FEDERAL LEVEL

The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care were developed by the Office of Minority Health, U.S. Dept. of Health and Human Services in 2001 and updated in 2013. They are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for health and health care organizations to 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.  This website contains a tremendous wealth of valuable information, including the full text of all 15 CLAS Standards, and is well worth exploring for anyone interested in increasing their understanding of cultural and linguistic competence.

Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance. The Act provides the legal foundation and rationale for developing culturally competent programs and organizations. To assist federal agencies that provide financial assistance, the wide variety of recipients that receive such assistance, and the actual and potential beneficiaries of programs receiving federal assistance, the U.S. Department of Justice has published a Title VI Legal Manual. The Title VI Legal Manual sets out Title VI legal principles and standards. Additionally, the Department has published an Investigation Procedures Manual to give practical advice on how to investigate Title VI complaints. Also available on the Federal Coordination and Compliance Website are a host of other materials that may be helpful to those interested in ensuring effective enforcement of Title VI.

Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons.  This Guidance sets forth the compliance standards that recipients of Federal financial assistance must follow to ensure that their programs and activities normally provided in English are accessible to limited English proficient persons and thus do not discriminate on the basis of national origin in violation of Title VI’s prohibition against national origin discrimination.

Executive Order 14224:  Designating English as the Official Language of The United States. This Executive Order, issued on March 1, 2025, declares English as the Official Language of the United States, and revoked Executive Order 13166.  Federal agencies and recipients of federal funding are no longer required to improve access to their services for individuals with limited English proficiency. The use of policy guidance documents relating to EO 13166 about standards, best practices, and technical assistance, and the implementation of language access plans was also no longer necessary.  A guidance memo released by the Department of Justice on July 14, 2025 further advises agencies on how to implement EO 14224 and recommends additional future actions. 

The National Immigration Forum noted the following: “Because Executive Order 14224 is not a statute, its legal impact is rather limited. Federal civil rights laws, like Title VI of the Civil Rights Act of 1964, remain unchanged. Title VI prohibits discrimination based on national origin. Courts have held that discrimination based on national origin includes discrimination against limited English proficiency (LEP) individuals in circumstances in which language is used as a proxy for national origin. This principle has not been overruled by EO 14224; it is still illegal for recipients of federal funding to discriminate based on national origin and use language as a vehicle to do so …. Additionally, many local and state governments have passed language access laws that govern the language access policies within their jurisdictions. EO 14224 does not overrule those laws, and those policies continue to be the law.” https://immigrationforum.org/article/designating-english-as-the-official-language-explainer/

This Health Affairs article – An Emerging Threat to Health Equity: Diminished Patient Access to Language Services – examines the importance of language services for health equity and good patient health outcomes, and the potential negative impact of recent executive actions. Topics addressed include policy threats to language services, impact of language services on patients and health care organizations, and practical actions that health care organizations can take to protect access to language services.

STATE LEVEL

STATE LEVEL NATIONAL CLAS STANDARDS IMPLEMENTATION: The United States Department of Health and Human Services, Office of Minority Health developed a set of 15 standards known as the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (the “CLAS Standards”). First published in 2000, the CLAS Standards provide a framework to advance health equity, improve health care quality, and help reduce disparities with a whole-person approach that considers cultural background when attending to a person’s health care needs. Currently, there is no federal legislation or administrative regulation that requires nationwide implementation of the CLAS Standards. Therefore, implementation of the CLAS Standards varies by state. This Fact Sheet provides an overview of state-level CLAS legislation introduced or enacted since 2016. This report provides a summary of 172 implementation activities across 32 states illustrating state-sponsored activities to implement the National Standards for Culturally and Linguistically Appropriate Services (National CLAS Standards).

PHYSICIAN EDUCATION: In 2005 the NJ State Legislature enacted a law requiring the New Jersey Board of Medical Examiners in consultation with the Commission on Higher Education to prescribe requirements, by regulation, for physician training in cultural competency.  The regulations relating to cultural competency training were adopted in their final form on April 7, 2008.  The legislation requires that all medical schools in New Jersey provide instruction to their current and future students in cultural competency. This instruction is required as a condition of receiving a diploma from a college of medicine in New Jersey. New Jersey medical schools are also required to provide cultural competency CME instruction for licensed physicians who were not required to and did not receive cultural competency training in their medical school curriculum. The required curriculum in cultural competency training has become more prevalent in medical schools since 2005. The curriculum required cannot be assumed to be included in medical, osteopathic and podiatric schools operating outside of New Jersey.

LAW ENFORCEMENT: In 2016, Governor Chris Christie signed a bill requiring police officers in NJ to undergo cultural competence/diversity training. The bill requires the state Department of Law and Public Safety to develop cultural diversity training materials and an online tutorial for local police chiefs, who are themselves required to draft a “cultural diversity action plan.” The attorney general’s directive implementing the legislation and creating a Continuing Education Institute may be found here.  A related news article can be found here.

NON-GOVERNMENTAL

The National Center for Cultural Competence (NCCC) has been in existence since 1995 and is a component of the Georgetown University Center for Child and Human Development. Housed within the department of pediatrics of the Georgetown University Medical Center, the Center is funded in part from the Maternal and Child Health Bureau, Health Resources and Services Administration of the U.S. Department of Health and Human Services. The NCCC defines the following framework for organizations hoping to improve their level of cultural competence: