The information included in this issue of Risk E-Notes is intended to provide members with a few of the procedural requirements impacting Covered Entities under Section 1557 of the Affordable Care Act (ACA). It is not intended as exhaustive or comprehensive treatment of this subject or as legal advice.
What is Section 1557?
On May 13, 2016, the Department of Health and Human Services (HHS) issued a final rule that implements Section 1557 of the Affordable Care Act (ACA). Section 1557 is the nondiscrimination provision of the ACA, and builds on prior federal civil rights laws to prohibit sex discrimination in healthcare. Under the rule, individuals are protected from discrimination in health care on the basis of race, color, sex, age, national origin, or disability in certain health programs or activities. It also includes important protections for individuals with disabilities and enhances language assistance for people with Limited English Proficiency (LEP).
Who does the final rule apply to?
This rule applies to those physicians who provide or administer health-related services or insurance coverage and receive "federal financial assistance." Federal financial assistance includes Medicare, Children's Health Insurance Program, Medicaid, meaningful use payments, HHS grants, Centers for Medicare and Medicaid Services gain-sharing demonstration projects, federal premium and cost-sharing subsidies, etc. The rule does not apply to physicians who participate only in Medicare Part B, unless they are also receiving meaningful use incentive payments.
How must covered entities comply with the requirements?
- By October 19, post a notice of nondiscrimination and taglines in the top 15 languages spoken by individuals with LEP in their state, indicating the right to receive language assistance services. Although HHS doesn’t dictate where to post this information, CAP suggests posting the notice using a variety of acceptable formats, such as on a poster in the waiting room, exam rooms, in the welcome packet, and on the practice's website.
- Develop and implement a language access plan.
- Covered entities with 15 or more employees are required to adopt a grievance policy and designate a compliance coordinator. A designated compliance officer could be your office manager, practice manager, senior staff, HIPAA Privacy Officer, or yourself.
- Submit an assurance of compliance form to Office for Civil Rights (OCR).
Must the covered entities provide foreign language interpreters?
There are mandates, both from state and federal government, to provide, or at least offer to provide, foreign language qualified interpreters to patients who need them. Covered entities are required to take reasonable steps to ensure meaningful access to each individual with LEP to services the physician provides, at no cost to the LEP person. Some commercial services such as those offered at www.certifiedlanguages.com may be of assistance to physicians. [Note: CAP does not endorse any specific vendor.]
What is the grievance process?
If your patients feel they have been subject to discrimination in healthcare or health coverage, they may file a complaint of discrimination under Section 1557. They can visit OCR’s website at www.hhs.gov/ocr to file a complaint or to request a complaint package, or call OCR’s at 800-368-1019 or 800-537-7697 (TDD) to speak with someone who can answer their questions and guide them through the process. The OCR’s complaint forms are available in a variety of languages.
This article is a summary of HHS' Final Rule on Nondiscrimination in Health Programs and Activities.
This article from the California Medical Association (CMA) summarizes the legal requirements and provides the following important links:
As additional information becomes available, CAP will provide more detailed instructions about how physicians may comply with this rule.
This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.