U.S. Department of Health & Human Services
FOR IMMEDIATE RELEASE
September 3, 2015
Contact: HHS Press Office
202-690-6343
HHS takes next step in advancing health equity through the Affordable Care Act
Proposed rule implements new protections against sex
discrimination; enhances language assistance; protects individuals with
disabilities; and extends to insurers participating in Health Insurance
Marketplaces
Washington, DC-- Today, the Department of Health and Human Services (HHS)
issued a proposed rule to advance health equity and reduce disparities in health
care. The proposed rule, Nondiscrimination in Health Programs and
Activities, will assist some of the populations that have been most
vulnerable to discrimination and will help provide those populations equal
access to health care and health coverage.
Section 1557 of the Affordable Care Act (ACA) extended civil rights
protections banning sex discrimination to health programs and activities.
Previously, civil rights laws enforced by HHSfs Office for Civil Rights (OCR)
barred discrimination based only on race, color, national origin, disability, or
age. The proposed rule also extends all civil rights obligations to the Health
Insurance Marketplaces and HHS health programs and activities, and clarifies the
standards HHS applies in implementing Section 1557 across all bases of
discrimination.
The proposed rule establishes that the prohibition on sex discrimination
includes discrimination based on gender identity. It also includes
requirements for effective communication for individuals with disabilities and
enhanced language assistance for people with limited English proficiency.
gThis proposed rule is an important step to strengthen protections for people
who have often been subject to discrimination in our health care system,h Health
and Human Services Secretary Sylvia M. Burwell said. gThis is another example of
this Administrationfs commitment to giving every American access to the health
care they deserve.h
While OCR has already been accepting complaints under the ACA, the proposed
rule makes clear that individuals can seek legal remedies for discrimination
under Section 1557.
Todayfs proposed rule applies to Health Insurance Marketplaces, any health
program that HHS itself administers, and any health program or activity, any
part of which receives funding from HHS, such as hospitals that accept Medicare
patients or doctors who treat Medicaid patients. Finally, the proposed
rule extends these nondiscrimination protections to individuals enrolled in
plans offered by issuers participating in the Health Insurance Marketplaces and
explicitly bars any marketing practices or benefit designs that discriminate on
the basis of race, color, national origin, sex, age, or disability. All
the plans of insurers participating in the Marketplace are covered by the
proposed rule.
The proposed rule makes clear HHSfs commitment, as a matter of policy, to
preventing discrimination based on sexual orientation, and requests comment on
how a final rule can incorporate the most robust set of protections
against discrimination that are supported by the courts on an ongoing
basis.
The proposed rule requests comment on whether Section 1557 should include an
exemption for religious organizations and what the scope of any such exemption
should be. Nothing in the proposed rule would affect the application of
existing protections for religious beliefs and practices, such as provider
conscience laws and the regulations issued under the ACA related to preventive
health services.
The proposed rule includes a number of new protections. Among them:
- Women must be treated equally with men in the health care they
receive. Other provisions of the ACA bar certain types of sex
discrimination in insurance, for example by prohibiting women from being
charged more than men for coverage. Under Section 1557, women are
protected from discrimination not only in the health coverage they obtain but
in the health services they seek from providers.
- Individuals may not be subject to discrimination based on gender identity.
For example, some insurance policies have historically contained categorical
exclusions on coverage of all care related to gender transition. Those
categorical exclusions are prohibited under the proposed rule.
Individuals must also be treated consistent with their gender identity,
including in access to facilities.
- The rule bolsters language assistance for people with limited English
proficiency, so that individuals are able to communicate more effectively with
their health care providers to, for example, describe their symptoms and
understand the treatment they have been prescribed. The proposed rule
provides clear guidance on the requirements of the law with regard to
provision of language services, such as oral interpreters and written
translations.
- For individuals with disabilities, the rule contains requirements for the
provision of auxiliary aids and services, including alternative formats and
sign language interpreters, and the accessibility of programs offered through
electronic and information technology.
The proposed rule is open for public comment through November 6, 2015 and is
available at:
https://www.federalregister.gov/public-inspection.
For more information, including a fact sheet and Frequently Asked Questions,
visit:
ttp://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html.