Compliance requirements with ACA Section 1557
Last year, the U.S. Department of Health and Human Services (HHS), and the Office for Civil Rights (OCR) issued the final rule for Section 1557, the nondiscrimination provision of the Affordable Care Act (ACA). In this article, we focus specifically on the elements of Section 1557 that outline what information should be posted and what reasonable steps should be taken for individuals with limited English proficiency (LEP) who are encountered within a medical practice.
A physician calls the MagMutual Risk Management Hotline with a question. He saw a patient for a follow-up appointment for her rheumatoid arthritis. The patient is from Mexico, only speaks Spanish, and was accompanied by her 14-year-old son, who was there to interpret for his mom. The physician discussed starting methotrexate and, as part of the conversation, he told the son to inform his mother that she cannot get pregnant while on methotrexate. After they leave, the physician mentioned the situation to his office manager who said that they should not use the minor son as an interpreter even if it was okay with the patient. The MagMutual representative who speaks with the physician confirms that the office manager is correct.
Who are “covered entities” that Section 1557 impacts?
Under Section 1557 “covered entities” applies to every health program or activity that receives HHS funding; including every health program or activity administered by HHS, such as the Medicare Part D program, and the Health Insurance Marketplaces and all the plans offered by issuers that participate in those marketplaces. Covered entities may include hospitals, health clinics, health insurance issuers, state Medicaid agencies, community health centers, physician’s practices and home health care agencies.
While the final rule applies only to HHS and the health programs and activities it funds, Section 1557 applies more broadly to health programs and activities that receive financial assistance from any federal department or agency. The rule does not apply to physicians who only receive payments from Medicare Part B (traditional Medicare), unless they are also receiving other federal financial assistance such as meaningful use incentive payments or Medicaid payments.
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