On May 18, 2016, the final rule of Section 1557 of the Affordable Care Act was implemented to prohibit healthcare and coverage discrimination based on a person’s race, skin color, national origin, sex, age, and disability. (source) The new rules apply to any entities (“covered entities”) that operate a health program or activity that receives federal financial assistance under programs operated by HHS, including but not limited to Medicare parts A, C, D, but excluding Medicare Part B.

There has been a bit of confusion when it comes to Section 1557 of the ACA, the provisions within it, and what it means for healthcare and coverage providers, as well as the individuals it potentially impacts.

At CQ fluency, we want to help clear up any misunderstandings that healthcare and coverage providers may have so that they can determine if their services are compliant with Section 1557 of the ACA.

Overview of Provisions of Section 1557

To begin, Section 1557 of the ACA addresses and puts to law some existing federal discrimination laws; however, it also includes new provisions while failing to clarify others. (source)

Notably, this is the first time healthcare and coverage has included discrimination based on sex as a protection. This is also the first time gender identity discrimination is considered sex discrimination, and specific coverage protections are available to transgendered individuals. (source)

Another provision of Section 1557 is that healthcare and coverage must avoid disability-discrimination by providing disability-accessible and –accommodating buildings, services (including communication and modifications to existing structures), and technology. (source)

Additionally, health insurance benefit designs that are discriminatory in nature are prohibited. (source)

Lastly, but perhaps most importantly, Section 1557 of the Affordable Care Act puts in ink the requirement for healthcare and coverage to be able to be meaningfully accessed by people with Limited English Proficiency, such as non-native speakers. (source)

Section 1557 Implications for Healthcare Providers

What does this mean for healthcare and coverage providers? Well, the ACA is holding healthcare and coverage providers responsible for ensuring that their services are compliant to Section 1557 by not being discriminatory in providing healthcare or coverage to individuals based on an individual’s race, skin color, national origin, sex, age, and disability, which includes what language a person speaks. Healthcare and coverage providers must also, as mentioned earlier, offer free, accurate, and timely translation services to those who have Limited English Proficiency. There are three issues currently causing confusion with many providers: Accessibility Requirements, Taglines, and Nondiscriminatory Statements/Notices.

1.    Accessibility Requirements

If an individual who does not speak English, calls an insurance company to request information about insurance plans, that insurance company is expected to provide accurate and timely translation services to the individual at no cost to them. Therefore, it is crucial for healthcare and coverage providers to have accurately translated information for those who do not speak English natively, or have Limited English Proficiency.

The interpreters provided must also be “qualified” as per section 1557 guidelines. A qualified interpreter must meet specific criteria in order to be considered:

  • They must adhere to generally accepted ethics principles, including confidentiality
  • Interpreters must demonstrate proficiency in both understanding and speaking English and the spoken language to be interpreted
  • They must be able to interpret effectively, accurately, and impartially. This includes an understanding and ability to utilize any necessary specialized vocabulary, terminology, and phraseology.

There is not a specific license that is required by the state, though proficiency is required. Familiarity and/or above average speaking or understanding of the second language does not necessarily qualify an individual as an interpreter. It is important to ensure a high degree of knowledge and skill with the given language in order to provide the correct level of competence in interpretation. Additional information on qualified interpreters can be found here.

CQ fluency is able to help ensure your healthcare and coverage services are ACA Section 1557 compliant, while simultaneously offering translation services to accurately provide information for those with Limited English Proficiency.

2.    Taglines

Taglines are simply statements of the availability of language assistance services. The languages that the taglines must be listed vary by state, depending on the estimated number of individuals speaking each non-English language. For larger and more standard publications, they must be posted in at least the top 15 languages as determined by state. For smaller publications (for example, postcards), the top two languages for each state must be used. A full list of the top 15 languages for each state can be found here: HHS Top 15 Languages by State. These taglines must be posted in significant publications/communications in conspicuous physical locations that are public-facing as well as on the covered entities’ website.

3.    Nondiscriminatory Statements/Notices

Nondiscriminatory statements must include a statement of nondiscrimination, the availability of interpretive services for LEP patients, the availability of additional services for individuals with disabilities, and a procedure for filing grievances in the instance of complaints regarding discrimination. These statements must also be posted in the same locations as taglines, and like taglines, may also be shortened in small-form publications such as postcards. In these instances, simply the nondiscrimination policy may be included.

Let CQ fluency Help You Get Started

In general, healthcare and coverage providers want to be able to provide non-discriminatory access and accommodations so as to better provide healthcare and coverage to all. The issue arises when there are healthcare and coverage providers that are without these resources and services in place, or there is just difficulty in navigating and understanding all of the changes that are continually added.

CQ fluency is here to help. We specialize in providing high quality translation services efficiently and at a low cost. We are the translation experts, have significant expertise in healthcare, and can help guide you through the whole process, ensuring your customers are well taken care of and that you are in full compliance.

Get started with CQ fluency today! Speak to a member of our team.