ACA Section 1557 Ruling – New Protections Against Discrimination in Health Care

On April 26, 2024, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA). 

“Today’s rule is a giant step forward for this country toward a more equitable and inclusive health care system and means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS,” said Secretary Xavier Becerra. “I am very proud that our Office for Civil Rights is standing up against discrimination, no matter who you are, who you love, your faith or where you live. Once again, we are reminding Americans we have your back.”

“Section 1557 is critical to making sure that people in all communities have a right to access health care free from discrimination. Today’s rule exemplifies the Biden-Harris Administration’s ongoing commitment to health equity and patient rights,” said OCR Director Melanie Fontes Rainer. “Traveling across the country, I have heard too many stories of people facing discrimination in their health care. The robust protections of 1557 are needed now more than ever. Whether it’s standing up for LGBTQI+ Americans nationwide, making sure that care is more accessible for people with disabilities or immigrant communities, or protecting patients when using AI in health care, OCR protects Americans’ rights.”

“CMS is steadfast in our commitment to providing access to high-quality, affordable health care coverage for millions of people who represent the vibrant diversity that makes America strong,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s rule is another important step toward our goal of health equity – toward the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health.”

Highlights follow:

  • HHS’ health programs and activities will be held to the same nondiscrimination standards as recipients of Federal financial assistance.
  • The Department will now consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the Department. 
  • Covered health care providers, insurers, grantees, and others, are required to proactively communicate with patients that language assistance and accessibility services are available at no cost.
  • Telehealth activities must be accessible to individuals with limited English proficiency and those with disabilities are to be offered on covered health programs. 
  • Codifies Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
  • Respects federal protections for religious freedom and conscience. Recipients can now rely on those protections or seek assurance of them from HHS.
  • Respects clinical judgement of health care providers.
  • Protects patients from insurers discriminating health insurance benefit designs.
  • Clarifies the application of Section 1557 nondiscrimination requirements to health insurance plans.
  • Requires covered individuals to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care.

The Final Rule may be viewed or downloaded at: https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html  Measures will advance protections against discrimination in health care because all people deserve safe, culturally competent, and free from discrimination.

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