Final Rule Implementing Section 1557 of the Affordable Care Act: What All Health Care And Coverage Providers Need To Know

All health care providers, programs, and insurers that receive funding from the Department of Health and Human Services need to immediately comply with the requirements imposed by Section 1557 of the ACA.  (Covered insurance companies and group health plan providers have until January 1, 2017 to come into compliance).  Section 1557 was implemented on July 18, 2016, and it prohibits discrimination based on race, color, national origin, sex, age, or disability in federally-funded health programs.  It is the first federal civil rights law to prohibit discrimination based on sex in such programs.  This article will focus on what is needed to comply with the gender and language-related aspects of Section 1557.

What Is Required

Under Section 1557, affected providers and insurers may not deny care or coverage based on gender, gender identification, or pregnancy.  In addition, covered programs and activities must treat individuals consistent with their gender identification.  While the rule does not include a religious exemption, it does not displace existing protections for religious freedom and conscience.

Covered entities are also required to take reasonable steps to provide meaningful access to non-English speakers likely to be encountered in their territory.  This may require looking into local demographics and program statistics.  Covered entities are encouraged to develop and implement a comprehensive language access plan consistent with the rest of the Act.

Procedural Requirements

Grievance Procedure: All covered entities with 15+ employees must have a grievance procedure and compliance coordinator.  For some, this may prove to be an expensive addition to operating costs.  Grievance procedures typically impose timing requirements not only for the complainant, but for the group’s response as well.  Compliance coordinators need to know the company’s policies, standards, and rules inside and out.  They must also receive training in the new grievance procedure and know the requirements for the coordinator and for the complainant.

Language Notices: In addition to implementing a grievance procedure, covered entities are also required to provide notices and taglines advising patients and consumers of the availability of free language assistance services.  The taglines must be provided in the top 15 non-English languages spoken in the State.

Health care and coverage providers need to immediately move into compliance with the requirements of Section 1557.  The rule allows violations to be directly challenged in federal court.  To avoid unnecessary litigation fees and costs, become familiar with the new requirements and avoid any delay in making the necessary additions.