Final rules implementing Section 1557 of the Affordable Care Act was published on May 18, 2016, and go into effect on July 18, 2016. However, any changes to applicable health insurance or group health plan benefit design will not be required to go into effect until January 1, 2017.

Section 1557 applies to state-based Marketplaces and as the federal Health Insurance Marketplace, as well as those health programs administered by the Department of Health and Human Services (HHS), and entities established under Title I of the ACA.

Under Subpart B, titled “Nondiscrimination Provisions,” the final rules provide:

“An individual shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any health program or activity to which this part applies.”

While that may seem like previously understood language, with regard to the Affordable Care Act, it’s been questioned about where Section 1557 applies within specific health programs. This is especially necessary to specify in terms of gender, disability and English proficiency. The final rules provide details regarding the implementation of the nondiscrimination rule, including notice, accessibility, and enforcement.

Commenters also raised questions regarding some of definitions. Commenters have questioned where immigration status falls within understanding an individual’s national origin and rules governing that form of discrimination. The Office of Civil Rights (OCR) and HHS, who co-published the final rules, response is as follows:

“An individual’s national origin is not the same as her citizenship or immigration status, and neither Title VI nor Section 1557 explicitly protects individuals against discrimination on the basis of citizenship or immigration status. However, as under Title VI, Section 1557 and this part protect individuals present in the United States, whether lawfully or not, who are subject to discrimination based on race, color, national origin, sex, age, or disability.”

Additionally, commenters suggested the importation of a blanket religious exemption into the final rule, which was declined by the OCR and HHS. The reasoning appears to be based on the existing Federal law with respect to religious beliefs, particularly with regard to the provisions of certain health-related services.

While the OCR and HHS received many comments and suggestions for improving Section 1557, the final rule is clear in its intent that nondiscrimination will be exercised within health programs from the scope of their service (i.e., to whom they are servicing) as well the health plans offered.

To read the details of Section 1557, click here.,