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Final ACA Section 1557 Nondiscrimination Rules: New Requirements for Group Health Plans, Healthcare Providers, and TPAs

Recording of a 90-minute premium CLE video webinar with Q&A

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Conducted on Tuesday, October 1, 2024

Recorded event now available

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This CLE webinar will provide guidance on the U.S. Department of Health and Human Services (HHS) Office for Civil Rights' (OCR) recently issued final nondiscrimination rules under Section 1557 of the Affordable Care Act (ACA). The panel will describe the final rule's requirements and how the rule expands the scope of covered entities, provides additional exemptions, and other key provisions under the final rule. The panel will also discuss the rule's compliance timeline and offer best practices for compliance for health plans, fiduciaries, and third-party administrators.

Description

On Apr. 26, 2024, the HHS and OCR issued final regulations reinterpreting Section 1557 of the ACA providing key revisions and expanding requirements under the ACA to prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in health programs and activities that receive federal financial assistance.

The recently released final rule encompasses staggered effective dates beginning July 5, 2024, making key revisions to the regulations interpreting Section 1557 of the ACA. The revisions restore some regulatory provisions repealed in 2020 and expand the rule's scope by adding other provisions to enhance nondiscrimination requirements for healthcare providers, significantly impacting group health plans, fiduciaries, and third-party administrators.

The final rule includes: (1) requiring covered entities to build up a Section 1557 compliance program with policies, staff training, and designation of a Section 1557 coordinator; (2) for the first time, interpreting federal financial assistance to encompass Medicare Part B payments; (3) expanding protections related to language assistance and accessibility services; (4) re-codifying HHS' position that the prohibition against discrimination based on sex includes discrimination against LGBTQI+ individuals; and (6) applying Section 1557's nondiscrimination principles to the use of patient care decision support tools including those using AI.

Benefits counsel must understand these new requirements under the final rule, recognize the impact to plan sponsors and administrators, and take necessary steps to ensure compliance with these new regulations.

Listen as our expert panel provides an in-depth look at the ACA Section 1557 final rule. The panel will discuss who is now covered under the expansive provisions and the rule's requirements. The panel will also describe the exemption process and offer best practices for compliance.

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Outline

  1. Introduction: history of the final rule
  2. Section 1557 final rule
    1. Covered entities
    2. Medicare Part B as federal financial assistance
    3. Protections for LGBTQI+ and pregnant individuals
    4. Language assistance and accessibility
    5. Exemption based on religious freedom and conscience laws
    6. Notice requirements
    7. Compliance timeline/staggered effective dates
  3. Key issues for plan sponsors and fiduciaries
    1. TPAs acting as service providers
    2. Managing medical services
  4. Judicial challenges
    1. Tennessee v. Becerra (and the imposition of a nationwide injunction)
    2. Other district court and appellate challenges
    3. Judicial deference and the impact of Loper Bright
    4. Prospects before the Supreme Court
  5. Next steps and best practices for compliance

Benefits

The panel will review these and other key considerations:

  • How does the final rule apply to group health plans, carriers, and third-party administrators?
  • How does the final rule expand the scope of covered entities?
  • What protections does the rule reinstate that were removed in 2020?
  • What compliance and notice requirements are included in the final rule?
  • When might we have some certainly about whether these rules apply?

Faculty

Bianchi, Alden
Alden J. Bianchi

Counsel
McDermott Will & Emery

Mr. Bianchi is the Practice Group Leader of the firm’s Employee Benefits & Executive Compensation Practice....  |  Read More

Kenkel, Scott
Scott Kenkel

Associate
McDermott Will & Emery

Mr. Kenkel focuses his practice on employee benefits and executive compensation matters. He has experience assisting...  |  Read More

Raaii, Sarah
Sarah G. Raaii

Partner
McDermott Will & Emery

Ms. Raaii focuses her practice on employee benefits and matters related to health care reform, data privacy and HIPAA...  |  Read More

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