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ACA Section 1557 - Are You in Compliance?
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ATTENTION: Any practice that receives government funding (ie. Medicare Parts A, C & D [NOT B], Medicaid, Meaningful Use, etc.), you are REQUIRED to post information to be in compliance with Section 1557 of the Affordable Care Act (ACA) by Sunday, Oct. 16. All practices - regardless of practice size - are required to post the non-discrimination poster and the taglines poster, at minimum. Please read below for additional specifications regarding practices with 15 or more employees.

Section 1557 of the ACA contains an anti-discrimination provision. You may not discriminate in healthcare delivery based on a patient’s race, color, national origin, sec, age or disability. You cannot delay or deny effective language assistant services to patient with limited English proficiency (LEP). These provisions apply to all patients in the US, legally or illegally. If your practice accepts payment from any HHS program or activity or an entity that HHS funds or you accept any Marketplace plans, this applies to YOU. Medicare Parts A, C & D (not Part B!), Medicaid, Meaningful Use, etc) Patients can sue for NON-COMPLIANCE of this ruling.

Checklist - Complete no later than Oct. 16, 2016:

HHS has provided resources to aid in generating these postings including sample wording so all you have to do is make the signs:

Language Interpreting Services

Hearing Impaired Interpreting Services

AOA Resources:

Section 1557 Final Rule Information

OCR Portal

Click here to visit the portal.

Key items without reading the entire Final Ruling

  • This is the first federal civil rights law exclusively focusing on nondiscrimination in healthcare. Specifically, Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs and activities.
  • The regulations implementing Section 1557 were published on May 18, 2016.
  • With few exceptions, the regulations apply to the provision of all healthcare-related activities by entities covered by the rules. Section 1557 applies to any provider receiving federal financial assistance (“FFA”) from the Department of Health and Human Services (“HHS”), such as Medicaid and Medicare Parts A, C and D as well as grants and credits from HHS such as meaningful use payments. While care reimbursed by Medicare Part B is outside of HHS Office for Civil Rights’ (“OCR”) enforcement of the Section 1557 regulations, providers receiving other forms of HHS payments are subject to the law. As a practical matter, very few providers are not subject to the Section 1557 regulations.
  • For providers with 15 or more employees, at least one employee must be designated to coordinate the entity’s Section 1557 compliance efforts and responsibilities. Included in these responsibilities are investigations of any grievance alleging discrimination.
  • A provider with 15 or more employees must also adopt grievance procedures, affording due process to the complainant and providing a prompt and equitable resolution. Beginning Oct. 17, 2016, all entities covered by the Section 1557 regulations must post a nondiscrimination notice containing the seven required elements including how to obtain language interpretation services offered by the provider, how to file a grievance with the provider, and how to file a discrimination complaint with OCR.
  • This notice must be posted in conspicuous physical locations and a link to the notice, accessible from the entity’s website, must be conspicuous on the provider’s homepage. The content of this notice may be combined with the content of other notices if the combined notice clearly informs individuals of their Section 1557 related rights.
  • Also beginning on Oct. 17, 2016, in all “significant publications and significant communications,” providers must post the required nondiscrimination notice as well as specified taglines in at least the top 15 languages spoken by individuals with limited English proficiency in the provider’s state.
  • The term “significant publications and significant communications,” is not defined but examples include materials “targeted to beneficiaries, enrollees, applicants, or members of the public, which may include patient handbooks, outreach publications, or written notices pertaining to rights or benefits or requiring a response from an individual.” OCR has indicated it intends to interpret the term broadly while providing entities flexibility to determine which of its communications and publications pertaining to its services are significant.
  • For small-sized significant publications and, such as those printed on postcards, pamphlets and trifold brochures, providers must include a nondiscrimination statement along with taglines in the top two languages spoken by individuals with limited English proficiency in the relevant state.
  • The regulations also require that covered entities provide meaningful access to healthcare for individuals with limited English proficiency. Providers are required to offer free, accurate and timely interpretation and translation services which protect the privacy and independence of the individual. Among other prohibitions, providers shall not require an individual with limited English proficiency to provide his or her own interpreter or rely on staff members except those who are qualified to communicate directly with the individuals needing interpretation services. If utilizing a third-party service providing interpretation by video, the regulations require that such services meet standards such as high-quality video and audio transmission in real time and the availability of staff adequately trained to quickly set up and use the interpreting equipment. HIPAA compliance must also be a consideration in utilizing these services.
  • The rules also provide accessibility standards pertaining to a covered entity’s buildings and facilities as well as for activities provided electronically. Providers must make reasonable modifications to their policies, practices and procedures to avoid discrimination on the basis of disability. The regulations also require providers treat individuals consistent with their gender identity and, among other prohibitions, entities may not limit healthcare to transgender individuals based on the fact the individual’s assigned gender identity at birth differs from the one for which healthcare is sought.
  • OCR has published a sample nondiscrimination and accessibility notice form on its website. The text for the nondiscrimination statement to be included in small-sized significant publications and signification communications is also included. A sample of the tagline information to inform individuals with limited English proficiency of the availability of language assistance services is also available on the OCR website along with a table displaying OCR’s list of the top 15 languages spoken by individuals with limited English proficiency in each state.
  • The website provides the nondiscrimination notice and statement materials and the taglines translated into over 60 different languages.
  • OCR has also published a model Section 1557 grievance procedure online. Section 1557-related fact sheets and training materials are available on OCR’s website. The new Section 1557 regulations are expected to apply to nearly every entity providing healthcare.
  • Legal counsel should be consulted regarding steps to take for compliance.

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