Cultural Competency Rules: What Health Providers Must Know Going Forward

Cultural Competency Rules: What Health Providers Must Know Going Forward

Cultural Competency Rules: What Health Providers Must Know Going Forward


Overview of Cultural Competency

What is Cultural Competence in Healthcare?

Healthcare workers are pioneering cultural competency. Is it surprising that physicians, nurses, and other health providers require cultural competence skills? A poor diagnosis due to provider-patient miscommunication might become fatal or costly to patients, their families, and communities.

a collage of diverse people, diversity and cultural competency

The challenge is cultural competency is difficult to measure. At its core, cultural competency analyzes values and attitudes to provide inclusive care. Consider how many agencies must research, document, and enforce diversity requirements (and we'll share those agencies if you keep reading). Our compliance team wants to help you understand and meet your organization's requirements.

This compliance guide outlines key essentials about diversity and cultural competence rules for employees and how to train your staff. The must-have workforce training components include but are not limited to Section 1557 (ACA), National CLAS Guidelines, and two Social Vulnerability Indices (SVIs). In summary, cultural competency requirements aim to promote inclusive care.

What is the Importance of Cultural Competency?

The Biden Administration issued 77 executive orders in 2021, including Executive Order 13985, which is increasing the number of federal regulations and mandates nationwide. In an official response, the "U.S. Department of Health and Human Services Equity Action Plan" ( reveals the post-pandemic objectives and enforcement priorities targetting the entire health sector today.

Public-facing workers across industries are recognizing the need for cultural competence in healthcare training. Covered entities and business associates are seeking to recruit a diverse workforce to function as a compliant organization. Almost 1 in 5 people in the United States speak a language other than English at home (67.8 million individuals), according to a 2019 US Census Bureau report. Did you know this population nearly tripled from 23.1 million people back in 1980 (US Census Bureau)?

About 1 in 5 people in US speak a different language

What Does Cultural Competency Offer?

Protection. Protects organizations legally and aims to promote efficient healthcare outcomes.

On the individual level, cultural competence offers:
✓ Cross-cultural communications skills;
✓ Providers or translators who speak the clients' language(s);
✓ Strengthened ability to recover from inevitable cultural collisions;
✓ Inclusive decision-making process;
✓ Awareness of cross-cultural differences, beliefs, and values;
✓ Openness to corrective action and good faith practice;
✓ Diversity management skills and leadership commitment.

Understanding Cultural Competence

What is Cultural Health?

"Culture includes knowledge, beliefs, arts, morals, laws, customs, and any other capabilities and habits acquired by a human as a member of society," defines the United Nations Educational, Scientific and Cultural Organization (UNESCO)

Cultural health is a discipline covering a particular culture's health and accurate description. The complex study covers both national cultural health and ethnic cultural health. What are the key differences? National cultural health studies the health status of individuals across the country. Ethnic cultural health studies the health status of people within a selected demographic set or geographic location.

What is Cultural Competency in the Workplace?

"A set of congruent behaviors, attitudes and policies that come together among employees of an organization enabling them to work effectively in cross-cultural situations." defines Cross 1989; Isaacs & Benjamin 1991.

Cultural competence means being able to communicate with anyone, which requires the following three elements: (1) Cultural Diversity, (2) Cultural Knowledge, and (3) Cultural Sensitivity. Culturally competent people can acknowledge diversity and collaborate with others. Policies and procedures can reveal cultural differences and how an organization serves a community.

diversity pie chart

Cultural competency in the workplace means a diversified workforce that reflects society. Diversity is any trait that distinguishes one person from another (such as visible and invisible elements). These aspects help firms discover diversity gaps, define targets, and increase workplace diversity.

The ensemble of HHS agencies, including the Office of Civil Rights (OCR), will be increasing enforcement activity based on the Equity Plan previously mentioned. For a sobering viewpoint, check out the latest HHS enforcement actions of non-compliance, resolution agreements, and civil money penalties.

Expect Greater Scrutiny and Enforcement of Workforce Diversity

For intriguing information, check out the "Data Visualizations" of enforcement charges documented by the U.S. Equal Employment Opportunity Commission (EEOC).

Strategically aligning diversity with operational business goals is highly recommended. Discrimination and poor diversity management have an economic cost:

  • Average EEOC complaint equals about $40,000 settlement and up to approximately $250,000 (depending on organizational size).
  • Estimated turnover costs could range between 75% to 150% of a replaced employee's salary (an employer dilemma).

Is achieving and maintaining workforce diversity an economic investment? Regarding economic and "goodwill branding" capital, perhaps the return on investment protection outweighs the cost. The anticipated increase in enforcement activity from multiple federal agencies will likely raise the current amount and severity levels of fines.

Training in Cultural Competency (4 Must-Have Elements)

What are the Four Must-Have Elements to Include in Cultural Competency Training?

Woman from different ethnicities
HCP Compliance Tip! An effective training course about diversity and cultural competency must include the National CLAS Standards, ACA Section 1557, Social Vulnerability Indices, and Improving Health Disparity.

The following four topics must be included within an effective cultural competency and diversity training course.

✓ Cross-Cultural Healthcare in the National CLAS Standards

Cross-cultural healthcare teaches professionals across the country how to communicate with people from other cultures. Workers, healthcare organizations, and the public can follow 15 stages to adopt the Nationally Culturally and Linguistically Appropriate Services (CLAS) Standards.

The CLAS Standard aims to advance health outcomes, enhance quality, and help eliminate healthcare disparities. View the complete National CLAS Standards by HHS Think Cultural Health for more detailed information.

Section 1557 of the Affordable Care Act (ACA)

ACA Section 1557 legally prohibits health discrimination based on race, color, national origin, sex, age, or handicap. Federally-facilitated marketplaces and Title I ACA businesses like state-based exchanges are examples that fall under Section 1557.

Covered entities include health providers. As the agency responsible for enforcement, the HHS Office of Civil Rights (OCR) provided the following statement about the Final Rule:

"There are numerous ways in which health services providers are recipients in their own right, whether the Federal financial assistance they receive comes through certain Medicare payments, Medicaid payments, or other funds from the Department. Therefore, instead of falling outside of Section 1557's purview, many health care providers will be subject to Section 1557 irrespective of their relationship to issuers receiving Federal financial assistance."

Measuring Social Vulnerability by CDC & OMH

Several factors, including poverty, limited access to transportation, and crowded housing, can weaken any community's ability to prevent human suffering and financial loss during a disaster incident. These factors are known as social vulnerability, according to the Centers for Disease Control and Prevention (CDC).

1). The Social Vulnerability Index (CDC/ATSDR SVI):

  • Developed by the CDC Agency for Toxic Substances and Disease Registry (ATSDR).
  • The SVI aims to enhance existing resources to identify racial and ethnic minority communities at the most significant risk of disproportionate impact and adverse outcomes due to the COVID-19 pandemic.
  • 16 U.S. Census factors categorize social vulnerability. Keep in mind this SVI may likely apply to future public health emergencies at the agency's discretion.

2). The Minority Health Social Vulnerability Index (Minority Health SVI):

  • Co-developed by the CDC/ATSDR and the HHS Office of Minority Health (OMH).
  • The Minority Health SVI uses five-year estimates of demographic data from the U.S. Census Bureau's American Community Survey (ACS) and provide an extension of the CDC/ATSDR SVI.
  • Collected information organizes into six themes: (1) Socioeconomic Status, (2) Household Composition and Disability, (3) Minority Status and Language, (4) Housing Type and Transportation, (5) Health Care Infrastructure and Access, (6) Medical Vulnerability.

Improving Health Disparity by CMS

The Centers for Medicare & Medicaid Services (CMS) state:

"Despite decades of attention and awareness, health care disparities persist across the United States. Racial and Ethnic minorities, people with limited English proficiency (LEP) and low health literacy, sexual and gender minorities and people with disabilities experience worse health outcomes, decreased access to health care services and lower quality of care than the general population."

The socioeconomic status of specific cultures can affect the health care an individual receives and seeks later. For instance, those living in impoverished regions may suffer from otherwise treatable conditions without the availability and affordability of healthcare.

Improving Healthcare Disparities: Building upon the Minority Health and Health Disparities Research Act of 2000, the five key areas in the Close the Health Care Gap Act of 2004 focus on helping improve healthcare disparities:

  1. Improving quality with better health information technology, performance measurement for federal health programs, and providing incentives;
  2. Expanding access to work towards providing high-quality health care for low costs;
  3. Strengthening national efforts and coordination;
  4. Increasing the diversity of health professionals;
  5. Conducting research to identify better sources of racial/ethnic, geographic disparities, and access intervention.

These same principles have been under continuous improvement since the creation of ACA in 2010.

a collage of diverse people, diversity and cultural competency

Implementing Cultural Competency into Practice

How to Measure the Effectiveness of Healthcare Cultural Competency?

Cultural Competency Assessment - This specialized assessment identifies the must-knows for your employees to work more effectively together. The best scenario? Everyone learns the rules, collaborates productively, and functions as a team.

An assessment relies on a triangulated approach utilizing archival, interview, and survey assessments. The results of the different instruments converge to identify cultural competence gaps.

  • Reviewing current documentation, policies, and procedures (Qualitative Data);
  • Interviewing key individual informants (Qualitative Data);
  • Conducting focus group interviews by demographics (Qualitative Data);
  • Conducting an organization-wide survey (Quantitative Data).

How to Implement Cultural Competency Training?

"More than 3 out of 4 job seekers and employees (76%) report a diverse workforce is an important factor when evaluating companies and job offers." (GlassDoor)

Here are seven steps of compliance guidance for covered entities and business associates:

a collage of diverse people, diversity and cultural competency

1. Include Diversity and Cultural Competency Training in all new-hire, onboarding training.

2. Conduct refresher training every six months to a year instead of every two years.

3. Discuss diversity in monthly staff meetings and daily conversations.

4. Train physicians, employees, contract workers, and business associates.

5. Hire interpreters, translation services, and care teams with multilingual skills available.

6. Consider based on qualifications when hiring physicians and employees.

7. Track performance along with federal equity outcomes.

What are the Benefits of Diversity and Cultural Competency?

What is the primary value which summarizes diversity and cultural competence? To strengthen work environments. Here are some of the benefits to healthcare organizations:

Improving Quality of Care:

  • Bringing a variety of skills and experience to the workplace environment.
  • Providing multiple perspectives to problem-solving.
  • Increasing sensitivity and awareness of diversity and cultural issues.

Increasing Patient Satisfaction:

  • Reducing complaints and grievances.
  • Achieving higher levels of patient engagement.
  • Improving self-reported provider perception and understanding of cultural competency.

Increasing Organizational Efficiency:

  • Increasing employee morale and therefore increasing employee retention rates.
  • Promoting employee awareness of the tools available to foster a more cohesive workplace.
  • Saving financial costs through the reduction of liability issues.

Improving Health Outcomes and Reducing Health Disparities:

  • Improving patient-provider communication and patient adherence to treatment.
  • Saving costs through improved service delivery and the reduction of costly urgent care costs.
  • Providing multiple perspectives to problem-solving. Increasing patient-centered care cost savings due to increased access to appropriate care.

A Recap of Cultural Competency and Compliance Recommendations

Office full of doctors

In conclusion, this article covered cultural competency in healthcare, its importance, and practical training. Cultural competency is a goal for inclusive care and an HHS requirement to eliminate health inequalities and enhance health outcomes.

The National CLAS Standards, Section 1557 (ACA), and Social Vulnerability Indices were briefly explained (SVI). Ultimately, the themes discussed were about measuring health efforts, the economic value of workforce diversity, and the benefits of cultural competence.

Getting Your Workforce in Trained

Health providers, covered organizations, and business associates need workforce training to avoid costly liabilities and deliver respectful patient care by encouraging an inclusive workplace.

Our compliance team suggests including Diversity and Cultural Competency course in new hire training, automated refresher courses, and a diverse workforce (course details).

For examples of more employee training courses, HCP recommends your learning management system (LMS) of choice include the following topics:

  • View the Diversity & Ethics Series;
  • Explore the Behavioral Health Awareness;
  • HIPAA Compliance Training Courses;
  • OSHA Compliance Training Courses;
  • Customize for state and local laws.

Whether you are a healthcare clinic, provider/facility, or management services organization (MSO), train your staff regularly to improve productivity and patient care.

Accessing Compliance Resources

Remember that compliance training alone doesn't mean an organization is fully compliant, especially with HIPAA, OSHA, Corporate Compliance, Coding & Billing, and other regulations. If any information shared is unfamiliar or unclear to you, we recommend consulting with your legal counsel or a compliance expert.

For HCP Clients:

  • Login into the HCP Portal or contact your dedicated team of compliance advisors for questions.
  • Access over 130 training courses.
  • CME & CEU Credits available.

If you are not an HCP Client yet, schedule a free consultation to learn about an effective compliance program with management software powered by advisors.

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An office full of doctors

This information is offered for educational purposes only, and you should not construe this information as legal advice. Specific legal questions regarding these topics should be addressed with one's own counsel.