Healthcare

Qualified Interpreters vs. Bilingual Staff: What the Rules Require

Under the Section 1557 rule (45 CFR 92.4 and 92.201), qualified bilingual staff may speak directly with patients in the patient's language. Only a qualified interpreter may interpret between a patient and an English-speaking provider. Family members, minors and untested staff may interpret only in narrow emergency or documented-request situations.

Key takeaways

Qualified bilingual staff may speak directly with patients in the patient's language.
Only a qualified interpreter may interpret between a patient and an English-speaking provider.
Family members, minors and untrained staff may interpret only in narrow emergency or documented-request situations.
Section 1557 does not require certification, but you must document that each interpreter meets the rule's definition.

In this guide

4 requirements

In the Section 1557 definition of a qualified interpreter

3 modalities

Phone, video and on-site interpreting

2 bodies

CCHI and NBCMI certify medical interpreters

How Does Section 1557 Define a Qualified Interpreter?

Section 92.4 defines a qualified interpreter for an individual with limited English proficiency (LEP), working on site or remotely. The interpreter must:

Have demonstrated proficiency in speaking and understanding spoken English and at least one other spoken language.

Interpret effectively, accurately and impartially, using any necessary specialized terms “without changes, omissions, or additions.”

Preserve “the tone, sentiment, and emotional level of the original oral statement.”

Follow generally accepted interpreter ethics principles, including client confidentiality.

When interpretation is required, a covered entity must offer a qualified interpreter (92.201(c)(1)).

What Counts as Qualified Bilingual or Multilingual Staff?

Section 92.4 defines qualified bilingual/multilingual staff as a workforce member the covered entity designates to give in-language oral assistance as part of their job. The person must have demonstrated to the entity proficiency in English and another spoken language, including specialized vocabulary, and the ability to communicate directly with individuals with LEP accurately and impartially.

The 2024 rule preamble adds two points. Self-identification as bilingual “is insufficient,” so entities need their own assessment process. And “the ability to interpret is a separate skill.” A bilingual nurse may conduct a visit in Vietnamese but should not interpret for an English-speaking surgeon unless the nurse also meets the qualified interpreter definition.

Qualified Interpreter vs. Bilingual Staff: Comparison Table

Person	What they may do	Standard to meet	Section 1557 limits
Qualified interpreter	Interpret between the patient and English-speaking staff	92.4 qualified interpreter definition	Required whenever interpretation is needed
Qualified bilingual/multilingual staff	Communicate directly with the patient in the patient’s language	Designated by the entity; proficiency demonstrated to the entity	May interpret only if also qualified as an interpreter
Bilingual staff not assessed	Not to be relied on to communicate	None met	Barred by 92.201(e)(4)
Adult family member or friend	Interpret only in limited cases	None	Emergency stopgap, or a private, documented patient request (92.201(e)(2))
Minor child	Interpret only in an emergency	None	Emergency stopgap only, confirmed later by a qualified interpreter (92.201(e)(3))

When Can Family Members, Minors or Untrained Staff Interpret?

Section 92.201(e) sets these limits:

You may not require a patient to bring or pay for their own interpreter.
An accompanying adult may interpret only as a temporary measure in an emergency involving an imminent threat to safety or welfare, when no qualified interpreter is immediately available. The qualified interpreter who arrives must confirm or supplement what was said.
An accompanying adult may also interpret if the patient asks for this in private, with a qualified interpreter present and the companion absent. The companion must agree, the request must be documented, and the arrangement must be appropriate.
A minor child may interpret only in the same kind of emergency. No patient-request exception applies to minors.
Staff who are not qualified interpreters, translators or bilingual staff may not be used.

These limits remain in effect. A federal court vacated only the rule’s gender identity provisions on October 22, 2025, and HHS stated on June 2, 2026 that the other provisions remain in force.

What Standards Apply to Video and Phone Interpreting?

Section 92.201(f) requires video remote interpreting (VRI) to provide:

Real-time, full-motion video and audio over a high-speed connection, without lags or choppy, blurry or grainy images.

An image large enough to show the interpreter’s face and the participant’s face.

Clear, audible voices.

Adequate user training to set up and run VRI quickly.

Section 92.201(g) sets parallel standards for audio remote interpreting. In the preamble, OCR said audio interpreting “may not be adequate” in some cases but declined to restrict it further. Both modalities must allow for meaningful access.

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We provide phone, video and on-site interpreters for healthcare and public services.

What Does California Law Add?

Where California and federal law both apply, meet the stricter standard.

Hospitals: Health and Safety Code 1259 requires general acute care hospitals to adopt and review annually a language assistance policy. Interpreters must be available, to the extent possible, on site or by telephone 24 hours a day. The law covers language groups that make up at least 5 percent of the hospital’s service area or patient population. It lets a patient choose a family member or friend after being told interpreters are available. Section 1557 adds conditions to that choice.
Health plans: SB 223 (2017) amended Health and Safety Code 1367.04 and Insurance Code 10133.8. Plan interpreters must show proficiency in English and the target language, know health care terms in both, and follow interpreter ethics. Enrollees cannot be required to use unqualified staff, or accompanying adults or minors, except in limited cases. SB 223 also added Health and Safety Code 1367.042, which requires notices in the top 15 languages spoken by Californians with LEP, as determined by the Department of Health Care Services.

Do Interpreters Need CCHI or NBCMI Certification?

Section 1557 does not require certification. In the 2024 preamble, OCR declined to add a certification requirement because “there are currently no consistent certification standards” and certification is lacking for many languages. OCR also stated that certified interpreters “will still need to meet the standards provided in this definition.”

Two national bodies certify medical interpreters:

CCHI offers the Certified Healthcare Interpreter (CHI) credential in Arabic, Mandarin and Spanish. Interpreters of all other languages can earn CoreCHI-Performance (CoreCHI-P). Candidates must be at least 18, hold a high school diploma or equivalent, and complete at least 40 hours of healthcare interpreter training.
NBCMI offers the Certified Medical Interpreter (CMI) credential in Spanish, Russian, Mandarin, Cantonese, Korean and Vietnamese. Its Hub-CMI credential is a non-language-specific credential for interpreters who pass the written exam.

Certification does not replace your own documentation that each interpreter meets the 92.4 definition.

When Should You Use Phone, Video or On-Site Interpreters?

The rule permits all three if they provide meaningful access, and OCR gives “substantial weight” to the importance of the communication (92.201(d)). Practical guidance:

Phone: Short, routine exchanges such as scheduling, registration, pharmacy questions and billing calls.
Video: Visits where facial expression or gestures matter, such as clinical exams and medication reviews.
On site: High-stakes or complex encounters, such as informed consent, end-of-life discussions, mental health care, pediatric visits with several family members, and patients who struggle with remote technology. Schedule in advance when possible.

Document the modality used and any quality problems.

Frequently Asked Questions

Can bilingual doctors see patients in their own language?

Yes, if the entity has designated them as qualified bilingual/multilingual staff and they have demonstrated proficiency, including medical terminology. They then communicate directly with the patient. If an English-speaking clinician joins the visit, a qualified interpreter should interpret, unless the bilingual doctor also meets the qualified interpreter definition in 45 CFR 92.4.

Can a patient's adult child interpret if the patient asks?

Only under 92.201(e)(2)(ii). The patient must make the request in private with a qualified interpreter present. The adult child must agree. The request and agreement must be documented, and the arrangement must be appropriate for the situation. California hospitals must also follow Health and Safety Code 1259.

Is a phone interpreter enough to comply with Section 1557?

It can be, if it provides meaningful access. Section 92.201(g) requires real-time audio without lags, clear voices and user training. OCR noted in the 2024 preamble that audio may not be adequate in some cases. For consent discussions and complex care, video or on-site interpreting is often a better fit.

Is certification required for medical interpreters?

No. Section 1557 does not require CCHI or NBCMI certification. An interpreter must meet the 92.4 definition: demonstrated proficiency, accurate and impartial interpreting, and adherence to interpreter ethics. Certification helps show competence. Keep records of each interpreter’s assessment, training and credentials.

How AsianText Helps

Qualified Interpreters, by Phone, Video or On Site

AsianText provides phone, video and on-site interpreting 24/7, so you can match the modality to the encounter. We help healthcare organizations write language access plans that set rules for bilingual staff, family interpreters and modality choice. Our ISO 17100 certified translation team, with 3,000+ native linguists, translates patient materials in 200+ language combinations. Contact AsianText to plan your interpreter program.

This article provides general information, not legal advice. Last updated October 5, 2026.

Written by Asyiah Abdullah

Part of the AsianText team, writing about language access, translation and interpreting for government, healthcare and life sciences.

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