, 2026.
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   “A covered entity must take reasonable steps to provide meaningful access to each individual with limited English proficiency (including companions with limited English proficiency) eligible to be served or likely to be directly affected by its health programs and activities.”; “Language assistance services required under paragraph (a) of this section must be provided free of charge, be accurate and timely, and protect the privacy and the independent decision-making ability of the individual with limited English proficiency.”; “When interpretation services are required under this part, a covered entity must offer a qualified interpreter in its health programs and activities.”; “When translation services are required under this part, a covered entity must utilize the services of a qualified translator in its health programs and activities.”; “If a covered entity uses machine translation when the underlying text is critical to the rights, benefits, or meaningful access of an individual with limited English proficiency, when accuracy is essential, or when the source documents or materials contain complex, non-literal or technical language, the translation must be reviewed by a qualified human translator.”; “Require an individual with limited English proficiency to provide their own interpreter, or to pay the cost of their own interpreter;”; “Where the individual with limited English proficiency specifically requests, in private with a qualified interpreter present and without an accompanying adult present, that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, the request and agreement by the accompanying adult is documented, and reliance on that adult for such assistance is appropriate under the circumstances;”; “Rely on a minor child to interpret or facilitate communication, except as a temporary measure while finding a qualified interpreter in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the individual with limited English proficiency immediately available”; “Rely on staff other than qualified interpreters, qualified translators, or qualified bilingual/multilingual staff to communicate with individuals with limited English proficiency.”; “Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection”; “Adequate training to users of the technology and other involved persons”; “A sharply delineated image that is large enough to display the interpreter’s face and the participating person’s face regardless of the person’s body position;”; “Nothing in this section shall be construed to require an individual with limited English proficiency to accept language assistance services.”.
2. U.S. Department of Health and Human Services, Office for Civil Rights, and Centers for Medicare & Medicaid Services. Nondiscrimination in Health Programs and Activities (final rule, 89 FR 37522, May 6, 2024; section III and the notice of interpretation). Checked October 23, 2026.
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   “The Department’s longstanding position has been that Medicare Part B (“Part B”) funding does not meet the definition of “Federal financial assistance””; “The Department is finalizing its interpretation that Medicare Part B (“Part B”) funding meets the definition of “Federal financial assistance” for the purpose of title VI, title IX, section 504, the Age Act, and section 1557.”; “compliance by entities whose Federal program participation has been limited to Part B must be in compliance with title VI, title IX, section 504, the Age Act, and section 1557 no later than May 6, 2025.”; “Thus, the requirements of section 1557 and other civil rights statutes apply to entities that receive payments through Medicare Part B.”.
3. American Speech-Language-Hearing Association. Multilingual Service Delivery in Audiology and Speech-Language Pathology (ASHA Practice Portal, professional topics; Overview and Key Issues). Checked October 23, 2026.
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   “Cross-linguistic—involves clinical practice with an individual who uses a different language than that of the clinician.”; “Language-matched—an individual and a clinician share language(s) in service delivery.”; “Being multilingual is not a communication disorder, but it is a significant consideration when there are concerns regarding a hearing or communication disorder.”; “According to the 2022 American Community Survey, the majority (78.0%) of the U.S. population speaks only English, whereas 22% of the U.S. population speaks a language other than English at home.”; “the most common spoken language (besides English) at home is Spanish (61%)”; “Patterns that are the result of influence or transfer are not indicative of a disorder.”; “Signs of a communication disorder are seen across all the languages that a multilingual person uses, but symptoms usually differ across languages.”; “age and manner of acquisition of the language(s)”; “language(s) used at home and at school/work”; “language of choice with health providers”; “Standardized test scores are not valid and are not reported for an individual who is not reflected in the normative sample for a given assessment”; “It is not appropriate to translate standardized assessments without proper validation studies to reach a standard score”; “The clinician obtains single-word and connected-speech (conversation or narrative) samples in all languages used by the client—through collaboration with an interpreter, if necessary”; “DA usually uses a test–teach–retest evaluation method”; “Unlike standardized assessments, DA does not rely on monolingual norms”; “SLPs can adopt a translanguaging approach to assessment practices that allow multilingual individuals to express themselves using their full linguistic repertoires.”; “For conditions not directly related to communication, such as swallowing and balance, clinicians use the client’s preferred language(s) based on home and work needs.”; “Advocate for the benefits of multilingualism to families who may have been told—or made to feel—that they should avoid using certain languages with their children and family members.”.
4. eCFR. 45 CFR Part 92, Nondiscrimination in Health Programs or Activities (current text, up to date as of October 22, 2026; sections 92.1, 92.2, 92.3, 92.4, 92.7, 92.8, 92.9 and 92.11). Checked October 23, 2026.
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   “The regulations in this part are effective beginning July 5, 2024”; “§ 92.8 Within one year of July 5, 2024.”; “§ 92.11 Within one year of July 5, 2024.”; “Every health program or activity, any part of which receives Federal financial assistance, directly or indirectly, from the Department”; “Nothing in this part shall be construed to supersede State or local laws that provide additional protections against discrimination”; “health clinic, health insurance issuer, physician’s practice, pharmacy, community-based health care provider”; “All of the operations of any entity principally engaged in the provision or administration of any health projects, enterprises, ventures, or undertakings described in paragraph (1) of this definition”; “Qualified bilingual/multilingual staff means a member of a covered entity’s workforce who is designated by the covered entity to provide in-language oral language assistance as part of the person’s current, assigned job responsibilities and who has demonstrated to the covered entity that they are:”; “Proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology and phraseology”; “Is able to interpret effectively, accurately, and impartially to and from such language(s) and English (or between two non-English languages for relay interpretation), using any necessary specialized vocabulary or terms without changes, omissions, or additions”; “Adheres to generally accepted interpreter ethics principles, including client confidentiality.”; “Machine translation means automated translation, without the assistance of or review by a qualified human translator”; “A covered entity that employs fifteen or more persons must designate and authorize at least one employee, a “Section 1557 Coordinator,””; “A covered entity that employs fifteen or more persons must implement written grievance procedures”; “A covered entity must implement written language access procedures in its health programs and activities describing the covered entity’s process for providing language assistance services to individuals with limited English proficiency when required under § 92.201. At a minimum, the language access procedures must include current contact information for the section 1557 Coordinator (if applicable); how an employee identifies whether an individual has limited English proficiency; how an employee obtains the services of qualified interpreters and translators the covered entity uses to communicate with an individual with limited English proficiency; the names of any qualified bilingual staff members; and a list of any electronic and written translated materials the covered entity has, the languages they are translated into, date of issuance, and how to access electronic translations.”; “A covered entity must train relevant employees of its health programs and activities on the civil rights policies and procedures required by § 92.8”; “The notice required under paragraph (a) of this section must be provided in English and at least the 15 languages most commonly spoken by individuals with limited English proficiency of the relevant State or States in which a covered entity operates”; “At a conspicuous location on the covered entity’s health program or activity website, if it has one;”; “In clear and prominent physical locations, in no smaller than 20-point sans serif font”; “Application and intake forms;”; “Communications related to the cost and payment of care with respect to an individual, including medical billing and collections materials, and good faith estimates”.
5. U.S. Department of Health and Human Services, Office for Civil Rights. Civil Rights FAQs (HHS.gov; the answers on federal financial assistance and on small practitioners). Checked October 23, 2026.
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   “Medicaid and CHIP are considered federal financial assistance. Medicare Part A is also considered federal financial assistance. However, the receipt of Medicare Part B is not considered federal financial assistance.”; “Small practitioners and providers will have considerable flexibility in determining precisely how to fulfill their obligations to take reasonable steps to provide meaningful access for persons with limited English proficiency.”.
6. Centers for Medicare & Medicaid Services, Medicaid.gov. Translation and Interpretation Services (Medicaid Administrative Claiming). Checked October 23, 2026.
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   “All providers who receive federal funds from HHS for the provision of Medicaid/CHIP services are obligated to make language services available to those with Limited English Proficiency (LEP) under Title VI of the Civil Rights Act and Section 504 of the Rehab Act of 1973. However, language interpretation services are not classified as mandatory 1905 services.”; “States are not required to reimburse providers for the cost of language services, nor are they required to claim related costs to Medicaid/CHIP.”; “In those cases, Medicaid/CHIP providers are still obligated to provide language services to those with LEP and bear the costs for doing so.”; “Still, states do have the option to claim Medicaid reimbursement for the cost of interpretation services, either as medical-assistance related expenditures or as administration.”; “75% under Medicaid”; “The increased CHIPRA matching rate is available for translation and interpretation services provided to “children of families for whom English is not their primary language,” and family members of these children.”; “Interpreters are not Medicaid qualified providers; however their services may be reimbursed when billed by a qualified provider rendering a Medicaid covered service. Interpreters may not be paid separately. As of February 2009, oral interpreter services can be claimed using billing code T-1013 code along with the CPT Code used for the regular medical encounter.”.
7. Federal Trade Commission. Advertising FAQ’s: A Guide for Small Business (business guidance). Checked October 23, 2026.
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   “Advertising must be truthful and non-deceptive;”; “Advertisers must have evidence to back up their claims; and”; “And every state has consumer protection laws that govern ads running in that state.”; “Is likely to mislead consumers acting reasonably under the circumstances; and”; “The FTC looks at both "express" and "implied" claims.”; “The FTC looks at what the ad does not say - that is, if the failure to include information leaves consumers with a misimpression about the product.”.
8. eCFR. 16 CFR 14.9, Requirements concerning clear and conspicuous disclosures in foreign language advertising and sales materials (Federal Trade Commission enforcement policy statement, current text). Checked October 23, 2026.
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   “In the case of any other advertisement or sales material, the disclosure shall appear in the language of the target audience (ordinarily the language principally used in the advertisement or sales material).”.
9. American Speech-Language-Hearing Association. Multilingual Service Providers (ASHA Practice Portal, professional topics). Checked October 23, 2026.
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   “A multilingual service provider is an audiologist, an SLP, an audiology assistant, or a speech-language pathology assistant who uses more than one language during professional and/or clinical service delivery”; “Multilingual service providers require a deep understanding of their primary language(s) and at least one additional language in the following domains during clinical management:”; “In addition to language proficiency, the provider must have the specific knowledge and skills necessary for the services to be delivered.”; “They lack “near-native” language proficiency (the term that was previously used to describe a multilingual provider).”; “select, administer, and interpret formal and informal assessment procedures to distinguish between communication influenced by heritage languages and communication disorders”; “Providers can also describe the types of clinical interactions they can implement comfortably in the languages they use”; “an SLP who speaks English and Mandarin may feel comfortable using Mandarin to counsel their patient’s care partner but feels more comfortable using English to provide swallowing treatment.”; “Multilingual audiology and speech-language pathology assistants are not interpreters.”; “Audiology and speech-language pathology assistants may be able to interpret to meet an unanticipated need.”; “Any clinician—monolingual or multilingual—can deliver cross-linguistic services with necessary language assistance.”; “ASHA does not accredit or approve specialty training programs for multilingual service providers”; “Laws and regulations for multilingual service providers in audiology and/or speech-language pathology vary by state.”; “titles used to identify multilingual service providers”. The domains listed are lexicon, semantics, phonology, morphology/syntax and pragmatics.
10. American Speech-Language-Hearing Association. Code of Ethics (effective March 1, 2023; Principles of Ethics I, II and III). Checked October 23, 2026.
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    “national origin, including culture, language, dialect, and accent”; “Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.”; “Individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly contributions.”; “Individuals’ statements to the public shall adhere to prevailing professional standards and shall not contain misrepresentations when advertising, announcing, or promoting their professional services, products, or research.”.
11. American Physical Therapy Association. Code of Ethics for the Physical Therapy Profession (dated January 1, 2026; standards 5.2, 6.1 and 8.1 and example 1.A of the downloadable code). Checked October 23, 2026.
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    “Physical therapists and physical therapist assistants shall address barriers to communication and comprehension with recipients of services, caregivers, students, and research participants.”; “Physical therapists and physical therapist assistants shall provide information about their services that is truthful and accurate and shall not make misleading representations in any forms of communication, including billing.”; “Physical therapists shall recognize and practice within the limits of their skills and competence and refer a patient or client to another health care professional when it is in the best interests of the patient or client.”; “Physical therapists and physical therapist assistants shall strive to acknowledge and respect an individual’s known identity and culture.”. APTA’s page for the earlier Code of Ethics for the Physical Therapist states: “This new Code of Ethics for the Physical Therapy Profession went into effect Jan 1, 2026.”
12. American Occupational Therapy Association. Ethics (Practice Essentials; the page links the AOTA 2025 Occupational Therapy Code of Ethics, doi:10.5014/ajot.2025.79S302, and AOTA’s Code of Ethics Core Values and Principles infographic (© 2025), which shows beneficence, nonmaleficence, autonomy, justice, veracity and fidelity as the guiding ethical principles and truth, equity and justice among the core values). Checked October 23, 2026.
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    “Occupational therapy personnel, including occupational therapists, occupational therapy assistants, and students, have an obligation to demonstrate ethical conduct that reflects professional values when working with clients, families, caregivers, administrators, colleagues, policymakers, payers, and other health care professionals.”; “Standards of Conduct, which outline specific and enforceable behaviors.”.
13. U.S. Department of Health and Human Services, Office for Civil Rights. Must a covered health care provider obtain an individual’s authorization to use or disclose protected health information to an interpreter? (HIPAA FAQ, content last reviewed October 24, 2023). Checked October 23, 2026.
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    “No, when a covered health care provider uses an interpreter to communicate with an individual, the individual’s authorization is not required when the provider meets the conditions below.”; “When the interpreter is a member of the covered entity’s workforce (i.e., a bilingual employee, a contract interpreter on staff, or a volunteer)”; “If a covered entity has an ongoing contractual relationship with an interpreter service, that service arrangement should comply with the Privacy Rule business associate agreement requirements.”; “a covered health care provider may, without the individual’s authorization, use or disclose protected health information to the patient’s family member, close friend, or any other person identified by the individual as his or her interpreter for a particular healthcare encounter.”; “In these situations, that interpreter is not a business associate of the health care provider.”; “HIPAA covered entities may also be required to comply with the Americans with Disabilities Act and/or Section 504 of the Rehabilitation Act of 1973, both of which have requirements for the provision of sign language and oral interpreters for people who are deaf or hard of hearing.”.
14. U.S. Department of Health and Human Services, Office for Civil Rights. Limited English Proficiency (LEP) (HHS.gov, content last reviewed July 18, 2025). Checked October 23, 2026.
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    “There are two federal laws that require these programs to provide language access services (LAS) free of charge:”; “Title VI of the Civil Rights Act of 1964 (Title VI) and implementing regulations”; “Section 1557 of the Affordable Care Act (Section 1557) and implementing regulations”.
15. U.S. Department of Health and Human Services, Office for Civil Rights. Summary of Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons (HHS.gov, content last reviewed March 6, 2025). Checked October 23, 2026.
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    “Title VI and Department of Health and Human Services regulations, 45 C.F.R. Section 80.3(b)(2), require recipients of Federal financial assistance from HHS to take reasonable steps to provide meaningful access to Limited English Proficient (LEP) persons.”; “physicians and other providers who receive Federal financial assistance from HHS”; “(1) the number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; (2) the frequency with which LEP individuals come into contact with the program; (3) the nature and importance of the program, activity or service provided by the recipient to its beneficiaries; and (4) the resources available to the grantee/recipient and the costs of interpretation/translation services.”; “what constitutes "reasonable steps" for large providers may not be reasonable where small providers are concerned”; “Recipients cannot require LEP persons to use family members or friends as interpreters.”; “(1) identifying LEP individuals who need language assistance; (2) language assistance measures (such as how staff can obtain services or respond to LEP callers); (3) training staff; (4) providing notice to LEP persons (such as posting signs); and (5) monitoring and updating the LEP plan.”.
16. American Speech-Language-Hearing Association. Collaborating With Interpreters, Transliterators, and Translators (ASHA Practice Portal, professional topics; Key Issues). Checked October 23, 2026.
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    “As of 2019, every state and the District of Columbia have at least three laws addressing language access (Youdelman, 2019).”; “This executive order does not undo existing language access obligations tied to federal funding (González-Cestari, 2025).”; “Some state Medicaid agencies reimburse language services, but most third-party payers do not pay for the services of an interpreter.”; “When collaborating with language assistance providers, audiologists and SLPs remain responsible for planning the session, selecting culturally and linguistically relevant materials, and appropriately administering assessment and treatment.”; “The clinician and the interpreter or transliterator collaborate using the briefing–interaction–debriefing framework (Langdon, 2002).”; “Provide a copy of assessment prompts, in advance, to avoid any sight translations.”; “Sight translation —the translator provides a spoken or signed translation while reading a written document in a clinical encounter reserved for more immediate and spontaneous needs.”; “This approach is not a reasonable option for informed consent, other legal documents, or formal assessment measures.”; “Consecutive interpreting is used more during assessments and interventions for spoken language.”; “Dialectal mismatches —such as a Spanish-speaking individual from Mexico interpreting for a Spanish-speaking patient from Spain or Argentina—may result in inaccurate interpretations, inaccurate translations, and/or cultural misunderstandings (Ostergren, 2014).”; “Include questions about languages used, communication needs , and preferences on patient intake forms.”; “Incorporate fields into electronic health record or electronic medical record systems to capture patients’ language preferences and communication needs”; “employers are encouraged to use the same interpreter, transliterator, or translator for multiple encounters”; “minors may not possess the emotional maturity and sensitivity necessary to serve in the role of assisting family members in the provision of services.”; “Reports and submissions for insurance claims note when a clinician works with language assistance providers and the impact of that collaboration on assessment and intervention findings. Documentation should also indicate the use of translated materials.”. The page dates the executive order designating English as the official language to March 1, 2025.
17. eCFR. 42 CFR 438.10, Information requirements (Medicaid managed care) (current text, paragraphs (d)(4) and (h)(1)(vii)). Checked October 23, 2026.
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    “Make interpretation services available to each potential enrollee and require each MCO, PIHP, PAHP, and PCCM entity to make those services available free of charge to each enrollee.”; “The provider’s cultural and linguistic capabilities, including languages (including American Sign Language) offered by the provider or a skilled medical interpreter at the provider’s office.”.
18. U.S. Department of Health and Human Services, Office for Civil Rights, and Centers for Medicare & Medicaid Services. Notice of Vacatur Regarding Certain Provisions of the 2024 Nondiscrimination in Health Programs and Activities Final Rule (notification of court decision, 91 FR 32887, June 2, 2026, reporting the October 22, 2025, judgment in Tennessee v. Kennedy). Checked October 23, 2026.
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    “Specifically, the court vacated certain provisions of the regulation to the extent they expand Title IX’s definition of sex discrimination to include gender-identity discrimination.”; “The other provisions of the Section 1557 Rule remain in force.”. The provisions listed as vacated, to that extent only, are 45 CFR 92.101(a)(2)(iv), 92.206(b)(1)-(4), 92.207(b)(3)-(5), 92.8(b)(1), 92.10(a)(1)(i) and 92.208, with related CMS sections; the language-access sections 92.8(d), 92.11 and 92.201 are not on the list.
19. U.S. Department of Health and Human Services. Rescinding Portions of the U.S. Department of Health and Human Services Title VI Regulations To Align With the Statutory Text and Conform to Executive Order 14281 (final rule, 91 FR 46746, July 24, 2026). Checked October 23, 2026.
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    “(i) removes and reserves 45 CFR 80.3(b)(2)”; “This final rule is effective on July 24, 2026.”; “to remove disparate-impact liability and related effects-based provisions and to reflect that Title VI prohibits intentional discrimination”. The current eCFR text of 45 CFR 80.3 reads “(2) [Reserved]” at paragraph (b)(2).
20. U.S. Department of Health and Human Services, Office for Civil Rights. May an LEP person use a family member or friend as his or her interpreter? (HHS.gov FAQ, content last reviewed November 19, 2015). Checked October 23, 2026.
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    “In many cases, especially when information about important medical decisions or consent is at issue, friends and family members may not have the ability to ensure the LEP person being served fully understands what a health provider is communicating to them.”; “when important information is being conveyed and providing interpretation is a reasonable step for providing meaningful access to a program by a person with LEP, it is the provider’s responsibility to provide competent interpreter services at no cost to the person being served.”; “A person with LEP can always decline using an interpreter provided by a recipient.”.
21. U.S. Department of Health and Human Services, Office for Civil Rights. Fact Sheet on Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons (HHS.gov, content last reviewed March 6, 2025). Checked October 23, 2026.
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    “clarifies that where an obligation exists, recipients must provide competent and timely language assistance services at no cost to their LEP clients”.
22. American Speech-Language-Hearing Association. Cultural Responsiveness (ASHA Practice Portal, professional topics; Difference Versus Disorder). Checked October 23, 2026.
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    “Cultural responsiveness requires clinicians to distinguish a communication difference from a communication disorder.”; “recognize that a regional, social, or cultural/ethnic variation of a communication system is rule based and should not be considered a disorder of speech or language (e.g., an accent or a dialect does not reflect an articulation disorder; Hamilton et al., 2018)”; “research has demonstrated that children from minoritized backgrounds who may speak nonmainstream English dialects are less likely to receive needed services than similar White peers (Morgan et al., 2015, 2016)”; “Ethnographic interviewing encourages the interviewee to provide information that they feel is relevant rather than to respond to clinician-presented questions.”; “the need to modify scheduling and appointment times due to cultural and individual values that may influence availability;”.
23. Ortiz JA, Nolasco JM, Huang YT, Chow JC. The Use of Language Sample Analysis to Differentiate Developmental Language Disorder From Typical Language in Bilingual Children: A Systematic Review and Meta-Analysis (J Speech Lang Hear Res. 2024;67(10):3803-3825; doi:10.1044/2024_JSLHR-24-00212; PMID 39259882; abstract). Checked October 23, 2026.
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    “The search yielded 35 articles that met the inclusion criteria.”; “Across studies, the pooled standardized mean difference indicated that children with DLD performed 0.78 SD lower on LSA measures than those with TL.”; “Further research is needed to examine classification accuracy as well as task characteristics that may improve its diagnostic utility.”.
24. American Speech-Language-Hearing Association. Aphasia (ASHA Practice Portal, clinical topics; Assessment and Treatment). Checked October 23, 2026.
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    “it is important for the SLP to consider the age of acquisition of each language, the premorbid use of each language, and the language(s) needed for return to daily activities when selecting the language(s) and materials for assessment.”; “Clinicians should gather data in all languages used to determine the degree of functional impact, keeping in mind that different languages may be impacted to varying degrees.”; “Treatment occurs in the language(s) used by the person with aphasia—either by a bilingual SLP or through collaboration with interpreters, when necessary.”.
25. Communication Health Support Association. Learning More Than One Language (public information page linked from ASHA’s Multilingual Service Delivery Practice Portal page; last reviewed May 1, 2026). Checked October 23, 2026.
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    “Using multiple languages does not confuse children or cause speech or language delays.”; “If your child has a communication issue, it will show up in all the languages they use.”; “Talk to your child in the language(s) you are most comfortable using.”.
26. Hambly H, Wren Y, McLeod S, Roulstone S. The influence of bilingualism on speech production: a systematic review (Int J Lang Commun Disord. 2013;48(1):1-24; doi:10.1111/j.1460-6984.2012.00178.x; PMID 23317381; abstract). Checked October 23, 2026.
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    “Children who are bilingual and have speech sound disorder are likely to be under-referred, possibly due to confusion about typical speech acquisition in bilingual children.”; “Sixty-six studies investigating bilingual speech production met inclusion criteria”; “There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production.”.
27. Paradis J, Crago M, Genesee F, Rice M. French-English bilingual children with SLI: how do they compare with their monolingual peers? (J Speech Lang Hear Res. 2003;46(1):113-27; doi:10.1044/1092-4388(2003/009); PMID 12647892; abstract). Checked October 23, 2026.
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    “Eight French-English bilingual children with SLI were compared to age-matched monolingual children with SLI”; “indicating that the bilingual children did not exhibit more profound deficits in the use of these grammatical morphemes than their monolingual peers”.
28. Kk Nair V, Clark GT, Siyambalapitiya S, Reuterskiöld C. Language intervention in bilingual children with developmental language disorder: A systematic review (Int J Lang Commun Disord. 2023;58(2):576-600; doi:10.1111/1460-6984.12803; PMID 36428270; abstract). Checked October 23, 2026.
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    “We included 14 papers in the review.”; “The majority indicated evidence for vocabulary intervention.”; “Cross-language generalization effects were evident for vocabulary, but in some instances also reported for morphosyntax and literacy.”.
29. American Physical Therapy Association. Cultural Competence and Cultural Humility in Physical Therapy (Patient Care, Public Health and Population Care). “Those cross-cultural situations aren’t limited to race or ethnicity — they also can include language, religion, age, gender identification, and much more.”; “Cultural competence isn’t a destination; it’s a journey that never stops.”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. Language-access duties depend on a practice’s funding, payers and state, and its examples are hypothetical, not DrSensory data.