Which Medicare programs are covered by 1557?
Section 1557 of the ACA, and the Department’s implementing regulation, apply to:
- All health programs or activities that receive HHS funding;
- All health programs or activities administered by HHS itself (e.g., by the Centers for Medicare & Medicaid Services or the Substance Abuse and Mental Health Services Administration); and,
- The Health Insurance Marketplaces and plans offered by issuers that participate in those Marketplaces.
Who must comply with Section 1557?
operations are considered part of the health program or activity, and must be in compliance with Section 1557 (e.g., a hospital’s medical departments, as well as its cafeteria and gift shop). The rule does not apply to employment practices such as hiring or firing , except that covered
What is the Affordable Care Act supposed to do?
“What the Affordable Care Act was intended to do was to bring everyone into a relatively low deductible, low co-pay health insurance policy that was going to cover the vast majority of their...
Is Affordable Care Act really affordable?
The Affordable Care Act (ACA) is designed to make insurance affordable for Americans with low and moderate incomes—particularly since it requires all Americans to have health insurance starting this year, or face financial penalties.
When was Section 1557 added to the Affordable Care Act?
On June 19, 2020, the Trump Administration issued final regulations implementing Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance.
What does Section 1557 of the Affordable Care Act apply to?
The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or ...
What is Section 1557 and the 2020 Final Rule?
The Trump administration issued a revised final rule in 2020, significantly narrowing many of the protections provided by section 1557 under the 2016 rule. Unlike the 2016 rule, the 2020 rule considered sex discrimination to only be discrimination based on gender assigned at birth.
Which entity enforces Section 1557 for program that receive funding from on are administered by HHS?
Section 1557 has been in effect since its enactment in 2010 and the HHS Office for Civil Rights (OCR) has been enforcing the provision since it was enacted.
Which Medicare programs are covered by the Affordable Care Act Section 1557?
Federal financial assistance includes grants, property, Medicaid, Medicare Parts A, C and D payments, and tax credits and cost-sharing subsidies under Title I of the ACA. (Medicare Part B is not included.)
Which Medicare programs are covered by the ACA Section 1557?
Medicare Advantage Plans Entities that receive reimbursement from an MA plan (including dental practices) must comply with Section 1557. Funds provided under the Medicare program (except for funds provided under Medicare Part B) constitute Federal financial assistance.
Which Medicare programs are covered by ACA Section 1557 quizlet?
health plans sold through the ACA Marketplaces only. Which Medicare programs are covered by ACA Section 1557? a. Part C (Medicare Advantage) only.
Does Section 1557 apply to self insured employee benefit plans?
Sponsors of self-funded plans, in particular, may conclude that Section 1557 is inapplicable to them, but they should tread carefully as if even one part of the program receives federal financial assistance, the entire program is subject to the rule and the plan sponsor is a covered entity.
Which Medicare programs are covered by ACA Section 1557 quizlet?
health plans sold through the ACA Marketplaces only. Which Medicare programs are covered by ACA Section 1557? a. Part C (Medicare Advantage) only.
What protections does the Patient Protection and Affordable Care Act provide to consumers with disabilities?
Section 1557 of the ACA prohibits discrimination based on disability, race, color, national origin (including limited English proficiency), sex, and age and is consistent with established federal civil rights laws.
What is the proposed rule for health insurance?
The proposed rule prohibits discrimination in health insurance coverage on the basis of race, color, national origin, sex, age, or disability. Among other things, this means that an issuer that participates in the Marketplace cannot deny, cancel, limit, or refuse to issue or renew any of its insurance policies or employ marketing practices or benefit designs that discriminate on any of these bases. The Marketplaces themselves must also operate in a nondiscriminatory way. And hospitals and certain other health care providers that receive federal financial assistance from HHS are also accountable for discrimination in the health plans they offer to their employees.
What is the HHS rule?
The Department of Health and Human Services (HHS) has issued a proposed rule to advance health equity and reduce disparities in health care. The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access ...
What is the proposed rule for OCR?
The proposed rule adopts the longstanding principle that covered entities must take reasonable steps to provide meaningful access to individuals with limited English proficiency. In determining what the standard requires, OCR will evaluate each case on its facts, including the nature of the communication, and, as applicable, how often the entity encounters individuals who speak the language at issue and the resources of the entity.
What is the proposed rule for auxiliary aids?
Consistent with existing requirements, the proposed rule also requires covered entities to provide effective communication for individuals with disabilities by providing access to auxiliary aids and services, including alternative formats and sign language interpreters, unless the entity can show an undue burden or a fundamental alteration. The notice that covered entities must post provides information about these services as well. The proposed rule also incorporates familiar requirements related to the accessibility of facilities and technology and requires reasonable modifications of policies and practices where necessary to provide equal access for people with disabilities.
Does the proposed rule apply to Medicare?
The proposed rule applies to any health program or activity, any part of which receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients. It applies to any health program that HHS itself administers. And it applies to the Marketplaces and to all plans offered by issuers that participate in those Marketplaces.
Can you be denied health care based on gender?
Individuals cannot be denied health care or health coverage based on their sex, including their gender identity. Individuals must be treated consistent with their gender identity, including in access to facilities. Sex-specific health care cannot be denied or limited just because the person seeking such services identifies as belonging ...
Is HHS covered by the 1557 rule?
And it provides that HHS’s health programs are covered by the rule. The proposed rule explains consumers’ rights under the law and provides clarity to covered entities about their obligations. Section 1557 has been in effect since its enactment in 2010 and the HHS Office for Civil Rights (OCR) has been enforcing the provision since it was enacted.
Limits Application of Section 1557
The Final Rule drastically limits the application and scope of Section 1557 by eliminating the definition of “covered entities” under the 2016 Rule. Under the Final Rule, Section 1557 applies to programs or activities administered under Title I of the ACA and to entities:
Eliminates Explicit Protections for Gender Identity, Sexual Orientation, and Abortion Under Section 1557
Section 1557 prohibits discrimination on the basis of sex. The 2016 Rule defined “sex” to include “gender identity,” “sex stereotyping,” and “termination of pregnancy,” thereby expanding Section 1557 anti-discrimination protections to transgender individuals and individuals who terminated pregnancies.
Adopts an Explicit Religious Exemption to Section 1557
The Final Rule adds explicit abortion and religious exemptions for entities subject to Section 1557 by stating that Section 1557 must comply with a series of “healthcare conscious laws,” the Religious Freedom Restoration Act, and the First Amendment.
Impact on Employers
Under the Final Rules, insurers no longer have to comply with Section 1557 for the group health plans they offer simply because they receive federal funding in a different line of business. This may result in insurers offering plans with less protections for transgender individuals and abortions.
Additional Resources
Disclaimer: This content is intended for informational purposes only and should not be construed as legal, medical or tax advice. It provides general information and is not intended to encompass all compliance and legal obligations that may be applicable.
When did the 1557 rule take effect?
Section 1557’s protections took effect when the ACA was enacted on March 23, 2010. Implementing regulations issued by HHS under the Obama Administration became effective on July 18, 2016. 9. Figure 1: Key Dates in Section 1557 Implementation. The provisions of the 2016 rule that included gender identity and termination of pregnancy in ...
What is HHS 1557?
Background and HHS’s Rationale for Changes. Section 1557 incorporates protections from existing civil rights laws. These include Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975, and Section 504 of the Rehabilitation Act of 1973 ...
What are the HHS regulations for Medicaid?
HHS characterizes these changes as “limited conforming amendments.” 26 These regulations include those that govern Medicaid managed care entities, state Medicaid programs, PACE organizations, group and individual health insurance issuers, Marketplaces, qualified health plan issuers, agents and brokers that assist with Marketplace applications and enrollment, and education programs that receive federal financial assistance. In the past, these regulations, some of which had been in place for several years, provided explicit protections against discrimination based on sexual orientation and gender identity. Without these protections, Medicaid managed care entities could discriminate against LGBTQ beneficiaries in policies authorizing covered services, and PACE organizations could refuse to serve someone based on their sexual orientation, for example. 27
What regulations remove discrimination based on gender identity and sexual orientation?
Beyond the Section 1557 regulations, HHS removes prohibitions on discrimination based on gender identity and sexual orientation in ten other Medicaid, private insurance, and education program regulations (Table 2).
What is the 1557 rule?
Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Notably, it is the first federal civil rights law to prohibit discrimination in health care based on sex. The final rule, issued in the midst of the ongoing COVID-19 ...
How much will HHS save in 1557?
HHS projects that all of its proposed Section 1557 changes will result in approximately $2.9 billion in undiscounted cost savings over the first five years after implementation, primarily from eliminating the notice and tagline requirements.50 HHS says that its original cost projections for the notice and tagline requirements did not account for approximately $585 million in additional average annual costs over the next five years. 51
What is Eliminating Provisions?
Eliminating provisions affirming the right of private individuals to challenge alleged violations of Section 1557 in court and obtain money damages (leaving the right to sue for courts to decide) and requirements for non-discrimination notices and grievance procedures;
What is the 1557 law?
Section 1557 of the Affordable Care Act, [2] the first health care-specific anti-discrimination provision in federal law, has been in the news again recently. The law and its regulations have had a complicated history, and the situation is still dynamic.
What state issued a nationwide injunction on this part of the 2016 regulations before it went into effect?
A federal district court in Texas issued a nationwide injunction on this part of the 2016 regulations before it went into effect. [4]
What changes did HHS make to the grievance policy?
First, they deleted the 2016 requirement of a grievance policy and a 1557 coordinator. Second, they removed the right to sue based on 1557 regulations. But HHS did acknowledge that a right to sue under the statute itself remains in place.
What are the changes to the LEP regulations?
The 2020 regulations made huge changes. First, they changed the regulatory focus from individual patients to the overall handling of the LEP population. They stated that when language services are required, they must be free, accurate and timely, and preserve the privacy and independence of the LEP individuals. To determine whether language services would be required, the 2020 regulations adapted guidance from 2003 to call for a 4 factor test that deemphasized nature of the communication and focused on the number/proportion of LEP eligible/likely to be served; frequency of contact; nature/importance of program/activity; and resources & costs.
What is the 2020 ADA?
The 2020 regulation set omitted “acquisition or modification of equipment and devices; and other similar services and actions” from the list of examples of appropriate auxiliary aids and services. The 2020 regulations left in place the 2010 ADA Standards for Accessible Design, and did not adopt additional exemptions for multi-story building elevators and TTY standards. And the 2020 regulation set maintained the 2016 “reasonable modification” standards.
What are the 2016 regulations?
The 2016 regulations had covered essentially all health insurers, prohibiting discriminatory denials, cancellations, limitations, refusals to issue or renew policies, denials and limitation of claims, imposition of discriminatory limitations/restrictions on coverage, and discriminatory marketing practices or benefit design.
When will the new regulations come out for Biden?
The Biden HHS has promised new regulations, but if they follow the timing pattern set by both the Obama and Trump Administrations, we should not expect them until 2024.
Section 1557 Developments: How We Got Here
Section 1557 is the Affordable Care Act’s (ACA’s) chief nondiscrimination provision and prohibits health programs or facilities that receive federal funds from discriminating based on race, color, national origin, age, disability, or sex.
Next Steps
OCR will ultimately want to revisit the Trump-era rule on Section 1557 and formalize its new interpretation of sex. Future rulemaking should be expected. In the meantime, complaints can inform a future rule, guidance, or enforcement position.
What is the 1557 rule?
Section 1557 makes it unlawful for any health care provider who receives funding from the federal government to refuse to treat an individual—or to otherwise discriminate against the individual—based on race, color, national origin, sex, age or disability. It builds upon longstanding nondiscrimination laws and provides some new civil rights protections. As such, many of the rule’s provisions will be familiar to physicians while others may require physicians to implement new policies and procedures. Covered physicians are strongly encouraged to review the final rule in its entirety.
How many employees are required to coordinate 1557?
Covered physician practices employing 15 or more individuals must designate at least one employee to coordinate its Section 1557 compliance efforts. This coordinator must investigate any grievance communicated to the practice alleging non-compliance with the final rule.In addition, covered practices employing 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and that provide for the prompt and equitable resolution of grievances alleging any action that would be prohibited by the final rule.14
Introduction
Background and HHS’s Rationale For Changes
- Section 1557 incorporates protections from existing civil rights laws. These include Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975, and Section 504 of the Rehabilitation Act of 1973 (disability). Notably, Section 1557 is the first federal civil rights law to prohibit discrimination on t…
Key Changes in The Trump Administration’S Final Rule
- Sex Discrimination
In the final rule, HHS eliminates entirely Section 1557’s regulatory definition of sex discrimination, as defined by the 2016 rule to include gender identity and sex stereotyping. The preamble notes that, while HHS “declines to replace it with a new regulatory definition. …the final rule reverts to, … - Non-Discrimination in Health Coverage
In addition to the specific gender identity provisions discussed above, HHS also eliminates the entire regulation prohibiting discrimination in health insurance issuance, coverage, cost-sharing, marketing, and benefit design. Under the 2016 regulations, covered entities were prohibited fro…
The Supreme Court’S Bostock Decision and Legal Challenges to The Final Rule
- Just after the Administration published its final rule in June 2020, the Supreme Court decided Bostock v. Clayton County, Georgia, a sex-based employment discrimination case with implications for Section 1557. In Bostock, the Court found that Title VII of the Civil Rights Act of 1964 protects employees against discrimination because of their sexual orientation or gender id…
Looking Ahead
- The final rule, issued in the midst of the ongoing COVID-19 pandemic, substantially narrows, and in many cases entirely eliminates, the prior regulations’ existing nondiscrimination protections in meaningful ways. Section 1557 sought to standardize the protections and processes that prohibit discrimination in health care for all protected populations. Section 1557 also recognizes intersect…