Issue Brief
  1. 84 Fed. Reg. 27846-27895, 27848 (June 14, 2019), https://www.federalregister.gov/documents/2019/06/14/2019-11512/nondiscrimination-in-health-and-health-education-programs-or-activities.

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  2. Kaiser Family Foundation, Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities (July 14, 2016); 81 Fed. Reg. 31375-31473 (May 18, 2016), https://www.federalregister.gov/documents/2016/05/18/2016-11458/nondiscrimination-in-health-programs-and-activities.

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  3. 42 U.S.C. § 18116.

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  4. HHS does not consider Medicare Part B payments to be federal financial assistance. See, e.g., 81 Fed. Reg. at 31383; 84 Fed. Reg. at 27863.

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  5. 45 C.F.R. § § 92.4, 92.208; 81 Fed. Reg. at 31396, 31432, 32445.

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  6. Except that provisions requiring changes to health insurance or group health plan benefit design took effect on the first day of the first plan year on or after Jan. 1, 2017. 81 Fed. Reg. at 31376.

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  7. 84 Fed. Reg. at 27848, 27849.

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  8. Franciscan Alliance v. Burwell, C.A. No. 7:16-cv-00108-O, Order, document 62,(N.D. Tex. Dec. 31, 2016), https://affordablecareactlitigation.files.wordpress.com/2018/10/franciscan-alliance-pi-order.pdf.

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  9. Flack v. Wis. Dep’t of Health Servs. 328 F. Supp. 3d 931 (W.D. Wis. 2018).

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  10. Prescott v. Rady Children’s Hospital – San Diego, 265 F. Supp. 3d 1090 (S.D. Cal. 2017).

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  11. Id.

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  12. 81 Fed. Reg. at 31388.

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  13. Id. at 31390.

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  14. Price Waterhouse v. Hopkins, 490 U.S. 228, 250-51 (1989); 81 Fed. Reg. at 31389.

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  15. The cases are brought under Title VI. Title IX relies on Title VI standards in this area. 84 Fed. Reg. at 27855, 27857.

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  16. 81 Fed. Reg. at 31455.

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  17. Id. at 31460.

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  18. Id. at 31428.

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  19. Id. at 31435.

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  20. Id. at 31429.

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  21. Id. at 31429.

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  22. “Insofar as the application of any requirement under this part would violate, depart from, or contradict definitions, exemptions, affirmative rights, or protections provided by any of the statutes cited in paragraph (a) of this section [including Title IX]. . . such application shall not be required or imposed.” Proposed § 92.6 (b).

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  23. The Title IX abortion exemption provides that “[n]othing in this title shall be construed to require or prohibit any person, or public or private entity, to provide or pay for any benefit or service, including the use of facilities related to an abortion. . . .” 20 U.S.C. § 1688.

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  24. The Title IX religious exemption provides that the prohibition of discrimination on the basis of sex “shall not apply to an educational institution which is controlled by a religious organization if the application of this subsection would not be consistent with the religious tenants of such organization.” 20 U.S.C. § 1681 (a)(3).

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  25. HHS specifically references the Coats-Snowe Amendment, the Church Amendments, the Religious Freedom Restoration Act, ACA § 1553, ACA § 1303, the Weldon Amendment, and any related, successor, or similar federal laws or regulations. Proposed § 92.6 (b).

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  26. The interaction between these changes, the recently finalized HHS OCR regulations protecting statutory conscience rights in health care, 84 Fed. Reg. 23170-23272 (May 21, 2019), https://www.federalregister.gov/documents/2019/05/21/2019-09667/protecting-statutory-conscience-rights-in-health-care-delegations-of-authority, and the Emergency Medical Treatment and Active Labor Act is unclear.

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  27. Cf. 81 Fed. Reg. at 31380.

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  28. 45 C.F.R. § 92.2 (b)(2) (providing that “[i]nsofar as the application of any requirement under this part would violate applicable Federal statutory protections for religious freedom and conscience, such application shall not be required”).

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  29. 81 Fed. Reg. at 31380.

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  30. Id.

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  31. Id.; see also 81 Fed. Reg. at 31397 (noting that the “availability of a religious exemption will depend on an analysis of the particular situation”).

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  32. Id. at 31429.

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  33. Id. at 31434, n.258.

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  34. Id. at 31433.

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  35. (emphasis added).

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  36. 81 Fed. Reg. at 31410.

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  37. Id. at 31413.

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  38. Small-sized publications may include a shorter non-discrimination statement and taglines in the top 2 non-English languages spoken.

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  39. 84 Fed. Reg. at 27882.

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  40. Id. at 27859.

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  41. Id. at 27883.

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  42. Id.

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  43. Id. at 27849.

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  44. Id. at 27857.

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  45. Id.

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  46. 81 Fed. Reg. at 31428.

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  47. 84 Fed. Reg. at 27863.

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  48. 84 Fed. Reg. at 27850, 27862-27863.

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  49. 81 Fed. Reg. at 31446.

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  50. Id. at 31439, n.278, 279.

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  51. Id.

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  52. HHS notes that the current Section 504 regulation permits this exception but also enables the Office for Civil Rights Director to require entities with less than 15 employees to provide auxiliary aids and services to afford people with disabilities an equal opportunity to benefit from the entity’s benefits or services if doing so would not significantly impair the entity’s ability to provide its benefits or services. 84 Fed. Reg. at 27867.

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  53. HHS notes that the architectural standards exempt multistory buildings owned by private entities from the requirement to provide an elevator, unless they are the professional office of a health care provider and that the standards also have different TTY requirements for public vs. privately owned buildings. Id. at 27867, n. 134-135.

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  54. HHS also seeks comment on whether the reasonable modification provision should be replaced with the Section 504 language that provides that entities “shall make reasonable accommodations to known physical or mental limitations of otherwise qualified people with disabilities.” Id. at 27868.

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  55. Id. at 27849.

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  56. Id. at 27850.

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  57. Id.

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  58. 84 Fed. Reg. 27857 (noting that “[t]his proposed rule is not intended to. . . deny States the ability to provide protections that exceed those required by Title IX.”).

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  59. See, e.g., Movement Advancement Project, Healthcare Laws and Policies (June 26, 2019), https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies.

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  60. 84 Fed. Reg. at 27872.

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  61. 81 Fed. Reg. at 31405.

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  62. 84 Fed. Reg. at 27846.

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Tables
  1. 45 C.F.R. § § 92.4, 92.206.

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  2. 45 C.F.R. § 92.2 (b).

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  3. HHS specifically references the Coats-Snowe Amendment, the Church Amendments, the Religious Freedom Restoration Act, ACA § 1553, ACA § 1303, the Weldon Amendment, and any related, successor, or similar federal laws or regulations. Proposed § 92.5 (b).

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  4. 45 C.F.R. § 92.207.

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  5. 45 C.F.R. § § 92.206, 92.207.

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  6. 45 C.F.R. § 92.207.

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  7. 45 C.F.R. § 92.201. Proposed § 92.101

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  8. 45 C.F.R. § 92.8.

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  9. HHS assumes that tagline requirements for Marketplaces, 45 C.F.R. § 155.205 (c)(2)(iii)(A), and Qualified Health Plan Issuers, HHS Notice of Benefits and Payment Parameters for 2016; Final Rule, 80 Fed. Reg. 10750, 10788 (Feb. 27, 2015), also would be “fully repealed because they depend on, or refer to, the Final [1557] Rule for authority for the tagline requirement” but that other CMS tagline requirements for group health plans and health insurance issuers, navigators, non-navigator assistance personnel, Medicaid, Medicaid managed care, CHIP, CHIP managed care, hospitals qualifying for tax-exempt status, and Medicare Advantage (Part C) and Prescription Drug (Part D) plans would remain in effect. 84 Fed. Reg. at 27881.

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  10. 45 C.F.R. § 92.202 (b).

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  11. 45 C.F.R. § 92.203 (a).

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  12. 45 C.F.R. § 92.205.

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  13. 45 C.F.R. § 92.7. Proposed § 92.5.

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  14. 45 C.F.R. § 92.8.

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  15. HHS assumes that tagline requirements for Marketplaces, 45 C.F.R. § 155.205 (c)(2)(iii)(A), and Qualified Health Plan Issuers, HHS Notice of Benefits and Payment Parameters for 2016; Final Rule, 80 Fed. Reg. 10750, 10788 (Feb. 27, 2015), also would be “fully repealed because they depend on, or refer to, the Final [1557] Rule for authority for the tagline requirement” but that other CMS tagline requirements for group health plans and health insurance issuers, navigators, non-navigator assistance personnel, Medicaid, Medicaid managed care, CHIP, CHIP managed care, hospitals qualifying for tax-exempt status, and Medicare Advantage (Part C) and Prescription Drug (Part D) plans would remain in effect. 84 Fed. Reg. at 27881.

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  16. 45 C.F.R. § 92.301.

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  17. 45 C.F.R. § 92.302.

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  18. 45 C.F.R. § § 92.1, 92.2, 92.4. Proposed § 92.3.

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  19. 45 C.F.R. § 92.101.

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  20. 42 C.F.R. § 438.3 (d)(4).

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  21. 42 C.F.R. § 438.206 (c)(2).

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  22. 42 C.F.R. § 440.262.

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  23. 42 C.F.R. § § 460.98, 460.112.

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  24. 45 C.F.R. § 147.104.

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  25. 45 C.F.R. § 155.120.

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  26. 45 C.F.R. § 155.220 (j)(2)(i).

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  27. 45 C.F.R. § 156.200 (e).

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  28. 45 C.F.R. § 156.1230 (b)(3).

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  29. 45 C.F.R. Part 86. Proposed new § 86.18.

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  30. HHS specifically references the First Amendment, Title IX’s religious exemptions, the Religious Freedom Restoration Act, the Coats-Snowe Amendment, ACA § 1303, and appropriations riders related to abortion such as the Hyde Amendment, the Helms Amendment, and the Weldon Amendment. Proposed 45 C.F.R. § 86.18 (c).

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  31. 45 C.F.R. § 86.31.

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