On September 8, 2015, the Department of Health and Human Services (HHS) published a proposed rule to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age, disability, and sex. In the preamble to the proposed rule, HHS emphasizes the importance of Section 1557 for achieving the ACA's goals of expanding health care and insurance, noting that discrimination within health programs, insurance, and care can contribute to poor health outcomes or coverage, increase health disparities among underserved communities, and negatively impact the distribution of health care resources. While Section 1557 and the proposed rule coordinate and incorporate existing federal laws, regulations, and policy for non-discrimination in health coverage and care, they also include new protections and provisions. Notably, Section 1557 is the first federal civil rights law to prohibit discrimination on the basis of sex in health care. Moreover, the proposed rule extends the definition of sex discrimination to include discrimination on the basis of gender identity (but does not explicitly include sexual orientation). In addition, the proposed rule establishes regulations related to the provision of language assistance services based on long-standing HHS policy guidance. This issue brief summarizes key provisions of the proposed rule, including: (1) Who is subject to the non-discrimination provisions; (2) Protections against discrimination based on sex; (3) Access for individuals with limited English proficiency (LEP); (4) Protections against discrimination based on disability; (5) Prohibitions against discrimination in health coverage; and (6) Compliance and enforcement. The 60 day public comment period for the proposed rule closes on November 9, 2015. A final rule will be issued based on HHS' consideration of the public comments and would be effective 60 days after it is published, and provide an additional tool to help prevent and remediate discrimination in health programs and activities.
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