On February 3, 2026, the Supporting Patient Education and Knowledge Act, or the SPEAK Act, became law. It directs the U.S. Department of Health and Human Services (HHS) to issue guidance by February 2027 on language access best practices in telemedicine and related health information technology.
For health systems building and expanding telehealth programs, that deadline matters now. The systems that will be in the best position when the guidance arrives are the ones already evaluating their telehealth infrastructure through a language access lens.
After more than 14 years working on language access in healthcare, I see the SPEAK Act as a real turning point. It signals a new phase in federal attention to language access and will require health systems to make real infrastructure decisions.
What the SPEAK Act actually requires
The law requires HHS to establish a task force and develop guidance on language access best practices across five specific areas:
1. Facilitating and integrating interpreter use during telemedicine appointments.
Telehealth platforms and workflows need to support timely access to qualified medical interpreters as part of the clinical encounter, without relying on side processes or workarounds.
2. Providing accessible instructions for accessing telehealth systems for patients with limited English proficiency.
Patients must receive the information they need to access telehealth and participate in their care in their preferred language. That includes appointment access details, instructions for joining the visit, and any related guidance needed before the encounter begins.
3. Improving access to digital patient portals for LEP patients.
Most patient portals remain English-first. Partial translation, often limited to the most visible navigation elements, leaves LEP patients without the clinical information they need. Patients need meaningful access to portal content, including results, messages, care instructions, and other information necessary to navigate and manage their care.
4. Integrating multi-person video platforms to support interpretation during telemedicine appointments.
Effective remote interpretation in a telehealth setting requires more than a two-way video call. Telehealth technology must be able to accommodate the clinician, the patient, and at least one interpreter simultaneously, with reliable audio and video quality.
5. Providing patient materials, communications, and instructions in multiple languages, including text message appointment reminders and prescription information.
Language access has to start before the appointment and extend beyond it too. Services offered, staff qualifications, locations, and pre-appointment instructions need to be understood by patients and family. Also, discharge instructions, prescription guidance, and follow-up reminders must reach patients in the languages they understand.
The law also makes the language services industry a required stakeholder in the HHS consultative process. The SPEAK Act explicitly requires HHS to consult with interpreters, language service companies, patient advocates, healthcare providers, and telemedicine platform providers. That means field expertise will help shape the guidance.
The Association of Language Companies (ALC) spent several years advancing this legislation, working directly with congressional offices and providing practical input throughout the drafting process. On of the initiatives that allows representatives’ and senators’ offices to hear from our industry is the the ALC On the Hill event. This event has a wonderful opportunity that I have been part of which helped build support for the bill and has helped with others.
Why the SPEAK Act matters now
Telehealth has been available to patients with limited English proficiency for years. But in many cases, the infrastructure behind it was not built with those patients in mind.
Clinical teams regularly encounter the same pattern: the platform does not support multi-person video, the interpreter has to join via a separate call with degraded audio, or the patient portal sends automated reminders and portal messages in English only. Appointment instructions are often available only in English and, at most, Spanish.
These are infrastructure gaps with direct consequences for workflow, communication, and patient access. They exist because language access was often excluded from platform selection requirements and telehealth program design. The SPEAK Act formalizes the expectation that it should be built in.
The legislation also arrives at a specific moment in the regulatory environment.
- The Joint Commission's 2026 National Performance Goals are now in effect, with direct and indirect language access implications across multiple goals.
- Section 1557 of the Affordable Care Act continues to impose meaningful access obligations on federally funded healthcare organizations.
- The Center for Improvement in Healthcare Quality (CIHQ) accreditation expectations are increasing their focus on language access program design.
The SPEAK Act adds another clear signal in a regulatory environment that is consistently moving toward greater accountability for communication access.
The 12-month planning horizon
HHS has until February 3, 2027 to publish its guidance. For health systems already facing accreditation and compliance pressure, that timeline is a reason to act now.
The organizations best positioned when the guidance arrives will be the ones that have already begun the work: auditing their current telehealth language access infrastructure, identifying gaps against the five SPEAK Act focus areas, and developing plans to close those gaps. Guidance published in early 2027 is unlikely to leave health systems with a long runway. Organizations that wait will be forced to respond under time pressure.
Consider the practical questions your organization should be asking today:
Interpreter integration
- Does your telehealth platform support multi-person video calls that include an interpreter?
- Can a qualified medical interpreter be connected within a reasonable timeframe without disrupting the clinical encounter?
- Is interpreter access documented in the patient's record?
Patient portal access
- What percentage of your LEP patient population can navigate your patient portal in their primary language?
- Are clinical results, care instructions, and messaging available in languages beyond English?
- What is your current gap against your patient population's language needs?
Multi-language communications
- Are your appointment reminders, discharge instructions, and prescription notifications reaching LEP patients in accessible languages?
- For the highest-volume languages in your patient population, what is your current language coverage?
These are auditable questions. The answers should inform decisions now, before HHS guidance creates an external standard against which health systems may be measured.
What health system leaders should prioritize
For health systems building or refining telehealth programs, three priorities stand out.
1. Conduct a structured language access audit of your telehealth infrastructure.
Map your current state against the five areas identified in the SPEAK Act. Where are the gaps? Which are addressable in the near term, and which require platform-level decisions? The SPEAK Act provides a useful framework for this assessment even before HHS issues formal guidance.
2. Evaluate your telehealth platform's technical capacity for interpretation.
Multi-person video capability, API integration with language access platforms, and documentation automation are decisions that take time to implement. Engage your platform providers now on their language access roadmap and their capacity to support the capabilities the SPEAK Act highlights.
3. Strengthen relationships with language services partners that are engaged in the HHS consultative process.
Organizations with direct visibility into the direction of the guidance can help health systems prepare earlier and more effectively. At Martti, our experts regularly work with health systems to assess language access gaps, strengthen telehealth and digital workflows, and prepare for evolving regulatory and operational expectations. If your team is working through these questions, our experts can help you assess where to focus first.
4. Language access in telehealth is clinical infrastructure
The SPEAK Act reflects a recognition that has been building for years: language access in healthcare is clinical infrastructure. When it is missing from telehealth programs, patients with limited English proficiency of who are Deaf receive a different standard of care, and health systems carry the associated safety, compliance, and financial risk.
Patients with limited English proficiency face greater risk of communication-related adverse events, and better access to professional interpreters has been associated with lower readmission rates at key care transitions. These are documented clinical realities that telehealth programs need to account for.
The SPEAK Act gives the federal government a mechanism to establish standards in this area for the first time. That is a significant development. Health systems that treat it as a planning opportunity will be better positioned on patient outcomes, accreditation readiness, and financial performance.
HHS guidance is coming. The question is whether your organization will be ready for it.
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