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Section 1557 of the Affordable Care Act and Language Access Resources

Section 1557 of the Affordable Care Act (§1557)

(The information was obtained from Oregon state statues and administrative rules, US Health and Human Services website, website and the website. Links to those resources are below.)

What is §1557?

  • Patient Protection and Affordable Care Act (ACA) which was enacted in 2010 by the US legislature which prohibits discrimination.
  • The rules which implement 1557 require any health care entity receiving federal financial assistance, such as Medicaid dollars, to engage in certain practices to prevent discrimination on the basis of age, race, color, nationality, or gender, including gender identity.

Who must comply with §1557?

An establishment that operates a health program or activity, any part of which received Federal Financial Assistance such as Medicaid from the US Department of Health and Human Services is considered a covered entity. Some examples of covered entities are:

  • Hospitals, public health departments, dentists, therapists, primary care providers, pediatricians, community health centers, nursing facilities, or community based treatment facilities that receive federal dollars such as Medicaid
  • Please note, that if the health program is principally engaged in health-related services then the regulations apply to the entire entity not just the health care program. Since OHA is principally engaged in health-related services 1557 applies to every part of the agency.

What are the requirements under § 1557?

  1. Coordinator and Grievance Process: Covered entities with 15 or more employees must have a §1557 Coordinator and a Grievance Process
  2. Postings: All covered entities must post a notice of nondiscrimination and language access taglines in at least the top 15 languages spoken in the state by individuals with limited English proficiency in:
    1. Conspicuous physical locations where the entity interacts with the public; and
  3. Conspicuous location on the covered entity's Website homepage. See OHA’s homepage for an example.
    Significant Document Insert: All covered entities must include a notice of nondiscrimination and language access taglines in all documents that are sent to the public that are "significant."
    Each program needs to establish and document criteria that they use to determine what is "significant" and then apply it consistently when deciding on whether these notices are required.

    Considerations for defining "significant"

    1. Is the person required to fill out the document or sign the document?
    2. Does the document contain critical information about benefits such as changes to benefits or the inclusion of something previously uncovered?
    3. Does the document contain critical information about billing?
    4. Does the document contain critical information about pharmacy benefits?
    5. Does the document talk about the individual’s right to do something?
    6. Is the document about consent?
    7. Does the document contain information about a provider?

      If any of the above is YES then it is likely significant and must include a notice and taglines.

    8. When the document is deemed a significant but is a postcard or pamphlet then a shorter notice and only the top two languages spoken by individuals with limited English proficiency are required.
    9. If it is not significant based on consistent criteria developed by the program, then the notice and taglines are optional.

      1. Best practice would be to error on the side of including the statement.

  4. Effective Communication with Individuals with Disabilities: All covered entities must take appropriate steps to ensure that communications with individuals with disabilities are as effective as communications with others in health program and activities. Parity is required.

  5. Accessibility Standards for Buildings and Facilities: All covered entities must provide:

    1. Full and equal access to health care services and facilities
    2. Reasonable modifications to policies, practices, and procedures when necessary to make health care services fully available to individuals with disabilities.

  6. Accessibility of Electronic and Information Technology: All covered entities must ensure that their health programs or activities provided through electronic and information technology are accessible to individuals with disabilities.

  7. Requirement to Make Reasonable Modifications: A covered entity must make reasonable modifications to policies, practices, or procedures when such modifications are necessary to avoid discrimination.

  8. Equal Program Access on the Basis of Sex: All covered entities shall treat individuals consistent with their gender identity.

Where can I find additional resources?

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