[ this article was last updated on November 9, 2016 ]

The Department of Health and Human Services (HHS) has issued final regulations prohibiting discrimination (under Section 1557 of the Affordable Care Act or ACA) on the basis of race, color, national origin, sex, age, or disability. The requirements apply to all health programs and activities that receive federal funds or assistance.

Effective Date – Posting a non-discrimination notice or statement, together with non-English taglines in significant publications, physical locations, and on the practice’s website (if applicable) was required by October 17, 2016. Note that this regulation is not part of HIPAA and only applies to covered entities that receive federal funds or assistance (including EHR incentive payments).

There are three elements to meeting requirements for posting non-discrimination information (Notice, Statement, and Non-English Taglines). In addition, practices with 15 or more employees are required to have a civil rights grievance procedure, and an employee designated to coordinate compliance. All employees, regardless of the total number, should receive basic training. Please follow the steps below to comply with these requirements.

Quick steps to Compliance with ACA 1557

1. Notice – Post the non-discrimination Notice in a conspicuous area of the practice, and on the practice website, if such is maintained. A sample Notice is available in English and in 61 other languages through the following link. Notices in non-English languages may be provided to patients upon request. Covered entities are only required to post the Notice in English. The sample Notices are available at this link.
2. Taglines – The final rule requires that covered entities post taglines that alert individuals with limited English proficiency to the availability of language assistance services in the top 15 languages spoken in the State in which the entity is located or does business. The posting of taglines shall also be in a conspicuous location, such as the check-in or waiting area of the practice. In addition, small-sized, significant communications such as postcards must include taglines in at least the top 2 non-English languages spoken in the State.
   • Lists of the top 15 languages spoken in each state may be found at this link.
   • You may find the top 15 translated Taglines for your State with this link.
3. Statement – A statement of non-discrimination must be included in all significant publications or communications of small size (if the material is too small to permit the full Notice to be included). Examples of such items include marketing brochures, bulletins or other announcements. You may use existing supplies of printed materials, and include the Statement as documents are reprinted. A sample Statement may also be found on this web page.
4. Grievance Procedure – If your practice employs 15 or more people, a grievance procedure must be established. This link will take you to a model grievance procedure.
5. Civil Rights Coordinator – If your practice employs 15 or more people, an employee must be designated to coordinate compliance with Section 1557 (i.e., to ensure that postings are made, employees are informed of the regulations, publications include required statements and taglines, and grievance procedures are followed).
6. Employee Training – Have employees read your Notice and Grievance Procedure so that they are familiar with the rights afforded by Section 1557, and inform them of the Civil Rights/Compliance Coordinator designation so that they know to whom questions or complaints should be directed.
7. Identify an Interpreter Service that you would use on an as-needed basis.  Additionally, you will need a Business Associate Agreement with each interpreter service you select.
8. Assurance of Compliance – To attest that you have met the requirement, you may use this HHS link to electronically attest.