The U.S. Department of Health and Human Services (HHS) announced on May 10 that its Office for Civil Rights (OCR) will begin enforcing Section 1557 of the Affordable Care Act to prohibit discrimination based on sexual orientation and gender identity. Found inside – Page 19-19The rule became final, with an effective date of July 18, 2016: 81 Fed. ... Proceedings in Challenge to ACA Section 1557 Nondiscrimination Regulations (Aug. Covered providers and payors should still consider the need for earlier compliance, since the proposed rules are likely to influence court decisions in the Section 1557 litigation. The HHS goal with the proposed rule is to remove what the department views as redundancies and inconsistencies with other laws, as well as reduce . Found insideThis book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout. The proposed changes paradoxically pose significant risks to those the law is intended to protect, including LGBTQ On Friday, June 12, 2020, the Department of Health and Human Services (HHS) released a rule change to Section 1557 of the Affordable Care Act (ACA) to eliminate all protections from discrimination for transgender and non-binary people by changing the definition of gender to a "binary of male and female". The purpose of this bulletin is to inform hospitals and health systems of significant changes to the regulations implementing section 1557, the nondiscrimination provision of the Affordable Care Act (ACA). Explicit categorical exclusions in coverage for all health care services related to gender transition are facially discriminatory. By: HUB's EB Compliance Team. However, under the 2020 Final Rule, HHS clarifies that providing health insurance is not a . Section 1557 is a "non-discrimination" provision that broadly prohibits . , Section 1557 prohibits discrimination on the basis of race, color, national origin, disability, age, and sex in health programs and activities that receive federal financial assistance. Section 1557 is the first federal civil rights law to prohibit discrimination on the basis of sex in health care. The proposed rule also incorporates familiar requirements related to the accessibility of facilities and technology and requires reasonable modifications of policies and practices where necessary to provide equal access for people with disabilities. Sec. By Nina Youngstrom HHS has scrapped some of the compliance requirements in its final rule on Sec. Removing gender identity and sex stereotyping from the definition of prohibited sex-based discrimination could allow health care providers to refuse to serve individuals who are transgender or who do not conform to traditional sex stereotypes. For example, a provider may not deny an individual treatment for ovarian cancer, based on the individual’s identification as a transgender man, where the treatment is medically indicated. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 The final rule also eliminates the provision that prohibits a health plan from categorically or automatically excluding or limiting coverage for health services related to gender transition. HHS Finalizes Sweeping Changes to Section 1557 Nondiscrimination Regulations. This new edition updates and expands the first. Background Information on Proposed Rule Change on Section 1557 of ACA • Section 1557 of the ACA forbids sex discrimination in federally-funded health programs and activities. The new Section […] Neither the 2020 final rule nor the 2016 rule recognizes discrimination on the basis of sexual orientation alone as a prohibited form of sex-based discrimination.16. Other cases challenging the Trump Administration’s Section 1557 final rule are pending. Found insideIn Health Care at Risk Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality ... Follow @SArtiga2 on Twitter The changes eliminate Section 1557 rule-specific enforcement provisions, and instead adopt the enforcement mechanisms available under the four statutes underlying the rule - Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, or Section 504 of the Rehabilitation Act of 1973. Follow @mmusumec on Twitter Found inside – Page 19-18[HHS Fact Sheet,
... , and Found insideLaws and regulations affect the daily lives of businesses and citizens. The final rule limits the scope of which entities are "covered" - and so must comply - with the rule. Found insideThis book contains: * A description of the institutions, procedures and criteria used by eight countries for assessing technologies for public insurance coverage * An analysis of the role of interest groups, and of the public interest, in ... The 2016 1 Section 1557 is the primary anti-discrimination provision in the ACA and prohibits health programs from discriminating against patients on the basis of race, color, national origin, sex, age or disability. In May 2019, the U.S. Department of Health and Human Services (HHS) proposed revisions to regulations under Section 1557, the nondiscrimination provision of the Affordable Care Act. In addition, it removes specific provisions that required covered entities to treat individuals consistent with their gender identity. Found inside – Page 4-59... they were negatively impacted by the changes to the program in comparison to other enrollees, their Section 1557 claim must be dismissed.228 Similarly, ... Relying in part on Bostock, two federal district courts have issued nationwide preliminary injunctions preventing the Administration from implementing parts of the Section 1557 final rule. On September 2, 2020, the DC federal district court blocked the Administration from implementing provisions excluding sex stereotyping from the definition of sex discrimination as well as from incorporating a blanket religious exemption from sex discrimination claims in Whitman-Walker Clinic v. HHS, a case brought by health care and social service providers who serve LGBTQ people and LEP people. . The final rule continues to apply to health care providers, such as physicians’ practices, hospitals, nursing homes, and organ procurement centers that receive federal funds such as Medicare (excluding Part B57) or Medicaid payments; health-related education and research programs; state Medicaid, CHIP, and public health agencies; and state-based Marketplaces.58. On June 19, 2020, the Department of Health and Human Services (HHS) finalized revised regulations implementing Section 1557 of the Affordable Care Act (ACA),1 which prohibits discrimination in health care based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance.2 The final rule (which mirrors a proposed rule issued by HHS in June of last year3) is a significant departure from the Obama Administration regulations issued in 2016. Found insideCommunities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. Found inside – Page 1978Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. The final rule extends nondiscrimination protections to individuals enrolled in coverage through the Health Insurance Marketplaces and certain other health coverage. In determining what the standard requires, OCR will evaluate each case on its facts, including the nature of the communication, and, as applicable, how often the entity encounters individuals who speak the language at issue and the resources of the entity. The court also found that HHS should have incorporated Title IX’s blanket abortion and religious exemptions into its Section 1557 regulations. Sex-specific health care cannot be denied or limited just because the person seeking such services identifies as belonging to another gender. Overall, the proposed rule ensures consumers have the equal access to health care and health coverage provided by the Affordable Care Act. In the final rule, HHS eliminates entirely Section 1557’s regulatory definition of sex discrimination, as defined by the 2016 rule to include gender identity and sex stereotyping. Issued by the Obama administration in 2016, these rules implement Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability. When it takes effect, hospitals, clinics and other covered entities won't have to post nondiscrimination notices or send taglines to patients with limited English proficiency (LEP . Finally, regardless of the outcome of these challenges, the final rule does not prohibit states from outlawing health care discrimination on the basis of gender identity, sexual orientation, or other grounds beyond those recognized under federal law,74 as several states already have done.75. This practical guide helps you strategize about how to design your employee health plans to satisfy ACA requirements; design your workforce to minimize penalty exposure; achieve significant cost-savings; understand new notice requirements; ... In issuing its June 2020 final rule, HHS under the Trump Administration stated that its changes were needed to “address legal concerns,” relieve costs and regulatory burden, and reduce confusion, because it now views the regulations as inconsistent with or duplicative of other civil rights provisions.14 In support of its changes, HHS cited the Franciscan Alliance decision, though HHS’s changes to the regulations go beyond the issues raised in that case. HHS Proposes Revisions to ACA Section 1557 Regulations. And it provides that HHS's health programs are covered by the rule. Section 1557 of the Patient Protection and Affordable Care Act (42 USC 18116) and its implementing regulation provide that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 U.S.C. Nationwide preliminary injunctions issued by federal district courts in NY and DC prevent the Administration from implementing provisions removing sex stereotyping from the rule’s definition of sex discrimination, and the NY court is now considering whether to expand its preliminary injunction to block additional provisions of the rule in light of Bostock. HHS believes that the 2020 Final Rule will enhance compliance, relieve billions of dollars in undue regulatory burdens, reduce provider and public confusion, and help clarify the scope of Section 1557. This latest rule change represents HHS acting on those court rulings, which the agency said were binding. Specifically, the court found that HHS should have limited its regulatory definition of sex discrimination to a binary definition encompassing biological differences between males and females. __ (__, 2019); Fact Sheet: HHS Proposes to Revise ACA Section 1557 Rule. Background and HHS's Rationale for Changes. A transgender man and health and social service providers serving LGBTQ and LEP people filed a case in Massachusetts federal district court (Boston Alliance of Gay, Lesbian, Bisexual & Transgender Youth v. HHS), and a group of 23 states led by New York filed a case in the Southern District of New York (NY v. HHS). Specifically, the Administration said that it “continues to expect that a holding by the U.S. Supreme Court on the meaning of ‘on the basis of sex’ under Title VII will likely have ramifications for the definition of ‘on the basis of sex’ under Title IX [as] Title VII case law has often informed Title IX case law.”65 However, HHS also noted that the “binary biological character of sex (which is ultimately grounded in genetics) takes on special importance in the health care context” and asserted that “[t]hose implications might not be fully addressed by future Title VII rulings even if courts were to deem the categories of sexual orientation or gender identity to be encompassed by the prohibition on sex discrimination in Title VII.”66 Rather than revisiting its revised Section 1557 rule in light of Bostock after the Court issued its decision, the Administration argued that Bostock’s “holding was limited to Title VII” and the case‘s “applicability to contexts outside of employment discrimination is a question for future courts to decide.”. The proposed rule makes clear HHS’s commitment, as a matter of policy, to banning discrimination based on sexual orientation, and requests comment on how a final rule can incorporate the most robust set of protections against discrimination that are supported by the courts on an ongoing basis. While the controversy over Section 1557's application to gender identity is likely to be decided by the Supreme Court, other revisions are likely to have a large impact, in particular the decisions to eliminate the . HHS is seeking feedback and public comment on the proposed rule. While the Department contends these changes are positive and will result in a cost savings of $2.6 billion over the next 5 years, many civil rights groups contend the changes are detrimental to vulnerable individuals. The Department of Health and Human Services ("HHS") announced on June 12, 2020, as part of a new final regulation (the "Final Rule"), that it had eliminated Obama-era nondiscrimination rules under Section 1557 of the Affordable Care Act ("ACA") that defined the term "on the basis of . Please take the time to make your voice heard. The proposed rule also requests comment on whether Section 1557 should include an exemption for religious organizations and what the scope of any such exemption should be. Washington, D.C. 20201 Eliminating prohibitions against discrimination based on gender identity and sexual orientation in ten other federal health care regulations outside Section 1557. The changes were scheduled to take effect on August 18, 2020, but a Supreme Court ruling in Bostock v Clayton County, Georgia,4 issued just days after the final regulation was released, found that discrimination based on sex encompasses sexual orientation and gender identity in the context of employment. The remaining provisions of the Trump Administration’s final rule remain in effect. For example -. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Opens in a new window. Figure 1 presents a timeline of key dates in Section 1557 implementation, including the development and revision of regulations and subsequent legal challenges. HHS's change to the rules implementing Section 1557 will have many effects felt in the healthcare and insurance industries. The notice that covered entities must post provides information about these services as well. Purpose. TTD Number: 1-800-537-7697, Content last reviewed on November 12, 2015, U.S. Department of Health & Human Services, Civil Rights for Individuals and Advocates, has sub items, Civil Rights for Individuals and Advocates. Introduction to Section 1557 Section 1557 is the nondiscrimination provision of the ACA and prohibits discrimination on the basis of race, color, national origin, sex, age, and disability. As the DC court noted when issuing its preliminary injunction, the Supreme Court in Bostock “expressly assumed that ‘sex’ [in Title VII] ‘refer[red] only to biological distinctions between male and female.”68 Notably, the Supreme Court went on to conclude that “it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.”69 The DC acknowledged that other federal courts, both pre- and post-Bostock have concluded that sex discrimination under Title IX includes gender identity, and “Bostock, at the very least, has significant implications for the meaning of Title IX’s prohibition on sex discrimination.”70 Consequently, for purposes of deciding whether the Trump Administration’s changes to Section 1557’s regulatory definition of sex discrimination violated the Administrative Procedures Act, the DC court concluded that “it was arbitrary and capricious for HHS to eliminate the 2016 Rule’s explication of that prohibition without even acknowledging — let alone considering — the Supreme Court’s reasoning or holding” in Bostock.71. Jennifer Kates In Franciscan Alliance v. Burwell, plaintiffs allege Section 1557 regulations force providing gender transition and abortion services against beliefs in violation of Religious Freedom Restoration Act This book offers a comprehensive view of what is known about lesbian health needs and what questions need further investigation, including: How do we define who is lesbian? Are there unique health issues for lesbians? The editors would like to thank all of the contributors for their timely and complete submissions. John P. Gearhart, M.D. Ranjiv Mathews, M.D. vii CONTENTS 1. The Embryology and Epidemiology of Bladder Exstrophy ................. . Section 1557 also recognizes intersectional discrimination that affects people who belong to multiple protected classes; for example, discrimination against an African-American woman could be discrimination on the basis of both race and sex.72 While HHS maintains that it “is committed to ensuring the civil rights of all individuals who access or seek to access health programs or activities of covered entities,”73 the final rule substantially scales back non-discrimination protections. The final rule limits the scope of which entities are "covered" and so must comply with the rule. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. On May 10, 2021, the Office for Civil Rights (OCR) at the U.S. Department for Health and Human Services (HHS) announced that it will interpret section 1557 to prohibit discrimination on the basis of gender . Gonen is correct: The finalized rule on Section 1557 doesn't change the fact that courts have consistently ruled on the side of LGBTQ+ access to healthcare, queer and trans people, who remain broadly protected from discrimination in almost half of U.S. states. Section 1557’s protections took effect when the ACA was enacted on March 23, 2010. If you need the regulation or summary in an alternative format, please call (800) 368-1019 or (800) 537-7697 (TDD) for assistance or email 1557@hhs.gov. Discrimination on How is the final rule under Section 1557 different from rules under the other civil PROPOSED CHANGES TO ACA SECTION 1557 RULES Christopher Hightower Northwest Health Law Advocates August 2, 2019. The change also means that the regulations do not apply to short term limited duration insurance, employer-sponsored group health plans, self-insured church plans, the Federal Employees Health Benefits Program, or non-Federal governmental plans, so long as coverage is offered by an entity that is not principally engaged in the business of providing healthcare and does not receive Federal financial assistance.55 In support of this change, HHS states that the “‘business of providing . __ (June 19, 2020); Fact Sheet: HHS Finalizes ACA Section 1557 Rule (June 12, 2020) HHS has . Questions such as, 'Does the Section 1557 regulation affect me?' 'What steps are needed when implementing section 1557 of the Affordable Care Act', and 'How do I comply with the language access requirements?' often arise. The final rule clarifies and codifies existing. This article discusses the new final regulations (2020 Rule) issued by the Department of Health and Human Services (HHS) that overhaul the existing Obama-era nondiscrimination rules (2016 Rule) under Section 1557 of the Patient Protection and Affordable Care Act (ACA). The purpose of this bulletin is to inform hospitals and health systems of a change of interpretation to section 1557, the nondiscrimination provision of the Affordable Care Act (ACA). While the plaintiffs in both the NY and DC cases also sought to have gender identity restored to the Section 1557 rule’s definition of sex discrimination, both courts concluded that they lacked authority to do so because the Franciscan Alliance court previously vacated the inclusion of gender identity from the 2016 regulations.67 The preliminary injunctions issued by the NY and DC courts block implementation of the 2020 regulations, reverting back to the 2016 regulations, which as a result of Franciscan Alliance no longer include gender identity in the definition of sex discrimination. U.S. Coronavirus Cases (9/16): 41.786 million, The Trump Administration’s Final Rule on Section 1557 Non-Discrimination Regulations…, DC federal district court issued a nationwide preliminary injunction blocking, Boston Alliance of Gay, Lesbian, Bisexual & Transgender Youth v. HHS, Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities. Individuals must be treated consistent with their gender identity, including in access to facilities. Beyond the Section 1557 regulations, HHS removes prohibitions on discrimination based on gender identity and sexual orientation in ten other Medicaid, private insurance, and education program regulations (Table 2). Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and ... The public has 60 days to comment on the proposed rules. In line with existing federal civil rights laws, the proposed rule provides for a private right of action, giving individuals the ability to file a lawsuit under Section 1557. In addition, OCR will translate the notice into 15 languages and provide the translated notices to covered entities, should they wish to post one or more of those notices for their consumers. Eliminating the general prohibition on discrimination based on gender identity and sex-stereotyping and specific health insurance coverage protections for transgender individuals; Adopting blanket abortion and religious freedom exemptions for health care providers; Eliminating the provision preventing health insurers from varying benefits in ways that discriminate against certain groups, such as people with HIV or LGBTQ people; Reducing protections that provide access to interpretation and translation services for individuals with limited English proficiency; Eliminating provisions affirming the right of private individuals to challenge alleged violations of Section 1557 in court and obtain money damages (leaving the right to sue for courts to decide) and requirements for non-discrimination notices and grievance procedures; Narrowing the regulations’ reach by only covering specific activities that receive federal funding, but not other operations, of health insurers and no longer applying the regulations to all HHS-administered programs; and. The proposed rule applies to any health program or activity, any part of which receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients. Found insideThis book is a rare and pioneering one. It is also a unique one....highly informative and useful. h�b```�
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Zo�߇� . Found inside – Page 5-96If the plan sponsor is not subject to Section 1557, OCR indicates it will refer the investigation to the EEOC. The rule requires that women have equal ... Filling the need for trusted information on national health issues, MaryBeth Musumeci HHS notes that commenters expressed concerns that this change would weaken nondiscrimination requirements and result in some LEP individuals being unable to access health care; many commenters further indicated that lack of understanding in a medical setting could cause harm and possibly death to patients with LEP.44 In response, HHS indicated that the 2016 standard was a stringent requirement that could be interpreted to require an entity to provide language assistance services to every LEP individual with which it comes in contact. Samantha Artiga The plaintiffs in NY v. HHS have filed a motion for partial summary judgement, seeking to have the entire 2020 rule vacated. The text of the regulation in English is available at https://www.federalregister.gov. 3. Section 1557 incorporates protections from existing civil rights laws. These include Title VI of the Civil Rights Act of 1964 (race, color, and . This rule change serves no other purpose than to target and discriminate against LGBTQ people.
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