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On July 25, the Department of Health and Human Services (HHS) released a proposed rule interpreting Section 1557 of the Affordable Care Act (ACA). It prohibits federally funded health care programs or activities from discriminating on the basis of race. skin color, national origin, gender, age, or disability. Section 1557 has a long and complicated history of rulemaking, revocation, and legal challenges. With this proposed rule, the Biden administration seeks to revive and expand Obama-era health care non-discrimination rules that have been amended or repealed by the Trump administration and have been repeatedly litigated in federal court.
The broad proposal is described as part of the Biden administration’s agenda to promote health equity and civil rights. If finalized as proposed, this broad proposal would look like this:
- Apply Section 1557 broadly to all entities receiving federal financial assistance, including:
- If a health insurance issuer is subject to section 1557 for: Any Your business must comply with Section 1557. all Business activities, including acting as a third-party administrator of employer schemes.
- For the first time, health care providers paying for outpatient services through Medicare Part B are subject to the requirements of Section 1557.
- Codify provisions prohibiting discrimination based on sexual orientation and gender identity (consistent with the Biden administration’s 2021 announcement that it would implement Section 1557, consistent with a 2021 Supreme Court ruling). match) Bostock vs. Clayton County (140 S. Ct. 1731 (2020)), held that discrimination “based on sex” includes discrimination based on sexual orientation or gender identity.
- Health coverage is discriminatory, including categorical coverage exclusions or limitations for all health services related to gender reassignment, or specific benefit designs that prioritize institutional care over home or community living for people with disabilities. Clarify that you cannot use benefits design, provider networks, or marketing;
- Re-establishes the requirements for entities covered by Section 1557 to distribute non-discrimination notices and language assistance availability notices (often referred to as “taglines”).
- Increase assistance requirements for individuals with limited English proficiency (LEP).
- Develop a formal process by which individuals and entities subject to section 1557 may seek exceptions to section 1557 under the federal Freedom of Conscience and Religious Act.
- Clarify the application of Section 1557 to technological innovations such as telemedicine, clinical algorithms, and “machine translation” (i.e., language translation performed by algorithms without human oversight).
- Request a written compliance policy and grievance procedure for Section 1557 regulations.When
- We request comment on how Section 1557 applies to the determination and valuation methodologies of health insurance provider networks.
If finalized as proposed, the revised Section 1557 standards would allow patients, health care providers, payers, and health care providers and payers to pay for products and services such as software-based clinical decision support and translation aids. This can have a significant impact on third parties who contract with you.Any comments on the proposed rule should indicate that the rule is Federal Gazetteis scheduled for August 4.
