In the final rule from the Department of Health and Human Services (HHS) on Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age or disabilities in certain health programs and activities, clarification on nondiscrimination requirements and new standards to implement Section 1557, particularly with respect to discrimination on the basis of sex, are provided.
While the effective date is July 18, 2016, provisions of the final rule that require changes to health insurance or group health plan benefit design have an applicability date of the first day of the first plan year, beginning on or after January 1, 2017.
The final rule applies to HHS-funded programs, which include Medicare A, C, and D plus Medicaid and other health programs, as well as HHS-administered programs, hospitals that take Medicare, doctors that take Medicaid, the Health Insurance Marketplace and its participants (issuers).
· For the most part, if a doctor participates in a Medicare B Plan, they are exempt from Section 1557, but may require compliance should they accept Medicaid.
· Covered Entities (those covered by the HHS under Section 1557), must submit an Assurance of Compliance form to the Office for Civil Rights (OCR) as proof of compliance.
· With respect to nondiscrimination requirements based on sex, the final rule defines “on the basis of sex” to include, but is not limited to, discrimination on the basis of pregnancy, termination of pregnancy, or recovery therefrom, childbirth or related medical conditions, sex stereotyping, and gender identity.
· The final rule does not include terms on discrimination based on sexual orientation. However, the final rule noted that sexual orientation is already included as a basis of discrimination as applied to most health insurance issuers and the Health Insurance Marketplaces through Centers for Medicare and Medicaid Services (CMS) regulations and Title I of the ACA. Whether sexual orientation will be included is still being evaluated.
To read the Final Rule in its entirety, click here.
