New Health Equity Regulations: What You Need to Know Federal civil rights rules emphasize nondiscrimination and access to information in other languages. Bottom Line
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Bottom Line  |   August 01, 2016
New Health Equity Regulations: What You Need to Know
Author Notes
  • Daneen Grooms, MHSA, is ASHA director of health reform analysis and advocacy. dgrooms@asha.org
    Daneen Grooms, MHSA, is ASHA director of health reform analysis and advocacy. dgrooms@asha.org×
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Regulatory, Legislative & Advocacy / Bottom Line
Bottom Line   |   August 01, 2016
New Health Equity Regulations: What You Need to Know
The ASHA Leader, August 2016, Vol. 21, 30-32. doi:10.1044/leader.BML.21082016.30
The ASHA Leader, August 2016, Vol. 21, 30-32. doi:10.1044/leader.BML.21082016.30
New regulations protecting patients against discrimination require audiologists and speech-language pathologists to review and update their existing policies to ensure compliance—and to post the availability of compliance information in 15 languages.
The Department of Health and Human Services’ Office for Civil Rights released the Nondiscrimination in Health Programs and Activities final rule in May. Many of the provisions of the rule, known as Section 1557, went into effect July 18, 2016.
What is Section 1557?
As the civil rights provision of the Affordable Care Act, Section 1557 expands on existing policies that prohibit discrimination based on race, color, national origin, sex, age or disability. The law applies to any health program or activity that receives federal money (or services or transfers of real or personal property) in the form of grants, loans, credits, subsidies and insurance contracts.
The definition does not include Medicare Part B, but it does include Medicare A, Medicare C, Medicare D and Medicaid.
How does Section 1557 apply to me?
Hospitals, clinics, programs, medical practices, and individual audiologists and SLPs that receive federal funds—including Medicaid or Medicare Part A or C—must comply with the rule.
  • If you are employed by a hospital or post-acute care facility, the rule applies to the facility’s hearing and speech-language programs because the facility receives federal financial assistance.

  • If you are employed by a clinic that receives federal financial assistance, the clinic is liable for discrimination.

  • If you own or are employed by a private group practice that receives federal financial assistance, your practice is providing the services and must adhere to the rules.

  • A solo practice (whether incorporated or not) that receives federal financial assistance is a covered health program or activity and is responsible for abiding by the provisions.

What are the new provisions under Section 1557?
The regulations address a number of issues: oral interpretation, written language access, electronic information, transgender patients and association with a protected class.
Oral interpretation services
Health care providers must take reasonable steps to offer free, timely oral interpretation services to people with limited English proficiency. Providers cannot require patients to provide their own interpreters and may not rely on an adult accompanying the patient to interpret, except in an emergency or if the patient specifically requests that the accompanying adult interpret or facilitate communication. Patients can decline the services of an interpreter.
Written language access plan
The Office for Civil Rights encourages health care providers to voluntarily develop and implement a written-language access plan, described in the rule as an essential tool to ensure adequate and timely provision of language-assistance services. A language-access plan includes:
  • How a provider determines an individual’s primary language.

  • Identification of telephonic oral interpretation service to access qualified interpreters when needed.

  • Identification of translation service to access qualified translators when needed.

  • How a provider identifies the types of language-assistance services required under certain circumstances.

  • Identification of documents for which written translations should be routinely available.

The civil rights office can provide technical assistance in the development and implementation of language-access plans. The federal Interagency Working Group on Limited English Proficiency also has resources and information on providing interpretation and translation services.
Electronic or information technology
If providers offer programs and activities through electronic or information technology, those activities must also be accessible to people with disabilities. If, however, compliance causes an undue financial or administrative burden or fundamental alteration of the nature of the program or activity, the provider can offer the information in another format that—to the maximum extent possible—ensures that people with disabilities have access to services or benefits.
Section 1557 also prohibits unnecessary segregation of people with disabilities.
Discrimination on the basis of sex/transgender status
Effective Jan. 1, 2017, a health plan or health insurer that receives federal funding cannot categorically exclude all services related to gender transition. They also cannot make coverage decisions—such as denying a claim or imposing limitations or restrictions on any health service—in a manner that results in discrimination against a transgender person.
This provision may justify coverage of voice-related services, a treatment that transgender individuals often require that is covered inconsistently by health plans.
Health care providers must treat people consistently with their gender identity. For example, a health care provider’s persistent and intentional refusal to use a transgender person’s preferred name and pronoun constitutes illegal sex discrimination if it creates a hostile environment.
Nondiscrimination on the basis of association
Health care providers are prohibited from discriminating against any person or entity on the basis of a relationship or association with a member of a protected class. For example, providers cannot refuse to accept a new patient because they disapprove of the race, color, national origin, age, sex or disability of someone in the patient’s family.
How can I ensure compliance with Section 1557?
The Office for Civil Rights will send an assurance of compliance form that providers must file. Health care providers must also “take appropriate initial and continuing steps to notify beneficiaries, applicants, and members of the public”:
  • That they do not discriminate on the basis of race, color, national origin, sex, age or disability in their health programs and activities.

  • That they will provide free, timely appropriate aids and services, including qualified interpreters, for people with disabilities.

  • That they will provide free and timely language assistance, including translated documents and oral interpretation.

  • How patients can obtain aids and services.

  • How patients can contact the designated responsible employee (if the covered entity has 15 or more employees).

  • That there is a grievance procedure and how patients can file a grievance (if the covered entity has 15 or more employees).

Providers must post the Notice of Compliance in conspicuous physical locations where they provide services and on their websites.
The Office for Civil Rights provides the content of this notice in English and in the top 15 non-English languages spoken in any state (a total of 64 languages). It also has translations of the notice, the statement of nondiscrimination and “taglines”—statements that information is available in a specific language—available online.
Providers are not required to post the nondiscrimination notice in non-English languages, but must post taglines in the top 15 languages spoken in their state notifying people of their right to obtain a copy of the notice.
Providers may combine the Section 1557 notice with the content of other civil rights notices, provided the combined notice clearly informs people of their civil rights under Section 1557.
Finally, providers with 15 or more employees must designate an employee responsible for compliance and adopt a grievance procedure.
Where can I find more information?
The Office for Civil Rights will provide training materials on key provisions of this regulation, which ASHA will promote when they become available.
ASHA members may also contact staff from multicultural affairs (multicultural@asha.org), audiology practices (audiology@asha.org) and speech-language pathology practices (healthservices@asha.org) for more information.
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August 2016
Volume 21, Issue 8