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Section 1557: The Who, What, When and Why


In May 2016, the Department of Health and Human Services (HHS) issued the final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination based on race, color, national origin, sex, age or disability in certain health programs and activities. 

The final rule aims to expand access to health care and coverage and reduce health disparities by enhancing language assistance for individuals with limited English proficiency* and protecting individuals with disabilities.

*The Office for Civil Rights (OCR) defines “an individual with limited English proficiency” as a person whose primary language for communication is not English and who has a limited ability to read, write, speak or understand English

Who must comply with Section 1557?

  • Any health programs and activities that receive Federal financial assistance (excluding Medicare Part B) from HHS 
  • Any health programs and activities administered by entities created under Title I of the ACA 
  • Any health programs and activities administered by HHS

What are the requirements of Section 1557?

Enhancing Language Assistance for Individuals with Limited English Proficiency

Covered entities must take reasonable steps to provide “meaningful access” to care and coverage for individuals who are Limited English Proficient.

Specifically, these new provisions require that covered entities provide:
  • Notices of nondiscrimination in offices, on websites and in any significant publications and communications 
  • Translated taglineswhich are short statements indicating the availability of language support, in at least the top 15 non-English languages spoken in the State in which the entity is located or does business
  • Oral interpretation and written translation services at no cost to the individual and in a timely manner
  • Qualified interpreters for oral interpretation

Additionally, covered entities with 15 or more employees are required to have a grievance procedure and a compliance coordinator.

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Protecting Individuals with Disabilities

Covered entities must provide auxiliary aids and services — such as qualified sign language interpreters and video remote interpreting services  to individuals with disabilities free of charge and in a timely manner. 

When does Section 1557 take effect?

The new regulations of the final rule took effect on July 18, 2016 (60 days after its publication in the Federal Register), however, to give covered entities adequate time to come into compliance, certain parts of the rule have a delayed applicability date:

  • The deadline for provisions that require changes to health insurance or group health plan benefit design is the first day of the first plan year beginning on or after January 1, 2017
  • The deadline to comply with the requirements of nondiscrimination notices and translated taglines just passed on October 16, 2016 (90 days after the rules publication in the Federal Register)

Why is it crucial to comply with Section 1557?

The U.S. Department of Health and Human Services , Office for Civil Rights (OCR) enforces Section 1557. Covered entities that violate Section 1557 will be required to take corrective actions — such as revising policies and procedures, providing training and implementing programs for monitoring compliance. Covered entities may also be required to pay compensatory damages to individuals proven to be victims of discrimination.

Where noncompliance cannot be corrected by informal means, OCR may suspend, terminate, or refuse to grant or continue Federal financial assistance.

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