SCGhealth Blog

Get those anti-discrimination notices up!

Tuesday, October 25, 2016

By: Marla Durben Hirsch, Contributing Writer

It’s crunch time for medical offices: October 16 was the deadline for notifying the public that your practice doesn’t discriminate in violation of the law.

The rule implementing section 1557 of the Affordable Care Act, released May 13, bans discrimination on the basis of race, color, national origin, sex, age and disability to any health program or activity which receives any federal financial assistance. Providers are except only if they receive Part B Payments and no other federal money.

Section 1557 in particular prohibits sex discrimination in health care, including denial of health care or coverage based on sex, pregnancy, gender identity and sex stereotypes. The law also enhances the obligations to provide language assistance to people with limited English proficiency and communication assistance to those with disabilities.

Notices to inform patients required

In addition to complying with the rule itself, providers (and other covered entities, such as a health plan or employer provided health clinic) need to post a notice informing the public of the providers’ obligations and patients’ rights. The notice needs to include:

    • That the provider does not discriminate in violation of the law
    • That it provides free aids and services to people with disabilities so that they can communicate with the provider, such as sign language interpreters and written information in other formats
    • That the provider provides free language services with people whose primary language isn’t English
    • How to obtain this help
    • How to file a complaint with the Office for Civil Rights (OCR) if the patient believes that his/her rights have been violated.

    The notice must be posted in conspicuously visible font in significant publications or communications, in conspicuous physical locations available to the public, and in a conspicuous location on the provider’s website.

    Providers also need to post taglines in different languages alerting patients that the language assistance help is available. The taglines need to be in at least the top 15 languages spoken by people with limited English proficiency in that state.

    OCR has provided a sample notice to post in Appendix A of the final rule, as well as on its website, with sample taglines.

    Grievance procedure also required for many

    If a provider has more than 14 employees, then the provider also has to provide patients who believe they have been discriminated against with an internal grievance procedure and designate an employee (known as the “civil rights coordinator” or “section 1557 coordinator”) who will be responsible for section 1557 compliance and handle investigations of alleged violations. The civil rights coordinator can also have other duties; this need not be a dedicated position.

    According to the rule, a grievance must be summited within a certain number of days (OCR suggests 60) after the complainant becomes aware of the alleged discrimination. The grievance must be in writing, with the name and address of the complainant and a description of the alleged discrimination. The civil rights coordinator or his/her designee shall conduct a “thorough” investigation, although it can be informal, and provide a written decision, OCR suggests no later than 30 days after the filing of the complaint. The decision needs to include notice to the complainant of the right to pursue other remedies, such as appealing the decision to the CEO/board/administrator of the entity and/or to file a complaint with the OCR.

    The availability of the internal grievance procedure, and the contact information of the civil rights coordinator also needs to be in the posted notice.

    OCR was kind enough to provide a sample grievance procedure, in Appendix C of the final rule.


    Providers should review their policies and procedures to ensure that they don’t discriminate, and can provide the auxiliary and language aids required. Don’t forget to post the public notice by the deadline and implement an internal grievance procedure if that hasn’t been done already. You can use the sample notice and grievance policy, especially if you’re running out of time; you can always update it down the road. This is a front burner issue for OCR, which has already begun enforcement.

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