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.

    ← Return to text

  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.

    ← Return to text

  3. 81 Fed. Reg. 31444.

    ← Return to text

  4. 45 C.F.R. § 92.1.

    ← Return to text

  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.

    ← Return to text

  6. 45 C.F.R. § § 92.1, 92.2(a).

    ← Return to text

  7. 81 Fed. Reg. 31379.

    ← Return to text

  8. 45 C.F.R. § 92.4.

    ← Return to text

  9. Id.

    ← Return to text

  10. 81 Fed. Reg. 31385.

    ← Return to text

  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.

    ← Return to text

  12. 45 C.F.R. § 92.4.

    ← Return to text

  13. 81 Fed. Reg. 31386.

    ← Return to text

  14.   45 C.F.R. § § 92.4 92.206.

    ← Return to text

  15. 45 C.F.R. § 92.206.

    ← Return to text

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

    ← Return to text

  17. 45 C.F.R. § 92.4.

    ← Return to text

  18. 81 Fed. Reg. 31390.

    ← Return to text

  19. Id.

    ← Return to text

  20. Id. 

    ← Return to text

  21. 45 C.F.R. § 92.101(b)(3)(iv).

    ← Return to text

  22. 81 Fed. Reg. 31409.

    ← Return to text

  23.   45 C.F.R. § 92.2(b)(2).

    ← Return to text

  24. Id.

    ← Return to text

  25. 45 C.F.R. § 92.4.

    ← Return to text

  26. 81 Fed. Reg. 31387.

    ← Return to text

  27. 45 C.F.R. §92.201(a).

    ← Return to text

  28. 45 C.F.R. § 92.201(b)(1).

    ← Return to text

  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.

    ← Return to text

  30. 45 C.F.R. § 92.201(c) and (d).

    ← Return to text

  31. 45 C.F.R § 92.201(e)(4).

    ← Return to text

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

    ← Return to text

  33. 45 C.F.R. § 92.201(f).

    ← Return to text

  34. 45 C.F.R § 92.201(g).

    ← Return to text

  35. 81 Fed. Reg. 31418-31419.

    ← Return to text

  36. 45 C.F.R. § 92.201(e)(1).

    ← Return to text

  37. 45 C.F.R § 92.201(e)(2).

    ← Return to text

  38. 45 C.F.R. § 92.201 (e)(3).

    ← Return to text

  39. 45 C.F.R. § 92.205.

    ← Return to text

  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.

    ← Return to text

  41. 45 C.F.R. § 92.202.

    ← Return to text

  42. 81 Fed. Reg. 31421.

    ← Return to text

  43. 45 C.F.R. § 92.4.

    ← Return to text

  44. 45 C.F.R. § 92.202(b).

    ← Return to text

  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).

    ← Return to text

  46. 81 Fed. Reg. 31424.

    ← Return to text

  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.

    ← Return to text

  48. 45 C.F.R. § 92.204(a).

    ← Return to text

  49. 45 C.F.R. § 92.207(b)(1).

    ← Return to text

  50. Id. 

    ← Return to text

  51. Id.

    ← Return to text

  52. 45 C.F.R. § 92.207(b)(2).

    ← Return to text

  53. 45 C.F.R. § 92.207(d).

    ← Return to text

  54. 81 Fed. Reg. 31434-31435.

    ← Return to text

  55. 42 C.F.R. § 92.1.

    ← Return to text

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

    ← Return to text

  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.

    ← Return to text

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

    ← Return to text

  59. 81 Fed. Reg. 31428.

    ← Return to text

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

    ← Return to text

  61. 81 Fed. Reg. 31429.

    ← Return to text

  62. Id. at 31434-31435.

    ← Return to text

  63. 45 C.F.R. § 92.5(a).

    ← Return to text

  64. Id. 

    ← Return to text

  65. 45 C.F.R. § 92.8(b).

    ← Return to text

  66. 45 C.F.R. § 92.8(a).

    ← Return to text

  67. Id.

    ← Return to text

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

    ← Return to text

  69. 45 C.F.R. § 92.8(f).

    ← Return to text

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

    ← Return to text

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

    ← Return to text

  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.

    ← Return to text

  73. 45 C.F.R. § 92.8(d)(2).

    ← Return to text

  74. 45 C.F.R. § 92.8(c) and (e).

    ← Return to text

  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.

    ← Return to text

  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. 

    ← Return to text

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

    ← Return to text

  78. Id. at 31441.

    ← Return to text

  79. 45 C.F.R. § 92.6(a).

    ← Return to text

  80. 45 C.F.R. § 92.6(b).

    ← Return to text

  81. 81 Fed. Reg. 31439.

    ← Return to text

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

    ← Return to text

  83. 45 C.F.R. § 92.301(a).

    ← Return to text

  84. 45 C.F.R. § 92.3(b).

    ← Return to text

  85. 45 C.F.R. § 92.1.

    ← Return to text

KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff

The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.