Final Rule Summary on Section 1557 Non-Discrimination Regulations Under the ACA: Medical Practices Requirements

The Final Rule on Section 1557 of the Affordable Care Act (ACA), issued by the Biden Administration on April 27, 2024, reinstates and expands upon many of the 2016 regulations from the Obama Administration. This rule 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 activities. The rule went into effect on July 5, 2024, with effective compliance dates staggered for certain provisions.

The rule applies to health programs or activities that receive indirect or direct federal financial assistance from the Department of Health and Human Services (HHS), including health insurance issuers, state-based health insurance exchanges, and HHS health programs and activities. It is important to note that, for the first time, Medicare Part B is considered as receiving federal financial assistance. The rule prevents covered entities from discriminating against certain protected groups in providing health care services, insurance coverage, and program participation.

Compliance Requirements for Medical Practices

Medical practices are required to implement and enforce non-discrimination policies that align with Section 1557, such as providing notices of non-discrimination and ensuring that all staff are trained on these policies. Practices must provide oral translation services and written materials in at least the 15 most common languages spoken by people with limited English proficiency (LEP) in the state(s) served, ensuring meaningful access to health services for all patients. Medical practices must also make their facilities and services accessible to individuals with disabilities. This includes providing auxiliary aids and services, such as sign language interpreters and accessible medical equipment.

Beyond these steps, covered entities also need to establish grievance procedures to handle complaints of discrimination, including having a designated compliance coordinator to oversee the implementation of Section 1557 requirements. Practices are required to post notices of non-discrimination in conspicuous locations within their facilities and on their websites, featuring information on how to file a complaint with the Office for Civil Rights (OCR).

In order to comply with Section 1557 requirements, medical practices should provide a range of auxiliary aids and services. Examples include:

• Interpreters for individuals who are deaf or hard of hearing, either on-site or through video remote interpreting (VRI) services.
• Real-time computer-aided transcription services.
• Written materials in alternative formats, such as Braille, large print, or audio recordings.
• Assistive listening devices and systems.
• Accessible information and communication technology, such as screen reader software and magnification software.

Penalties for Non-Compliance

Penalties for non-compliance with Section 1557 can be severe. They include:

• Civil penalties ranging from $5,000 to $10,000 per violation, plus three times the amount of damages sustained by the government.
• Suspension, termination, or refusal to grant or continue federal financial assistance.
• Referral to the Department of Justice with a recommendation to bring proceedings to enforce any rights of the United States.
• Exclusion from participation in the Medicare program and state health care programs.

“Notice of Non-Discrimination” Statement

As practices work towards compliance with Section 1557, it is important to clearly post a notice of non-discrimination within their facility and on their website. The below sample can serve as a helpful starting point, keeping in mind that it should be customized based on the specific provider:

"As a recipient of federal financial assistance, (name of provider) does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, sex, or national origin, or on the basis of disability or age in admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in employment therein, whether carried out by (name of provider) directly or through a contractor or any other entity with whom (name of provider) arranges to carry out its programs and activities. This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Section 1557 of the Affordable Care Act of 2010, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84, 91, and 92."

Healthcare providers and insurers receiving federal financial assistance are obligated to comply with these regulations, making it imperative that they understand and implement the compliance measures. For more information, please refer to the HHS’s official documentation on Section 1557.

If you have any questions or would like support with healthcare regulations and compliance, please contact us to learn more.

Tamiya Williams is an Associate Director, Practice Management at Medic Management Group. MMG is a national provider of advisory and consulting competencies, transaction support services, and back office administrative support to independent and system owned physician practice groups.