Section 1557 prohibits categorical exclusions or limitations in coverage for all health services associated with gender dysphoria or gender transition (e.g., categorically classifying all gender reassignment surgeries as excluded cosmetic procedures).
Full Answer
What is Section 1557 of the Affordable Care Act?
Because Section 1557 is the first Federal civil rights law that broadly prohibits sex discrimination in all federally funded health care programs and activities, the final rule contains provisions designed to educate consumers and covered entities specifically about sex discrimination in the health care context.
Who does the Section 1557 final rule apply to?
The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS. Which of the following best describes Section 1557 of the Affordable Care Act?
Can HHS OCR enforce Section 1557 on the basis of gender?
Burwell, enjoining the Section 1557 regulation’s prohibitions against discrimination on the basis of gender identity and termination of pregnancy on a nationwide basis. Accordingly, HHS’ Office for Civil Rights (HHS OCR) may not enforce these two provisions of the regulation implementing these same provisions, while the injunction remains in place.
Does student health insurance cover gender transition surgery?
Vanderbilt University announced in June 2016 that they would begin to cover gender transition surgeries on their student health plan, and the city of Portland, Maine will begin covering transgender-specific health care as of January 2017.
Which Medicare program are covered by ACA Section 1557?
Medicare Advantage Plans Entities that receive reimbursement from an MA plan (including dental practices) must comply with Section 1557. Funds provided under the Medicare program (except for funds provided under Medicare Part B) constitute Federal financial assistance.
Who does Section 1557 of the Affordable Care Act applies to?
The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS.
Which area of potential discrimination is not covered by ACA Section 1557?
In the final rule, HHS eliminates entirely Section 1557's regulatory definition of sex discrimination, as defined by the 2016 rule to include gender identity and sex stereotyping. The preamble notes that, while HHS “declines to replace it with a new regulatory definition. …
Which of the following would be permissible under Section 1557?
Section 1557 incorporates earlier civil rights protection in regard to race, color, and national origin but does not incorporate protections against discrimination based on age and disability. Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex.
Which of the following statements best describes Section 1557 of the Affordable Care Act ACA )?
Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? c. Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex.
Is Section 1557 still in effect?
In 2016, the Obama administration issued a final rule implementing section 1557. Parts of that rule are still subject to ongoing litigation today....May 24, 2021.To:Hospital Chief Executive Officers, Legal Counsel and Government Affairs StaffSubject:Update to Section 1557 Nondiscrimination Final Rule1 more row•May 24, 2021
Does Section 1557 apply to discrimination based on religion?
Section 1557 does not apply to discrimination based on religion. Section 1557 has been in effect since 2010 when the ACA became effective. There have been several court decisions and enforcement actions based on section 1557.
What are possible consequences of violation of ACA Section 1557?
As a result of violations of ACA Section 1557 nondiscrimination rules, a. health plans may be fined, but their agents and brokers are not affected.
Does Section 1557 apply to self funded plans?
Under the 2020 rule, Section 1557 generally does not apply to self-funded group health plans under ERISA or short-term limited duration plans because the entities offering the plans are typically not principally engaged in the business of providing health care, nor do they receive federal financial assistance.
Which entity enforces Section 1557 for programs that receive funding from on are administered by HHS?
Section 1557 has been in effect since its enactment in 2010 and the HHS Office for Civil Rights (OCR) has been enforcing the provision since it was enacted.
When did the 1557 Act come into effect?
Section 1557 has been in effect since the enactment of the ACA in 2010. Since that time, the Office for Civil Rights (OCR) has been receiving and investigating discrimination complaints under Section 1557.
What is the 1557 rule?
Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability. Section 1557 imposes similar requirements on health insurance issuers that receive federal financial assistance. Health care providers and insurers are barred, among other things, from excluding or adversely treating an individual on any of these prohibited bases. The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS.
What is the final rule of the ACA?
The final rule is consistent with existing, well-established Federal civil rights laws and clarifies the standards HHS will apply in implementing Section 1557 of the ACA. These standards provide that individuals cannot be denied access to health care or health coverage or otherwise be subject to discrimination because of race, color, national origin, sex, age, or disability.
What is the 1557 Act?
Seyfarth Synopsis: On Monday, the Department of Health and Human Services (“HHS”) announced that the prohibition against discrimination “on the basis of sex” under Section 1557 of the Affordable Care Act (“Section 1557”) once again includes gender identity and protects transgender patients from discrimination ...
When was the 1557 rule passed?
The law was challenged in 2016, and in 2019, HHS issued a notice of proposed rulemaking pertaining to Section 1557. [4] . In June 2020, HHS issued its final rule, scrapping health care protections based on gender identity on the grounds ...
When did HHS stop based on gender?
In June 2020, HHS issued its final rule, scrapping health care protections based on gender identity on the grounds that the protections stretched “the plain meaning of the underlying civil rights statutes” too far. [5]
Why was my child denied coverage for gender reassignment surgery?
The child was denied coverage for a gender reassignment surgery after being diagnosed with gender dysphoria, a medical condition in which a person’s gender identity is determined to be different from the one assigned at birth.
Is gender identity a protected group?
The Memorandum and Opinion issued by the court explicitly stated that gender identity is a protected group set forth by Section 1557.
Does the ACA cover gender identity?
The ACA’s Section 1557 Extends to Gender Identity. A recent court ruling in Minnesota has affirmed that the provision of the Affordable Care Act extends to transgender and gender non-conforming people, and has dealt another possible setback to employers and the third-party entities that administer self-funded health plans. ...
What is ACA 1557?
Section 1557 of the ACA applies those same non-discrimination rules to health plans and activities that receive federal funding. Section 1557 applies to any organization that provides healthcare services or health insurance (including organizations that have self-insured health plans for their employees) if they receive any sort ...
When did the ACA 1557 go into effect?
ACA Section 1557 has been in effect since 2010, but it's only a couple of paragraphs long and very general in nature. It prohibits discrimination in health care based on existing guidelines—the Civil Rights Act, Title IX, 3 the Age Act, and Section 504 of the Rehabilitation Act—that were already very familiar to most Americans (i.e., age, disability, race, color, national origin, and sex). Section 1557 of the ACA applies those same non-discrimination rules to health plans and activities that receive federal funding.
What is the ACA for transgender people in 2021?
Updated on June 24, 2021. For transgender Americans, access to necessary health care can be fraught with challenges. Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on a wide variety of grounds for any "health program or activity" that receives any sort of federal financial assistance. 1 . sturti / Getty Images.
When was the HHS decision issued?
Argued October 2019; Decision issued June 15, 2020. U.S. Department of Health and Human Services. HHS Announces Prohibition on Sex Discrimination Includes Discrimination on the Basis of Sexual Orientation and Gender Identity. May 10, 2021.
Does Section 1557 cover sex reassignment surgery?
While Section 1557 was initially a big step towards equality in health care for transgender Americans, it does not require coverage for sex reassignment surgery and related medical care. And the implementation of Section 1557 has been a convoluted process with various changes along the way. Most recently, the Biden administration has restored ...
Is it illegal to discriminate based on gender?
Just a few days later, however, the Supreme Court ruled that it was illegal for a workplace to discriminate based on a person's gender identity or sexual orientation. 7 The case hinged on the court's interpretation of what it means to discriminate on the basis of sex, which has long been prohibited under US law.
Is transgender coverage universal?
But although health coverage for transgende r-specific services has become more available, it is still far from universal. In 2019, a county in rural Georgia refused to add coverage for transgender healthcare services to its employee health insurance plan. 16.
What is the ACA law?
On May 13, 2016, the Department of Health and Human Services (HHS) issued final regulations implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age or disability in health programs or activities that receive federal funds. In order to comply with these regulations, “covered entities” must satisfy a myriad of requirements, similar to existing Federal civil rights laws, that are designed to ensure that individuals have equal and nondiscriminatory access to health programs and activities. The focus of this Troutman Sanders advisory is on three of these requirements:
Does HHS 1557 apply to TPAs?
Section 1557 does not apply to an employer that is not engaged in a health program or activity for which it receives HHS funding. However, the preamble to the final rule reiterates the extensive application of the rule, and specifically states that third-party administrators (“TPAs”) for employer group health plans, including self-insured health plans, may be subject to Section 1557 because TPA services involve the administration of health services, making them a health program or activity. Therefore, to the extent that the TPA receives HHS funds, it will be a covered entity – regardless of whether or not the HHS funding supports the covered entity’s TPA function. For example, if a health insurance carrier that functions as both an insurer and TPA receives HHS funding, all of the insurance carrier’s operations (including its TPA business) will generally be subject to Section 1557 even if the HHS funding pertains only to its insurance business.