by Ray Foxworth, D.C., FICC, MCS-P
President & Founder, ChiroHealthUSA
As you probably already know, Section 1557 of the Affordable Care Act contains an anti-discrimination provision. You may not discriminate in healthcare delivery based on a patient’s race, color, national origin, sex, age, or disability. You may not delay or deny effective language assistance services to any patient with limited English proficiency (LEP). These provisions apply to all patients in the US regardless of citizenship status. This final rule of the Patient Protection and Affordable Care Act went into effect on Monday, July 18, 2016 (HHS, 2016).
The US Department of Health and Human Services’ Office for Civil Rights (OCR) enforces Section 1557 on programs that receive funding from HHS. Some Medicare Part B providers may be excluded from the requirements under Section 1557. If you accept Medicare Part B, but do not accept payments under any other federal health care program, then you may not be required to comply with these rules. However, if you receive any federal payments in addition to Part B (including Medicaid, TriCare, Federal Employee Health Benefits, meaningful and use payments), then you must comply.
Beginning October 17, 2016, all entities covered by the Section 1557 regulations were required to post a nondiscrimination notice containing seven required elements, including how to obtain language interpretation services offered by the provider, how to file a grievance with the provider, and how to file a discrimination complaint with OCR. This notice must be posted in a conspicuous physical location, and a link to the notice, accessible from the entity’s website, must be conspicuous on the provider’s website. The content of this notice may be combined with the content of other notices, if the combined notice clearly informs individuals of their Section 1557 related rights. For providers with 15 or more employees, some of the requirements also include designating at least one employee to coordinate the clinic’s Section 1557 compliance efforts and responsibilities. Included in these responsibilities are investigations of any grievance alleging discrimination, adopting grievance procedures, affording due process to the complainant, and providing a prompt and equitable resolution. The OCR has published a model Section 1557 grievance procedure online.
All employees should be aware of these rules, and any changes made in policy, because the price is high if you are found not to be in compliance. HHS may suspend, terminate, or refuse to continue further funding. In addition, individuals may file individual or class action claims in federal court. The HHS website offers a number of sample documents to assist you (see below), and Dr. Mario Fucinari will be presenting a free webinar on this topic on Tuesday, August 20, 2019, at 2:15 PM EDT. Register you and your team at https://events.genndi.com/register/818720503324739130/17ba64ec59.
- Section 1557 Patient Protection and Affordable Care Act and Final Rule – http://www.hhs.gov/civil-rights/for-individuals/section-1557
- Training materials – http://www.hhs.gov/civil-rights/for-providers/training/index.html
- Sample Notices, Statement of Nondiscrimination and Taglines and Translated Resources – http://www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/
- FAQ’s and Language Access Requirements – http://www.hhs.gov/civil-rights/for-individuals/section-1557/1557faqs/top15-languages/index.html and http://www.hhs.gov/sites/default/files/resources-for-covered-entities-top-15-languages-list.pdf
- Auxiliary Aids – https://www.ada.gov/reachingout/t3regl2.html
- Assurance of Compliance form – http://www.hhs.gov/sites/default/files/hhs-690.pdf
Why is the Discount Challenge prize amount $11,181? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $11,181 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.