Summary of HHS's Final Rule on Nondiscrimination in Health Programs and Activities

Issue Brief
  1. 81 Fed. Reg. 31376-31473 (May 18, 2016), available at http://federalregister.gov/a/2016-11458. The proposed rule was published at 80 Fed. Reg. 54172-54221 (Sept. 8, 2015), http://www.gpo.gov/fdsys/pkg/FR-2015-09-08/pdf/2015-22043.pdf.

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  2. 42 U.S.C. § 18116; 45 C.F.R. § 92.101.  In addition to prohibiting discrimination based on an individual’s own race, color, national origin, age, disability, or sex, Section 1557 also prohibits discrimination against an individual known or believed to have a relationship or association with someone else based on that other person’s race, color, national origin, age, disability, or sex. 45 C.F.R. § 92.209.  For example, a primary care physician could not refuse to accept a new patient based on the disability status of one of the patient’s family members.  80 Fed. Reg. 54191.

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  3. 81 Fed. Reg. 31444.

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  4. 45 C.F.R. § 92.1.

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  5. 45 C.F.R. § § 92.2, 92.4.  Consistent with the HHS Office for Civil Rights’ enforcement of other civil rights authorities, the definition of Federal financial assistance does not include Medicare Part B payments.  81 Fed. Reg. 31383.

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  6. 45 C.F.R. § § 92.1, 92.2(a).

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  7. 81 Fed. Reg. 31379.

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  8. 45 C.F.R. § 92.4.

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  9. Id.

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  10. 81 Fed. Reg. 31385.

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  11. Unless the primary purpose of the Federal financial assistance is to fund employee health benefits, Section 1557 does not apply to an employer’s provision of employee health benefits where the provision of those benefits is the only health program or activity operated by the employer. 45 C.F.R. § 92.208; 81 Fed.Reg. 31437.

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  12. 45 C.F.R. § 92.4.

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  13. 81 Fed. Reg. 31386.

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  14.   45 C.F.R. § § 92.4 92.206.

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  15. 45 C.F.R. § 92.206.

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  16. 45 C.F.R. § 92.4; 81 Fed. Reg. 31388.

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  17. 45 C.F.R. § 92.4.

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  18. 81 Fed. Reg. 31390.

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  19. Id.

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  20. Id. 

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  21. 45 C.F.R. § 92.101(b)(3)(iv).

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  22. 81 Fed. Reg. 31409.

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  23.   45 C.F.R. § 92.2(b)(2).

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  24. Id.

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  25. 45 C.F.R. § 92.4.

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  26. 81 Fed. Reg. 31387.

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  27. 45 C.F.R. §92.201(a).

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  28. 45 C.F.R. § 92.201(b)(1).

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  29. 45 C.F.R. § 92.201(b)(2). HHS does not outline minimum requirements for a language access plan but notes that effective plans often address how the entity will determine an individual’s primary language; identify a telephonic interpretation service; identify a translation service; identify the types of language assistance services that may be required; and identify any documents for which written translations should be routinely available.  81 Fed. Reg. 31415.

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  30. 45 C.F.R. § 92.201(c) and (d).

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  31. 45 C.F.R § 92.201(e)(4).

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  32. 45 C.F.R. § § 92.4, 92,201(e)(4).

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  33. 45 C.F.R. § 92.201(f).

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  34. 45 C.F.R § 92.201(g).

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  35. 81 Fed. Reg. 31418-31419.

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  36. 45 C.F.R. § 92.201(e)(1).

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  37. 45 C.F.R § 92.201(e)(2).

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  38. 45 C.F.R. § 92.201 (e)(3).

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  39. 45 C.F.R. § 92.205.

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  40. HHS notes that whether Section 1557 applies to people with chronic conditions depends on whether an individual meets the final rule’s definition of disability, which is based on the ADA/504.  81 Fed. Reg. 31382.

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  41. 45 C.F.R. § 92.202.

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  42. 81 Fed. Reg. 31421.

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  43. 45 C.F.R. § 92.4.

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  44. 45 C.F.R. § 92.202(b).

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  45. 45 C.F.R. § 92.203(a).  Most facilities already are subject to the 2010 Standards.  Those that are not subject to the 2010 Standards as of July 18, 2016, have until January 18, 2018 to comply with those standards for new construction or alternations.  81 Fed. Reg. 32422-23. Construction or alteration that began before July 18, 2016 is deemed to comply with Section 1557 if it meets the 2010 Standards or the 1991 Standards, or the Uniform Federal Accessibility Standards but only if the facility was not covered by the 1991 or 2010 Standards. 45 C.F.R. § 92.203(b).

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  46. 81 Fed. Reg. 31424.

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  47. 45 C.F.R. § 92.204(a). Consistent with the ADA and Section 504, HHS notes that when determining whether an action is an undue burden, a covered entity must consider all resources available for use in the health program or activity’s funding or operation.  81 Fed. Reg. 31425.  The final rule replaces the language defining electronic and information technology with a citation to the Section 508 regulation to ensure that the definition is consistent with other civil rights laws and is not outdated and unduly narrow.  45 C.F.R. § 92.4.

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  48. 45 C.F.R. § 92.204(a).

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  49. 45 C.F.R. § 92.207(b)(1).

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  50. Id. 

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  51. Id.

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  52. 45 C.F.R. § 92.207(b)(2).

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  53. 45 C.F.R. § 92.207(d).

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  54. 81 Fed. Reg. 31434-31435.

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  55. 42 C.F.R. § 92.1.

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  56. 81 Fed. Reg. 31434, n.258.

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  57. Jane Perkins and Wayne Turner, NHeLP and The AIDS Institute Complaint to HHS Re HIV/AIDS Discrimination by Florida Insurers (May 29, 2014), available at  http://www.healthlaw.org/publications/browse-all-publications/HHS-HIV-Complaint#.Vg7Zx03bKUk.

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  58. 45 C.F.R. § § 92.206, 92.207(b)(3).

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  59. 81 Fed. Reg. 31428.

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  60. 45 C.F.R. § 92.207 (b)(4) and (5).

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  61. 81 Fed. Reg. 31429.

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  62. Id. at 31434-31435.

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  63. 45 C.F.R. § 92.5(a).

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  64. Id. 

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  65. 45 C.F.R. § 92.8(b).

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  66. 45 C.F.R. § 92.8(a).

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  67. Id.

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  68. Covered entities may exhaust their existing supply of hard copy publications before complying with this provision.  81 Fed. Reg. 31396.

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  69. 45 C.F.R. § 92.8(f).

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  70. 45 C.F.R. § 92.8(f)(1)(i) and (g).

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  71. 45 C.F.R. Part 92, Appendices A and B.

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  72. 45 C.F.R. § 92.8(b), (d), (f).  Covered entities that serve individuals in more than one state may aggregate the number of individuals with LEP in those states to determine the top non-English languages spoken.  81 Fed. Reg. 31400.

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  73. 45 C.F.R. § 92.8(d)(2).

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  74. 45 C.F.R. § 92.8(c) and (e).

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  75. 45 C.F.R. § 92.7(b).  The preamble indicates that covered entities may use the same grievance procedures and individuals as used to comply with Section 504 and Title IX if their scope is broadened to include all bases of discrimination prohibited by Section 1557.  81 Fed. Reg. 31394.

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  76. 45 C.F.R. § 92.7(a).  OCR will serve as the responsible employee for Section 1557 compliance in HHS programs and activities and the Federally-facilitated Marketplace.  Id. 

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  77. 45 C.F.R. Part 92, Appendix C.

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  78. Id. at 31441.

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  79. 45 C.F.R. § 92.6(a).

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  80. 45 C.F.R. § 92.6(b).

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  81. 81 Fed. Reg. 31439.

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  82. 45 C.F.R. § § 92.302(d), 92.301(b).

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  83. 45 C.F.R. § 92.301(a).

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  84. 45 C.F.R. § 92.3(b).

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  85. 45 C.F.R. § 92.1.

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