Associate Deputy Director, Policy Division

0945-AA17 202310 The Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions 0945 Office for Civil Rights OCR 0900 Department of Health and Human Services HHS Nondiscrimination in Health Programs and Activities

This rule proposed to address changes to the 2020 Final Rule implementing section 1557 of the Patient Protection and Affordable Care Act (PPACA). Section 1557 of PPACA prohibits discrimination on the basis of race, color, national origin, sex, age, or disability under any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency, or any entity established under title l of the PPACA.

]]> Section 3(f)(1) Significant Previously Published in The Unified Agenda Final Rule Stage Yes No 42 CFR 438 42 CFR 440 42 CFR 457 42 CFR 460 45 CFR 80 45 CFR 84 45 CFR 86 45 CFR 91 45 CFR 92 45 CFR 147 45 CFR 155 45 CFR 156 ... sec. 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) 42 U.S.C. 1302 42 U.S.C. 1395 42 U.S.C. 1395eee(f) 42 U.S.C. 1396u-4(f) 42 U.S.C. 2000d-1 20 U.S.C. 1405 29 U.S.C. 794 42 U.S.C. 290dd-2 21 U.S.C. 1174 42 U.S.C. 300gg to 300gg–63 42 U.S.C. 300gg–91 42 U.S.C. 300gg–92 42 U.S.C. 300gg-111 to 300gg-139 as amended, sec. 3203 Pub. L. 116-136, 134 Stat. 281 42 U.S.C. 18021 to 18024 42 U.S.C. 18031 to 18033 42 U.S.C. 18041 to 18042 42 U.S.C. 18044 42 U.S.C. 18051 42 U.S.C. 18054 42 U.S.C. 18061 42 U.S.C. 18063 42 U.S.C. 18071 42 U.S.C. 18081 to 18083 26 U.S.C. 36B Yes

The Biden-Harris Administration has made advancing health equity and nondiscrimination in health care a cornerstone of its policy agenda. The current section 1557 implementing regulation significantly curtails the scope of application of section 1557 protections and creates uncertainty and ambiguity as to what constitutes prohibited discrimination in covered health programs and activities. Issuance of a revised section 1557 implementing regulation is important because it would provide clear and concise regulations that are consistent with the statutory text and protect historically marginalized communities as they seek access to health programs and activities.

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The Secretary of the Department is statutorily authorized to promulgate regulations to implement section 1557. 42 U.S.C. 18116(c). The current section 1557 Final Rule (issued in 2020) is in litigation.

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The Department has considered the alternative of maintaining the section 1557 implementing regulation in its current form; however, the Department believes it is appropriate to undertake rulemaking given the Administration’s commitment to advancing equity and access to health care and in light of the issues raised in litigation challenges to the current rule.

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In enacting section 1557 of the ACA, Congress recognized the benefits of equal access to health services and health insurance that all individuals should have, regardless of their race, color, national origin, sex, age, or disability. The Department anticipates that this rulemaking will result in significant benefits that are difficult to quantify, namely by providing clear guidance to the covered entity community regarding requirements to administer their health programs and activities in a non-discriminatory manner. In turn, the Department anticipates cost savings as individuals are able to access a range of health care services that will result in decreased health disparities among historically marginalized groups and increased health benefits. The Department estimates annualized costs over a 5-year time horizon of about $551 million or $560 million; however, it is important to recognize that this rule applies pre-existing nondiscrimination requirements in Federal civil rights laws to various entities, the great majority of which have been covered by these requirements for years.

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To be determined.

]]> NPRM 08/04/2022 87 FR 47751 NPRM Comment Period End 10/03/2022 Final Action 01/00/2024 No Federal Local State No No https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html https://www.regulations.gov/document/HHS-OS-2022-0012-0001 No No 0945-AA02 Related to 0945-AA11 Related to 0938 Centers for Medicare & Medicaid Services CMS Common Daniel Shieh Associate Deputy Director, Policy Division 0945 Office for Civil Rights OCR 800 368-1019 1557@hhs.gov 200 Independence Avenue SW, Washington DC 20201