HHS Restores Full Scope of ACA Non-Discrimination Provision to Include Sex, Gender Identity, Pregnancy Status

May 7, 2024

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. This long-awaited regulation restores the full scope of ACA’s section 1557 non-discrimination protections on the basis of sex, gender identity, or pregnancy status, after the scope of the protections had been limited by the previous administration.

The final rule also strengthens protections against discrimination on the basis of race, color, national origin, sex, age, and disability. This regulation aims to reduce language access barriers, expand physical and digital accessibility, and address bias in health technology, among many other provisions.

Additionally, for first time, HHS will consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the department. Health care providers and suppliers receiving Part B funds are prohibited from discriminating on the basis of race, color, national origin, age, sex, and disability. This new interpretation of “Federal financial assistance” will have implications for community oncology practices. The Association for Clinical Oncology (ASCO) continues to analyze the regulations and will work with other stakeholders to determine the full impact on Medicare providers and offer appropriate recommendations for next steps.

Key provisions of the final rule include:

  • Holding HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
  • Requiring covered health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.
  • Requiring covered health care providers, insurers, grantees, and others to let the public know that accessibility services are available to patients at no cost.
  • Clarifying that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.
  • Protecting against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
  • Respecting federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.
  • Respecting the clinical judgement of health care providers.
  • Protecting patients from discriminatory health insurance benefit designs made by insurers.
  • Clarifying the application of Section 1557 nondiscrimination requirements to health insurance plans.

ASCO applauds steps the administration has taken to protect cancer patients from discrimination in health care. ASCO submitted comments on the proposed rule urging the agency to finalize section 1557 non-discrimination protections on the basis of sex, gender identity, or pregnancy status. In additional comments to the agency, ASCO strongly supported the proposal to amend 45 CFR 147.104(e) such that its nondiscrimination protections would explicitly prohibit a health insurance issuer and its officials, employees, agents, and representatives from employing marketing practices or benefit designs that would discourage the enrollment of individuals based on sexual orientation and gender identity.

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