Language Access Updates Q2 2026 | Joint Commission, ADA, HHS

Issue #2 | Q2 2026

Welcome to our second issue. At the request of our Client Advisory Board, BURG Translations developed this briefing to keep our clients informed about language access requirements that may affect your industries.

Compliance officers in healthcare and regulated industries spent much of this quarter waiting for guidance that didn’t come. The federal guidance that organizations used to structure their language access programs was formally withdrawn more than a year ago. The replacement information that the DOJ promised still hasn’t appeared. This quarter, two major accessibility deadlines were extended within days of implementation, while OCR resolved three enforcement actions in three months, all under the same statutes and with the same corrective actions. Organizations are still being asked to interpret their own obligations without the federal frameworks that once defined what meeting them looked like.

This issue covers regulatory changes, new legislation, enforcement actions, and legal developments across healthcare, life sciences, manufacturing, and legal services from 2025 through Q2 2026.

Catch up on last quarter’s updates in the Q1 2026 issue.

In This Issue

Regulatory Updates

Legal Developments

Regulatory Updates

1. ADA Title II Web Rule: Digital Accessibility for Government Entities

What Happened

No matter how closely we keep an eye on all these regulations, they continue to be moving targets. This quarter, two major federal accessibility deadlines were extended within days of taking effect, one under DOJ and one under HHS.

Just over two years ago, the Department of Justice published a final rule establishing specific technical standards for how state and local government websites and mobile applications must function for people with disabilities. For the first time, the April 2024 rule set a concrete, enforceable benchmark: Web Content Accessibility Guidelines (WCAG) Version 2.1, Level AA. The first major compliance deadline was April 24, 2026, for government entities serving populations of 50,000 or more.

However, four days before that deadline, the DOJ published an Interim Final Rule extending compliance by one year. Large government entities now have until April 26, 2027. Smaller jurisdictions and special districts have until April 26, 2028. The substantive requirement — WCAG 2.1 Level AA across all digital services — did not change.

What the Law Says

The rule applies to all digital services through which a state or local government delivers programs, services, or activities. WCAG 2.1 Level AA is the international standard that determines whether a person with a disability is able to use a website or mobile app to access the services they need.

It covers websites, mobile apps, online forms, digital documents, and third-party platforms operating on a government entity’s behalf. If a government agency contracts with a software vendor to run a patient portal, scheduling system, or public health platform, that vendor’s product has to satisfy WCAG 2.1 Level AA. The government entity retains legal responsibility regardless of whether the failure originates with a vendor.

BURG’s Perspective | What This Means for You

The DOJ’s extension postpones its own enforcement timeline by one year. It doesn’t affect private litigation, which produced 3,117 federal web accessibility lawsuits in 2025, up 27% from 2024. For any organization operating a public-facing digital platform, the extension applies only to DOJ enforcement. Private plaintiffs operate on their own timeline and don’t need federal action to file suit.

For government entities, including public hospital systems, county health departments, courts, and public universities, the obligation remains unchanged. The new deadline is a year off, but the work required to meet it is the same. Organizations that haven’t begun a WCAG 2.1 Level AA audit of their digital properties have less time than the new deadline implies, because private plaintiffs are not waiting for the DOJ to act.

For healthcare, life sciences, manufacturing, and legal services organizations that operate digital platforms on behalf of government clients, the procurement obligation is independent of the government’s deadline. Any platform deployed on a government client’s behalf must meet WCAG 2.1 Level AA before your client’s compliance date. The government entity retains legal responsibility for its vendor’s product, which means a noncompliant platform is your client’s compliance problem.

Organizations already working to meet Section 1557 and other language access requirements will recognize the overlap. A patient portal that fails WCAG 2.1 Level AA is frequently the same portal that can’t support multilingual navigation, translated documents, or language selection for LEP users. The compliance frameworks are different, but the underlying failure is the same: a patient who cannot use the platform.

Current Status

The extended deadlines are April 26, 2027 for government entities serving populations of 50,000 or more, and April 26, 2028 for smaller jurisdictions and special districts. The DOJ stated it fully anticipates implementing the regulation by the new deadline. The public comment period on the Interim Final Rule closed June 22, 2026. DOJ has also signaled it may pursue additional rulemaking that could revise the scope or requirements of the rule before the new deadline arrives.

2. HHS Section 504: Digital Accessibility for Healthcare Organizations

What Happened

Any organization that accepts Medicare, Medicaid, or any other form of HHS funding is subject to Section 504 of the Rehabilitation Act. In May 2024, HHS published a final rule adding, for the first time, specific digital accessibility requirements to those existing obligations. Covered organizations with 15 or more employees had until May 11, 2026, to bring their websites, mobile apps, and patient-facing kiosks into compliance with WCAG 2.1 Level AA. Smaller organizations have until May 10, 2027.

On May 7, four days before the deadline for larger organizations, HHS published an Interim Final Rule extending compliance by one year. Recipients with 15 or more employees now have until May 11, 2027. Smaller recipients have until May 10, 2028. The technical standard did not change.

What the Law Says

The rule impacts any organization that receives HHS funding, whether directly or indirectly. A single Medicare or Medicaid payment is sufficient to trigger coverage. That includes hospitals, clinics, community health centers, health plans, and health systems participating in any HHS-administered program. The requirement extends to digital tools provided through third-party vendors. If a covered entity contracts with a software company to run its patient portal, that portal has to meet the standard. The covered entity is legally responsible regardless of where the failure originates.

BURG’s Perspective | What This Means for You

Where the ADA Title II Web Rule applies to government entities, Section 504 applies to private healthcare organizations. If your organization accepts Medicare or Medicaid, this rule applies to you.

While this extension changes the compliance date, it doesn’t change what organizations are required to do, and it doesn’t pause OCR’s enforcement authority. Section 504 also provides a private right of action. OCR’s extension doesn’t affect patients who choose to file suit directly.

HHS opened a 60-day comment period on the Interim Final Rule that closed July 6, 2026, where it invited input on whether further rulemaking is warranted. That language signals the rule’s scope or requirements could still change before the 2027 deadline arrives.

Current Status

The new compliance deadline for recipients with 15 or more employees is May 11, 2027. The deadline for smaller recipients is May 10, 2028. HHS has indicated it is considering whether additional rulemaking is needed, which could affect the rule’s scope or requirements.

3. OSHA Hazard Communication Standard: Updated Training Deadlines

What Happened

OSHA’s updated Hazard Communication Standard introduced new requirements for how chemical hazards are classified, how Safety Data Sheets are structured, and what appears on container labels. The compliance deadlines are phased by organization type. Chemical manufacturers, importers, and distributors evaluating substances were required to comply by May 19, 2026. Employers have until November 20, 2026, to update workplace labeling, hazard communication programs, and employee training for substances.

The May 19 deadline for manufacturers, importers, and distributors has passed. Updated Safety Data Sheets and labels for substances are beginning to reach employers. That flow of new documentation triggers the employer obligation: when hazard classifications or label information changes, workplace labeling, written programs, and worker training have to follow.

What the Law Says

The updated standard requires employers to retrain employees whenever new chemical hazards are introduced or hazard information changes. OSHA’s training requirement is clear. Employees must be able to understand the information being presented to them. That standard applies to the updated HazCom training as it does to all safety instructions under 29 CFR 1910.1200.

BURG’s Perspective | What This Means for You

When Safety Data Sheets and hazard classifications change, employee training needs to reflect those changes. For manufacturing operations with multilingual workforces, updating a HazCom program means updating the training materials workers use, in the languages they speak. That is what OSHA compliance officers look for when they assess whether training was genuinely received.

Six months may feel like a comfortable window. For organizations managing large chemical inventories, multiple facilities, or distributed workforces, the work of updating materials, revising internal labels, and documenting training completion may take longer.

Current Status

The November 20, 2026 employer training deadline is the one most directly relevant to operations teams. A second wave of deadlines covering mixtures follows in 2027 and 2028.

4. Joint Commission: National Performance Goals and Language Access

What Happened

On January 1, 2026, the Joint Commission replaced its National Patient Safety Goals with a new framework called National Performance Goals (NPGs), covering all accredited hospitals and critical access hospitals. The framework reorganizes existing requirements into 14 measurable topics with clearly defined goals, moving away from procedural checklists and toward documented outcomes. No new requirements were added. What changed is how existing requirements are organized, weighted, and measured during surveys.

What the Standards Require

Goal 4 requires hospitals to show that all patient groups are receiving comparable care. If they are not, hospitals must produce a written action plan identifying and addressing the disparity. Goal 7, formalized as NPG.07.01.01, requires that patients receive information about their care in a language they understand, and are provided with qualified interpreters for informed consent, discharge instructions, and other high-stakes clinical conversations. The standard also requires hospitals to meet the specific communication needs of patients with vision, speech, hearing, or cognitive disabilities, which falls under a separate Element of Performance and is not satisfied by a general language services contract.

BURG’s Perspective | What This Means for You

Accredited hospitals have always been required to provide language access. What the National Performance Goals changed is what surveyors look for and how they document it. Having a contracted interpreting service used to be sufficient. Now hospitals need to show, through actual outcome data, that LEP patients and patients with disabilities receive care comparable to the care provided to English-speaking patients. Access and outcomes are not the same thing, and the Joint Commission is now measuring both.

NPG.07.01.01 is active in surveys being conducted right now. Hospitals that haven’t assessed whether their current language access program addresses all three Elements of Performance, including disability-related communication needs, may find that a language services contract alone does not satisfy the standard.

Current Status

The 2026 accreditation survey cycle is now underway and the National Performance Goals are in effect for all accredited hospitals and critical access hospitals as of January 1, 2026. The Joint Commission has also replaced its Survey Activity Guide with a new Survey Process Guide, which consolidates the NPGs alongside CMS Conditions of Participation into a single preparation resource. Hospitals in the 2026 survey cycle should review both documents against their current language access programs.

5. U.S. Commission on Civil Rights: Language Access for Individuals with Limited English Proficiency

What Happened

On May 18, 2026, the U.S. Commission on Civil Rights released Language Access for Individuals with Limited English Proficiency, a 214-page report formally transmitted to the President and Congress. The Commission is an independent, bipartisan agency established by the Civil Rights Act of 1957 to advise the nation’s leaders on civil rights matters. Commissioners approved the report unanimously before its public release. The investigation focused on Medicare- and Medicaid-funded hospitals and the Supplemental Nutrition Assistance Program, programs where language barriers carry direct consequences for health and basic needs. The Commission held a public briefing, reviewed academic and government research, analyzed county, state, and hospital websites, and sent formal document requests to USDA and HHS.

What the Report Found

Language access across federally funded programs is inconsistent. Some institutions have built language access into their systems but many still have not. The Commission found the same failures recurring across institutions.

Untrained interpreters, including family members and children, substitute for qualified professionals. Machine translation is used without human review. Staff often fail to use the language tools available to them, and organizations rarely collect data on whether their services are reaching the people they serve.

In hospitals, a 2016 Health Affairs study cited by the Commission found that about 25% of hospitals in high-need areas provide no language assistance. The Commission’s own analysis of hospital websites found that only 18.3% offered any website translation. Most provided a phone number as the entry point to language services, but these resources often require LEP patients to navigate several pages in English before reaching any translated information.

The Commission’s recommendations to Congress ask for language access to be codified as permanent federal law rather than left to executive policy, for agencies to translate vital documents into the languages they frequently encounter, and for systems that track whether services are actually reaching the people who need them.

BURG’s Perspective | What This Means for You

Federal investigations of this scope don’t happen often. This one looked specifically at whether hospitals and government programs are meeting their language access obligations. The Commission reviewed hospital websites, surveyed community organizations, and took testimony from patients who could not communicate with their providers. The full report is available at usccr.gov.

Current Status

The April 24, 2026, deadline applies to government entities serving populations of 50,000 or more. Smaller jurisdictions and special districts have until April 26, 2027. The rule is active and DOJ enforcement authority is in place.

6. Executive Order 14224: The “Official English” Policy

What Happened

On March 1, 2025, the administration issued Executive Order 14224, designating English as the official language of the United States and revoking the 25-year federal requirement for agencies to maintain language access plans. LEP.gov, the central federal resource for compliance guidance, was suspended. On March 4, 2026, the Department of Treasury formally rescinded its own Title VI language access guidance, which had been in place since 2005.

In July 2025, the Department of Justice committed to publishing replacement guidance within 180 days. That deadline passed on January 10, 2026. As of this writing, the guidance hasn’t been published, and no explanation has been offered.

What the Law Says

Executive Order 14224 changed internal federal policy, but it didn’t repeal federal statutes. Organizations that receive federal funding are still legally required to provide meaningful access to services for individuals with limited English proficiency under Title VI of the Civil Rights Act and Section 1557. These laws remain fully enforceable even though the government has removed the guidance organizations once used to structure and document their compliance programs.

BURG’s Perspective | What This Means for You

“Meaningful access” is a legal standard with a specific definition: LEP individuals must be able to participate in your services as effectively as English speakers. This obligation has not changed. Simultaneously, the federal framework organizations used to measure, document, and defend their compliance programs is gone, and the replacement DOJ committed to producing is nowhere to be found.

Compliance officers who built their language access programs around federal guidance now have to assess, on their own, whether those programs satisfy the statutory standard.

Current Status

LEP.gov remains suspended. The DOJ’s replacement guidance, promised by January 10, 2026, has not been published and no timeline for publication has been announced. Language access obligations under Title VI and Section 1557 remain in full effect.

7. Section 1557: Language Access Requirements for Healthcare

What Happened

On May 6, 2024, HHS published a final rule under Section 1557 of the Affordable Care Act establishing more robust requirements for language access in healthcare. The compliance deadline was July 5, 2025. For healthcare organizations that receive federal funding, which includes virtually every hospital, clinic, and health plan that accepts Medicare or Medicaid, those requirements are now in effect and have been since that deadline passed.

What the Law Says

The 2024 final rule requires covered entities to maintain written language access policies and procedures, provide multilingual notices of available language services in the top 15 languages spoken in their state, use only qualified interpreters, prohibit reliance on family members or untrained staff for interpretation, and ensure that machine translation of critical documents is reviewed by a qualified human translator.

The rule establishes specific qualifications for interpreters at 45 CFR § 92.4. To meet the standard, interpreters need to demonstrate proficiency in both languages, the ability to interpret accurately and impartially, knowledge of specialized vocabulary, and adherence to interpreter ethics principles. Being bilingual does not satisfy this standard. Organizations with 15 or more employees are required to designate a Section 1557 Coordinator responsible for overseeing compliance.

BURG’s Perspective | What This Means for You

Section 1557’s language access requirements are statutory. They exist independently of which administration is enforcing them and the federal guidance changes described in entry six. Healthcare organizations uncertain about their obligations after EO 14224 should know that Section 1557’s language access requirements were unaffected by that order. Private litigation under Section 1557 does not require federal enforcement action to proceed.

Current Status

The language access requirements are in full effect. Court orders that stay provisions of the 2024 rule apply only to the gender identity and pregnancy termination provisions and do not affect language access requirements. OCR continues to enforce, as the legal developments section of this issue reflects.

8. The SPEAK Act: Telehealth Language Access Mandates

What Happened

The SPEAK Act has been law since February 3, 2026. HHS has a 12-month window that expires in February 2027 to publish standardized telehealth language access guidance. As of this writing, no task force has been announced and public consultation has not begun. The law requires HHS to establish guidance on language access in telehealth, which has never existed at the national level. When that guidance is finalized by February 2027, federally funded health systems will be expected to align their telehealth programs with those standards.

What the Law Says

The SPEAK Act directs HHS to develop guidance on how federally funded health systems should deliver language access across the full scope of a telehealth encounter, from how qualified interpreters join virtual visits and how LEP patients receive pre-visit instructions, to how patient portals function in languages other than English and how follow-up communications, including appointment reminders and prescription information, reach patients in their preferred language.

BURG’s Perspective | What This Means for You

Section 1557 requires meaningful language access in telehealth but doesn’t define what it looks like in a virtual care environment. Research published in the Journal of General Internal Medicine found that adults with limited English proficiency have 20% lower odds of using telehealth than English-speaking adults, even after considering income, insurance, and other access factors. The SPEAK Act requires HHS to supply that definition by February 2027.

Current Status

HHS has until February 3, 2027 to publish its guidance. Federally funded health systems remain subject to existing Section 1557 obligations in the meantime.

9. FDA Clinical Trial Guidance: Enrollment Practices and Language Access

What Happened

The FDA’s guidance on Enhancing Participation in Clinical Trials has been in effect since December 15, 2025. It finalizes and replaces the FDA’s 2020 document, covering eligibility criteria, enrollment practices, and trial design for drug and biologics applications. The guidance addresses how sponsors should design trials that produce data applicable to the actual patient populations who will use approved therapies.

What the Guidance Says

FDA guidance documents are recommendations, not binding regulations or laws. That said, FDA uses guidance documents in its review of applications, and sponsors who consistently deviate from them take on regulatory risk.

On language access specifically, the guidance recommends that sponsors provide trial resources and documents in multiple languages, as well as multilingual staff or interpreters, to encourage participation and retention among LEP individuals. It also recommends community outreach in locations accessible to underrepresented populations, and flexibility in trial design to reduce participation burdens that disproportionately affect non-English-speaking communities.

BURG’s Perspective | What This Means for You

Informed consent forms, patient-reported outcome instruments, recruitment materials, and participant communications all need to work in the languages of the populations being enrolled. IRBs review these materials and can delay first-patient-in dates when language access plans are inadequate. For sponsors running global trials, the documentation and linguistic validation requirements compound quickly across multiple languages and regulatory jurisdictions.

Current Status

The guidance is in effect. It applies to clinical investigations of human drugs and biological products regulated as drugs. Sponsors preparing NDAs and BLAs should review their enrollment practices and participant-facing materials against these recommendations.

10. Language Access for All Act: Proposed Federal Legislation

What Happened

The Language Access for All Act was introduced in the House of Representatives on January 22, 2026, as a direct legislative response to Executive Order 14224. It remains in the House Committee on Oversight and Government Reform with no scheduled hearings and no new cosponsors. The sponsors are in the congressional minority, and the current administration is actively opposed to the policy the bill would enact.

What the Bill Proposes

The bill would make the language access framework of Executive Order 13166 permanent federal law, putting it beyond the reach of future executive action. It would require every federal agency to develop and maintain a language access plan, provide qualified interpreters for critical communications, and establish a formal complaint process through the DOJ. Noncompliance would be treated as discrimination under Title VI. Under its AI provisions, agencies could not use AI language services as a full replacement for qualified human translators or interpreters, and Inspectors General would be required to audit agency AI language systems at least every two years.

Current Status

The bill hasn’t been passed and currently remains in committee. Executive orders can be revoked by the next administration, as this one was, and a statute cannot. In May 2026, the U.S. Commission on Civil Rights formally recommended Congress make language access permanent federal law.

Legal Developments

1. San Juan Capestrano Hospital and Essentia Health West | April 2026

What Happened

On April 13, 2026, the HHS Office for Civil Rights resolved two separate investigations in a single announcement, both stemming from complaints that deaf patients were denied effective communication at federally funded hospitals. San Juan Capestrano Hospital, a psychiatric facility in Puerto Rico, and Essentia Health West, based in Fargo, North Dakota, and operating as Innovis Health across Minnesota and North Dakota, each entered into voluntary resolution agreements with OCR.

What the Law Says

Section 504 of the Rehabilitation Act and Section 1557 of the Affordable Care Act both require federally funded healthcare organizations to provide effective communication for patients with disabilities. For deaf and hard-of-hearing patients, that obligation includes providing qualified sign language interpreters or other appropriate auxiliary aids and services, free of charge and in a timely manner. The requirement applies across all healthcare settings, including mental and behavioral health.

BURG’s Perspective | What This Means for You

OCR resolved two disability communication cases on the same day with identical corrective action requirements. Bayhealth Medical Center received the same requirements in February. Three enforcement actions in three months, all under the same statutes, all for the same violation, indicates OCR is pursuing disability communication failures at federally funded hospitals systematically.

Current Status

Both organizations must now document patient communication assessments, provide qualified interpreters on demand, train staff, and designate a civil rights coordinator. Federally funded hospitals that have not implemented these practices are exposed to the same enforcement.

2. Bayhealth Medical Center (February 2026)

What Happened

On February 4, 2026, the HHS Office for Civil Rights entered into a voluntary resolution agreement with Bayhealth Medical Center, a Delaware health system, after a deaf patient filed a complaint alleging that Bayhealth failed to provide a qualified interpreter during his three-day hospitalization. OCR investigated under Section 504 of the Rehabilitation Act and Section 1557 of the Affordable Care Act. It was the first of three OCR enforcement actions for disability communication failures at federally funded hospitals in 2026.

What the Agreement Required

Bayhealth must modify its policies and procedures for effective communication with patients who have disabilities and train every employee who interacts with patients on those changes. To verify compliance, Bayhealth will report grievances related to auxiliary aids or services to OCR and submit compliance reports every six months. OCR will monitor compliance for two years.

BURG’s Perspective | What This Means for You

Both Section 504 and Section 1557 require federally funded health systems to communicate with patients who have disabilities as effectively as with any other patient. A single complaint from one patient was sufficient to trigger system-wide corrective action and two years of federal monitoring at Bayhealth. OCR has since brought two more enforcement actions under the same statutes for the same violation, with identical corrective action requirements in each case. The standard OCR is applying is consistent, and the enforcement is ongoing.

3. MMG Fusion (March 2026)

What Happened

Five years after a breach that exposed the protected health information of approximately 15 million patients, the HHS Office for Civil Rights settled with MMG Fusion, a Maryland company that provided software and marketing tools to dental practices. The breach occurred in December 2020, when an unauthorized actor accessed patient records through MMG’s systems and posted them to the dark web. MMG did not notify the dental practices it served within the required 60-day window. OCR learned of the breach from a complaint filed more than two years later, not from MMG.

What the Settlement Required

MMG paid $10,000 and entered into a corrective action plan under three years of OCR monitoring. The plan covers a security risk analysis, a risk management plan, updated HIPAA policies and procedures, and workforce training. OCR set the penalty with MMG’s financial condition in mind.

BURG’s Perspective | What This Means for You

MMG Fusion’s settlement is OCR’s twelfth enforcement action under the Risk Analysis Initiative, a targeted effort the agency launched in October 2024 to enforce the risk analysis requirement under the HIPAA Security Rule. OCR has flagged that same failure as one of the most common findings behind its Security Rule settlements overall. MMG never performed one. A risk analysis exists to catch vulnerabilities before they become breaches. MMG’s breach, affecting 15 million people, is what happens without one.

4. Freeport Police Department (December 2024)

What Happened

The Freeport Police Department asked the Department of Justice for help before receiving a complaint that required an investigation. On December 19, 2024, the two entered into a Voluntary Technical Assistance Agreement, the first agreement of its kind under DOJ’s Law Enforcement Language Access Initiative (LELAI), which launched in December 2022.

What the Agreement Required

The agreement runs two years. During that time, DOJ will help Freeport develop a written language access policy, designate a coordinator to oversee it, train staff department-wide, and set interpretation protocols for different types of police encounters.

BURG’s Perspective | What This Means for You

Freeport’s agreement was the product of the DOJ’s Law Enforcement Language Access Initiative, which grew out of Executive Order 13166’s requirement that federally funded programs maintain language access plans. Executive Order 14224 rescinded EO 13166 on March 1, 2025. Freeport’s program was built under a law that’s since been rescinded. The agreement itself has not been undone.

About the BURG Brief

The BURG Brief is published quarterly by BURG Translations. Each issue tracks regulatory changes, enforcement actions, and legal developments affecting language access across healthcare, life sciences, manufacturing, and legal services.

The next issue will cover Q3 2026 developments. If a regulation or enforcement action covered in this issue is directly relevant to your organization’s current compliance priorities, contact your BURG account team.

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