Basics of Section 1557 of the Affordable Care Act

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The basics of the law are to protect individuals against discrimination on the basis of race, color, national origin, sex, age, or disability.  At first look it doesn’t look too bad unless you take time to read it and consider the cost of implementation but we are getting ahead of ourselves so let’s digest some of the details before we proceed. The first key aspect of the law is that the same only applies to health programs or activities linked to federal funds.  For example, Medicaid, all products sold in the exchanges and those Covered Entities that received payment for the implementation of healthcare technology.  In other words, participation in Medicare does not necessarily mean that you are a Covered Entity under this law nor that the same applies to you. The second key aspect is that it only applies to Covered Entities which by the law are defined as “an entity that operates a health program or activity, any part of which receives Federal financial assistance.” In short, if you receive payment from a federal agency this applies to you.  There is an actual list for this but I have omitted the same for the sake of simplicity at this time. The next key aspect is the number of employees and the potential for misunderstanding based on the same.  Let’s start with a simple statement, if you have more than 15 employees you must comply with all requirements of the law.  If you have less than 15 employees then you do not need a formal grievance procedure and a compliance coordinator. Note: I’m working on a formal grievance procedure and compliance officer actions as part of our EPI Compliance software and should have those completed by the end of the month. Key provisions include:

•  Extending protections against sex discrimination to health coverage and care for the first time and including gender identity discrimination within the definition of sex discrimination;
• Codifying long-standing guidance regarding meaningful access for individuals with Limited English Proficiency, including the provision of free, accurate, and timely language assistance services;  
• Incorporating existing law that requires reasonable modifications, effective communication, and readily accessible buildings and information technology to avoid disability-based discrimination; and
• Prohibiting discriminatory health insurance benefit designs and including specific coverage protections for transgender individuals.

Translation, you must have an action plan in order to comply with the law which we recommend include the following:

•  Assign compliance officer (if you have over 15 employees);
• Create and implement formal grievance procedure (if you have over 15 employees);
• Post Notice of Nondiscrimination and taglines for individuals with limited English proficiency;
• Post nondiscrimination statement in the top non-English language spoken;

• Covered Entity with 15 or more employees must post tag line in in the top 15 non-English languages spoken in the State in which the entity is located or conducts business;
• Covered Entity with 14 or less employees must post tag line in in the top 2 non-English languages spoken in the State in which the entity is located or conducts business;

Note: Contact us for a list of the languages that apply to your state.

•  Create protocol to include at least the tagline when communicating with the patient electronically;
• Post Notice of Non-Discrimination and taglines in your website if available;
• Include an acknowledgement of understanding of your nondiscrimination notice in your patient record;
• Develop and implement a language access plan;

Note: Currently working on a cost effective language access plan.  Should have more details by the end of the month or sooner.

•  Ensure all programs and services offered are accessible to individual with disabilities;
• .

Note: The above list is not all inclusive and additional actions may be required in order to meet the requirements of this law. We are working on cost effective solutions as it regards this new law and we plan to continue issuing guidance to assist Covered Entities with this particular requirement.  However, if you need additional information or guidance simply contact us and we will be more than happy to assist.