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HHS/OCR RIN: 0945-AA17 Publication ID: Fall 2023 
Title: 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.

Agency: Department of Health and Human Services(HHS)  Priority: Section 3(f)(1) Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 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    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 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   
Legal Deadline:  None

Statement of Need:

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.

Summary of the Legal Basis:

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.


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.

Anticipated Costs and Benefits:

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.


To be determined.

Action Date FR Cite
NPRM  08/04/2022  87 FR 47751   
NPRM Comment Period End  10/03/2022 
Final Action  01/00/2024 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal, Local, State 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Information URL:   Public Comment URL:  
RIN Data Printed in the FR: No 
Related RINs: Related to 0945-AA02, Related to 0945-AA11  Related Agencies: Common: HHS/CMS; 
Agency Contact:
Daniel Shieh
Associate Deputy Director, Policy Division
Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW,
Washington, DC 20201
Phone:800 368-1019