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Webinar and Information on the Proposed Rule to Implement Section 1557 (Anti-discrimination Provisions) of the Affordable Care Act

August 1, 2022
Elliot Kennedy, Director of the Office of Policy Analysis and Development, Center for Policy and Evaluation

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is seeking comments on a proposed rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination based on race, color, national origin, sex, age, or disability in covered health programs and activities.

The proposed rule would strengthen civil rights protections for people who use health programs and services funded by HHS and includes a number of provisions that are particularly relevant for older adults and people with disabilities. 

The proposed rule also clarifies that the non-discrimination protections of Section 1557 of the ACA apply to all HHS-administered health programs and activities, and outlines requirements for covered entities. ACL programs may be covered entities. 

Comments may be submitted starting August 4 through October 3, 2022. We'll share a link for commenting online as soon as it is available.

What you need to know about the Section 1557 proposed rule 

The proposed rule would:

  • Clarify that the “integration mandate” of Section 504 of the Rehabilitation Act applies to covered entities with respect to the design of health insurance plans and other health-related coverage
  • Clarify that nondiscrimination requirements apply to health programs and activities provided through telehealth services
  • Clarify that the non-discrimination protections of Section 1557 apply to all HHS-administered health programs and activities. This may include ACL’s programs
  • Require covered entities to establish Section 1557-related policies and staff training
  • Clarify that payments made under Medicare Part B constitute federal financial assistance, meaning that Section 1557 and other civil rights protections apply to health programs and activities paid for under Medicare Part B
  • Clarify that discrimination on the basis of sex includes discrimination based on sexual orientation, gender identity, sex stereotypes, sex characteristics (including intersex traits), as well as pregnancy or related conditions 
  • Describe requirements related to effective communication for individuals with disabilities, including notice requirements and the right to receive auxiliary aids and services free of charge
  • Describe requirements related to language assistance for people with limited English proficiency, including notice requirements and the right to receive language assistance services free of charge
  • Prohibit the use of discriminatory clinical algorithms in decision making. This includes, for example, prohibiting use of discriminatory assessment tools to allocate scarce resources in crisis situations

What input is needed

OCR seeks input on a number of questions, including several issues of particular interest to ACL’s stakeholders:

  • Appropriate standards and accessibility requirements for websites, mobile applications, and medical diagnostic equipment
  • Steps HHS can take to help covered entities meet their language access and effective communication responsibilities
  • The ways in which provider networks limit or deny access to care for individuals on the basis of race, color, national origin, sex, age, or disability. This includes the extent to which the lack of availability of accessible medical diagnostic equipment in a provider network constitutes discriminatory benefit design or network inadequacy and/or limits or denies access to care for people with disabilities
  • Design features of insurance or plan benefits that result in segregation or institutionalization of individuals with disabilities or place them at serious risk of institutionalization or segregation
  • Examples of how state Medicaid agencies can avoid creating incentives for institutional services over home and community-based services through policies on reimbursement, scope of services, service authorization, and the like
  • The application of the integration mandate to a wide variety of health services commonly covered by health insurance, such as services provided to help people recover from injury, illness, or surgery and/or hospitalization and mental health service

OCR also has released a fact sheet summarizing the rule: OCR Fact Sheet: Proposed Rule - Section 1557 of the Affordable Care Act.

Because our networks work with older adults, people with disabilities, and people with chronic conditions, you have critical insights that will be valuable for OCR to consider. We strongly encourage you to review and comment on the proposed rule to help ensure the Section 1557 final rule reflects the needs of the people we serve.

This proposed rule is the first of two expected to be published by OCR that will have significant impact for ACL’s networks and the people we serve. Earlier this year, OCR also announced plans to update its rule implementing Section 504 of the Rehabilitation Act (which protects people from discrimination based on disability). The Section 504 rule will complement the disability provisions in the proposed Section 1557 rule. Input from our networks will be crucial for that rule, as well – we will let you know when it is open for comment. 

Information about the Webinar

Please join ACL and the Department of Health and Human Services’ Office for Civil Rights for a grantee and stakeholder webinar on Thursday, August 11 at 2:30 PM ET. The webinar will provide an overview of the Notice of Proposed Rulemaking for Section 1557 of the Patient Protection and Affordable Care Act.  If you have questions that you would like addressed during the webinar, please send them in advance to by 12:00 noon on Tuesday August 9, 2022.

Register in advance for this Zoom webinar HERE

After registering, you will receive a confirmation email containing information about joining the webinar.

ASL translation and closed captioning will be provided as part of this Zoom webinar. If you have any additional accommodation needs to participate in this meeting, please contact Marcia Gordon at by 12:00 noon on Tuesday August 9th.

Last modified on 08/02/2022

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