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ACA Section 1557 Compliance for Health Coverage Toolkit
Practical Law Toolkit w-036-4870 (Approx. 8 pages)
ACA Section 1557 Compliance for Health Coverage Toolkit
by Practical Law Employee Benefits & Executive Compensation
| Maintained • USA (National/Federal) |
A collection of resources addressing compliance issues for covered entities that are subject to the nondiscrimination requirements of Section 1557 of the Affordable Care Act (ACA). ACA Section 1557 prohibits individuals from being excluded from participation in, being denied the benefits of, or being subject to discrimination under any health program or activity that receives federal financial assistance on specified grounds (for example, disability).
Section 1557 of the Affordable Care Act (ACA) imposes a nondiscrimination requirement that prohibits individuals from being excluded from participation in, being denied the benefits of, or being subject to discrimination under a health program or activity that receives federal financial assistance on specified grounds (42 U.S.C. § 18116; see Practice Note, Affordable Care Act (ACA) Overview). Specifically, ACA Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability, or sex in covered health programs and activities.
Section 1557 has been the topic of significant implementing regulations issued by three successive presidential administrations (including the current one). These regulations include:
- Final regulations issued by the Obama administration in May 2016 (81 Fed. Reg. 31375 (May 18, 2016); see Article, Nondiscrimination in Health Programs and Activities Under the ACA (Section 1557): Overview of Section 1557).
- Final regulations issued by the Trump administration in June 2020, which replaced and significantly scaled back the Obama-era regulations (86 Fed. Reg. 37160 (June 19, 2020); see Practice Note, June 2020 Final Regulations Under ACA Section 1557: Nondiscrimination in Health Programs and Activities).
- Re-proposed regulations issued by the Biden administration in August 2022, which would reinstate some provisions from the Obama administration's regulations and add new requirements (87 Fed. Reg. 47824 (Aug. 4, 2022); see Legal Update, Re-Proposed Section 1557 Regulations Would Apply to Many Health Insurers and Require Adoption of Policies and Procedures).
Final Regulations (May 2024)
In May 2024, the Biden administration finalized the August 2022 re-proposed regulations (89 Fed. Reg. 37522 (May 6, 2024)). Relatedly, in June 2024, the Supreme Court overruled its 40-year-old Chevron decision, which had required reviewing courts to defer to agency interpretations of ambiguous statutes that Congress authorized the agency to administer (Loper Bright Enters. v. Raimondo, (June 28, 2024); see Legal Update, Supreme Court Overrules Chevron Framework for Interpreting Laws Administered by Federal Agencies: Employee Benefits). In July 2024, three district courts applied the Loper ruling in issuing stays and preliminary injunctions barring HHS from enforcing provisions of the May 2024 final regulations as applicable to gender transition services (see Legal Update, Applying Supreme Court Decision Overruling Chevron, Three District Courts Bar HHS from Enforcing ACA Section 1557 Final Regulations on Gender Identity).
Recent Section 1557 Litigation
Section 1557 has been the topic of significant and ongoing litigation. For recent examples of this litigation, see Legal Updates:
Against this rapidly changing regulatory and litigation backdrop, this Toolkit provides a collection of compliance resources for use by health plan sponsors, health insurers, TPAs, other service providers, and their advisors in offering health plan benefits in compliance with ACA Section 1557.