for a health plan, what are the possible consequences of violations of aca section 1557?

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Section 1557 Nondiscrimination Requirements

Learn more about the nondiscrimination requirements under section 1557 of the ACA. See the chart of fees, taxes and penalties that may apply to employers and individuals.

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Section 1557 Nondiscrimination Requirements

Nondiscrimination Requirements

Section 1557 of the Affordable Care Act.

Under Section 1557 of the Affordable Care Act (ACA), individuals may not be denied, cancelled, limited, or refused health coverage on the basis of race, color, national origin, sex, age, or disability. The original rule was finalized in 2016.

On June 19, 2020, the Department of Health and Human Services’ (HHS’) Office for Civil Rights (OCR) published a final rule (the 2020 Rule) on nondiscrimination which repealed or replaced many provisions of the 2016 rule. Of significance, this rule repealed the 2016 rule's expanded definition of "basis of sex" that included pregnancy termination, sex stereotyping, and gender identity. The 2020 rule continued to prohibit discrimination on the "basis of sex," but under the prior interpretation of the word "sex" (i.e., as defined by gender assignment at birth).

In May 2021, the Biden Administration announced the Office for Civil Rights (OCR) would interpret and enforce Section 1557 of the ACA and Title IX’s nondiscrimination requirements based on sex to include sexual orientation and gender identity. The update was made in light of the June 2020 U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.

The 2020 Rule applies to the part(s) of health programs or activities that receive federal financial assistance, and any program or activity under Title I of the ACA (i.e., Exchanges) or entities established under that Title. Under the 2020 rule, Section 1557 generally does not apply to self-funded group health plans under ERISA or short-term limited duration plans because the entities offering the plans are typically not principally engaged in the business of providing health care, nor do they receive federal financial assistance.

Key requirements affecting health plans and services include:

Ensure physical access and/or appropriate communication technology to assist people with applicable disabilities

Ensure meaningful access for people with limited-English proficiency (LEP) based on a "four-factor analysis" test that includes an assessment of the proportion of LEP individuals in the population being served, and the frequency with which they come in contact with the entity’s health program activity or service.

Provide accessible grievance procedures for individuals who believe they have been subjected to discrimination in their health care or health care coverage

The 2020 Rule also repealed provisions which required the inclusion of notices and taglines in at least fifteen languages with all "significant communications" to patients and customers.

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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details

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Section 1557: Frequently Asked Questions

Section 1557: Frequently Asked Questions

Section 1557: Frequently Asked Questions

Frequently Asked Questions on the Estimates for the Top 15 Languages Spoken by Individuals with Limited English Proficiency

Frequently Asked Questions on Aggregation for the Tagline

General Questions about Section 1557

Frequently Asked Questions on the Estimates for the Top 15 Languages Spoken by Individuals with Limited English Proficiency

As a resource for covered entities, OCR has made available a table displaying OCR’s list of the top 15 languages spoken by individuals with limited English proficiency (LEP) in each State, the District of Columbia, Puerto Rico and each U.S. Territory.

Read the FAQs on the Top 15 Languages

(A .pdf file version of the FAQs on the Top 15 languages is available here - PDF)

Frequently Asked Questions on Aggregation for the Tagline

Read the FAQs on Aggregation for the Tagline for further information on applying the requirements to covered entities that operate health programs or activities in more than one state.

(A .pdf file version of the FAQs on the Aggregation for the Tagline is available here - PDF)

General Questions about Section 1557

On December 31, 2016, the U.S. District Court for the Northern District of Texas issued an opinion in Franciscan Alliance, Inc. et al v. Burwell, enjoining the Section 1557 regulation’s prohibitions against discrimination on the basis of gender identity and termination of pregnancy on a nationwide basis. Accordingly, HHS’ Office for Civil Rights (HHS OCR) may not enforce these two provisions of the regulation implementing these same provisions, while the injunction remains in place. Consistent with the court’s order, HHS OCR will continue to enforce important protections against discrimination on the basis of race, color, national origin, age, or disability, as well as other sex discrimination provisions that are not impacted by the court’s order.

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs or activities that receive Federal financial assistance or are administered by an Executive agency or any entity established under Title I of the ACA. Section 1557 has been in effect since enactment of the ACA.

Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability. Section 1557 imposes similar requirements on health insurance issuers that receive federal financial assistance. Health care providers and insurers are barred, among other things, from excluding or adversely treating an individual on any of these prohibited bases. The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS.

The final rule is consistent with existing, well-established Federal civil rights laws and clarifies the standards HHS will apply in implementing Section 1557 of the ACA. These standards provide that individuals cannot be denied access to health care or health coverage or otherwise be subject to discrimination because of race, color, national origin, sex, age, or disability.

Building on long-standing and familiar civil rights principles, the final rule is an important step toward eliminating unlawful discrimination in federally funded programs and HHS programs. Section 1557 is the first Federal civil rights law to broadly prohibit discrimination on the basis of sex in all federally funded health care programs. The final rule extends nondiscrimination protections to individuals enrolled in coverage through the Health Insurance Marketplaces and certain other health coverage. It also applies to HHS’s own health programs.

Section 1557 has been in effect since the enactment of the ACA in 2010. Since that time, the Office for Civil Rights (OCR) has been receiving and investigating discrimination complaints under Section 1557.

The final rule is effective 60 days after publication in the Federal Register. There are three situations in which covered entities have additional time to comply with the rule’s requirements: posting notices of consumer rights and taglines; accessibility standards for buildings not previously covered by the Americans with Disabilities Act; and design changes to health coverage.

If you feel that you have been subject to discrimination in health care or health coverage, you may file a complaint of discrimination under Section 1557. Please visit OCR’s website at www.hhs.gov/ocr to file a complaint or to request a complaint package, or call OCR’s toll free number at (800) 368-1019 or (800) 537-7697 (TDD) to speak with someone who can answer your questions and guide you through the process. OCR’s complaint forms are available in a variety of languages. Individuals can also file lawsuits under Section 1557.

Source : www.hhs.gov

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ACA SECTION 1557 DIFFERS FROM EARLIER LEGISLATION IN PROVIDING BROADER PROTECTION AGAINST DISCRIMINATION BASED ON

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SEX

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SECTION 1557 OF THE AFFORDABLE CARE ACT APPLIES TO

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ALL HEALTH PROGRAMS AND ACTIVITES ADMINSTRATED BY OR RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM HHS.

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Terms in this set (17)

ACA SECTION 1557 DIFFERS FROM EARLIER LEGISLATION IN PROVIDING BROADER PROTECTION AGAINST DISCRIMINATION BASED ON

SEX

SECTION 1557 OF THE AFFORDABLE CARE ACT APPLIES TO

ALL HEALTH PROGRAMS AND ACTIVITES ADMINSTRATED BY OR RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM HHS.

WHICH MEDICARE PROGRAMS ARE COVERED BY ACA SECTION 1557?

PARTS A,C, AND D, BUT NOT B

UNDER ACA SECTION 1557, PROHIBITED ACTION INVOLVE

ELIGIBILITY, CLAIMS, AND MARKETING

UNDER ACA SECTION 1557, A PERSON

CANNOT BE DISCRIMINATED AGAINST BASED ON HER LEGAL OR ILLEGAL IMMIGRATION STATUS OR ABILITY TO SPEAK ENGLISH.

UNDER ACA SECTION 1557, A HEALTH PLAN

CANNOT DENY COVERAGE TO LEP INDIVIDUALS AND IS REQUIRED TO PROVIDE LANGUAGE ASSISTANCE TO THEM, FREE OF CHARGE

WHICH OF THESE ACTIONS IS MOST LIKELY TO BE PERMITTED IN DEALING WITH A PERSON WITH LIMITED ENGLISH PROFICIENCY?

ALLOWING A CHILD TO INTERPRET IN AN EMERGENCY.

UNDER ACA SECTION 1557, SEX DISCRIMINATION INCLUDES A PERSON'S

SEX, PREGNANCY, SEX STEREOTYPES, OR GENDER IDENTITY.

UNDER ACA SECTION 1557, A HEALTH PLAN SOLD THROUGH A STATE EXCHANGE MAY, BASED ON AN INDIVIDUALS AGE

CHARGE HIGHER PREMIUMS.

ACA SECTION 1557 RULES FOR DISABILITY CONCERN

POLICIES AND PROCEDURES, PHYSICAL ACCESS, AND COMMUNICATION.

FOR A HEALHT PLAN, WHAT ARE THE POSSIBLE CONSEQUENCES OF VIOLATIONS OF ACA SECTION 1557?

LOSS OF FEDERAL BUSINESS AND COMPENSATORY DAMAGES.

AS A RESULT OF VIOLATIONS OF ACA SECTION 1557 NONDISCRIMINATION RULES.

A HEALTH PLAN REVOKE AN AGENT OR BROKER'S APPOINTMENT WITH THE HEALTH PLAN.

IF A HEALTH PLAN VIOLATES ACA SECTION 1557 NONDISCRIMINATION PROTECTIONS, IT MAY BE

REQUIRED TO TAKE CORRECTIVE ACTION AND SOMETIMES PAY DAMAGES, AND IT MAY BE SUED BY INDIVIDUALS.

WHICH AREA OF POTENTIAL DISCRIMINATION IS NOT GENERALLY COVERED BY ACA SECTION 1557?

EMPLOYMENT

WHICH OF THE FOLLOWING STATEMENTS BEST DESCRIBES SECTION 1557 ACA

SECTION 1557 INCORPORATES EARILER PROTECTIONS IN REGARD TO RACE, COLOR, NATIONAL, ORIGIN, DISABILITY....

WHICH ENTITY ENFORCES SECTION 1557 FOR PROGRAMS THAT RECEIVE FUNDING FROM ONE.............

THE OFFICE OF CIVIL RIGHTS OCR OF HHS

WHICH OF THE FOLLOWING STATEMENTS BEST DESCRIBES THE SCOPE OF OPERATIONS SUBJECT TO SECTION 1557 UNDER 2020...........

THE SCOPE OF OPERATIONS SUBJECT TO SECTION 1557 UNDER THE TRUMP ADM 2020 FINAL RULE REMAINS............

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