Final Rule Broadens ACA’s Nondiscrimination Protections

The U.S. Department of Health and Human Services (HHS) has issued a final rule for Section 1557 of the Affordable Care Act (ACA) that broadens protections against discrimination on the basis of race, color, national origin, sex, age, and disability with health programs and activities receiving federal financial assistance.

The final rule does not apply to employment practices, which means that public agencies cannot face employment discrimination claims brought under Section 1557 (although other federal and state laws prohibiting employment discrimination continue to apply to public agency employment).  Although Section 1557 is not an employment discrimination law, public agency employers should still be aware of Section 1557 since it relates to services provided by health insurance issuers that the public agencies may contract with.  Here are the key provisions of the Section 1557 final rule public agencies should be aware of:

• Section 1557 makes it unlawful for health care providers and health insurance issuers that receive federal financial assistance to refuse to treat or otherwise discriminate against an individual on the basis of race, color, national origin, sex, age, or disability.
• Section 1557 applies to doctors, hospitals, health clinics, health insurance issuers, state Medicaid agencies, community health centers, physicians’ practices, home health care agencies, and Covered California when these providers receive federal financial assistance.
• Section 1557 requires health insurance coverage and other health-related coverage to provide the most integrated setting appropriate to meet the needs of qualified individuals with disabilities.
• The prohibition of sex discrimination includes, but is not limited to, prohibiting discrimination on the basis of sexual orientation, gender identity, sex characteristics (including intersex traits), pregnancy or related conditions, and sex stereotypes.
• The Office for Civil Rights investigates discrimination complaints under Section 1557.

Final Rule and Interpretation: Nondiscrimination in Health Programs and Activities, 42 CFR Parts 438, 440, 457, and 460; 45 CFR Parts 80, 84, 92, 147, 155, and 156, 89 Fed. Reg. __ (May 6, 2024); Fact Sheet: Strengthening Nondiscrimination Protections and Advancing Civil Rights in Health Care through Section 1557 of the Affordable Care Act (Apr. 26, 2024); Section 1557 Final Rule: Frequently Asked Questions (Apr. 26, 2024).