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    which medicare programs are covered by aca section 1557?

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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.

    1. What is Section 1557?

    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.

    2. In what ways does Section 1557 protect consumers?

    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.

    3. How is the final rule under Section 1557 different from rules under the other civil rights laws the Office for Civil Rights already enforces?

    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.

    4. Is Section 1557 currently being enforced?

    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.

    5. What is the effective date for the final rule?

    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.

    6. What can I do if I believe my civil rights under Section 1557 have been violated?

    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

    Fraud, Waste, Abuse

    Start studying Fraud, Waste, Abuse - 1. Learn vocabulary, terms, and more with flashcards, games, and other study tools.

    Fraud, Waste, Abuse - 1

    4.7 46 Reviews d

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    ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on

    a. disability. b. national origin. c. age. d. sex.

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    a

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    Section 1557 of the Affordable Care Act applies to

    a. all health programs and activities administered by or receiving federal financial assistance from HHS.

    b. Medicare Advantage plans only.

    c. all health programs and activities, public and private.

    d. health plans sold through the ACA Marketplaces only.

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    Terms in this set (14)

    d

    ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on

    a. disability. b. national origin. c. age. d. sex. a

    Section 1557 of the Affordable Care Act applies to

    a. all health programs and activities administered by or receiving federal financial assistance from HHS.

    b. Medicare Advantage plans only.

    c. all health programs and activities, public and private.

    d. health plans sold through the ACA Marketplaces only.

    b

    Which Medicare programs are covered by ACA Section 1557?

    a. Part C (Medicare Advantage) only.

    b. Parts A, C, and D, but not B.

    c. Part D (prescription drug coverage) only.

    d. Parts A and B (Original Medicare) only.

    c

    Under ACA Section 1557, prohibited actions involve

    a. marketing only. b. claims only.

    c. eligibility, claims, and marketing.

    d. eligibility only.

    d

    Under ACA Section 1557, a person

    a. can be discriminated against if she is unable to speak English.

    b. can be discriminated against if she is an immigrant (legal or illegal).

    c. can be discriminated against if she is an illegal immigrant.

    d. cannot be discriminated against based on her legal or illegal immigration status or ability to speak English.

    b

    Under ACA Section 1557, a health plan

    a. can deny coverage to limited English proficient (LEP) individuals.

    b. cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge.

    c. cannot deny coverage to LEP individuals and is required to provide language assistance to them, but at the individual's cost.

    d. cannot deny coverage to LEP individuals but is not required to provide language assistance to them.

    a

    Which of these actions is most likely to be permitted in dealing with a person with limited English proficiency?

    a. Allowing a child to interpret in an emergency.

    b. Requiring the individual to supply her own interpreter.

    c. Using an administrative staff member who once took classes in the individual's language to interpret.

    d. Allowing the individual to bring her own interpreter when there are confidentiality issues or the interpreter's competency is unclear.

    d

    Under ACA Section 1557, sex discrimination includes a person's

    a. sex only.

    b. sex or pregnancy.

    c. sex, pregnancy, or sex stereotypes.

    d. sex, pregnancy, sex stereotypes, or gender identity.

    c

    Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age,

    a. exclude benefits and services.

    b. deny benefits and services.

    c. charge higher premiums.

    d. limit benefits and services.

    b

    ACA Section 1557 rules for disability concern

    a. Policies and procedures only.

    b. Policies and procedures, physical access, and communication.

    c. Communication only.

    d. Physical access and communication.

    b

    Which area of potential discrimination is not generally covered by ACA Section 1557?

    a. Payment of claims.

    b. Employment (with the exception of the provision of health insurance).

    c. Marketing practices.

    d. Eligibility for coverage.

    b

    As a result of violations of ACA Section 1557 nondiscrimination rules,

    a. health plans may be fined, but their agents and brokers are not affected.

    b. a health plan may revoke an agent or broker's appointment with the health plan.

    c. agents and brokers may be fined, but health plans are not affected.

    d. an agent or broker can have her state insurance license revoked by HHS.

    d

    For a health plan, what are the possible consequences of violations of ACA Section 1557?

    a. Loss of federal business only.

    b. None, although it may have to take corrective action.

    c. Compensatory damages only.

    d. Loss of federal business and compensatory damages

    a

    If a health plan violates ACA Section 1557 nondiscrimination protections, it may be

    a. required to take corrective action and sometimes pay damages.

    b. required to take corrective action and sometimes pay damages, but it is protected from lawsuits by individuals.

    c. required to take corrective action only.

    d. required to take corrective action and sometimes pay damages, and it may be sued by individuals.

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    Combating Medicare Parts C and D Fraud, Waste…

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    Source : quizlet.com

    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.

    Home Employers Industry Insights Informed on Reform

    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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