Section 1557: What You Need to Know

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While we may be far removed from the days of water fountains being segregated by race, there’s plenty of discrimination issues that still require our attention and forethought. The US Department of Health and Human Services recently passed a provision within the Affordable Care Act (or Obamacare, if you’d prefer) to help combat discrimination. But what does all that legal talk mean? Are you covered? Will your patient statements and communications need to be changed? We have the answers you’re looking for below, all in plain English.

What is Section 1557?

As described on the U.S. Department of Health and Human Services website, Section 1557 is the non-discrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs or activities that receive Federal financial assistance or are administered by an Executive Agency or any established entity under Title I of the ACA.

…Huh?

That’s what we said. To boil it down to its simplest terms, all entities within the Healthcare industry (not just hospitals and insurance, but all covered entities as well) need to make changes to ensure no one is being left out in the cold, no matter their sex, race, or what language they speak. That means a few things specifically to anyone sending out patient statements or any kind of communications:

· A non-discrimination policy must be sent with vital communications such as a patient statement or any other communication, ensuring that the organization in question is Section 1557 compliant.

· A tagline that informs the patient of available language assistance services must be written in the two most prominent languages in the area (though this rule depends on the size of the organization. More on that later)

· While not necessarily a steadfast rule, it’s not a bad idea to make sure that all fonts used are clear, large, and easy to read. This goes beyond bills and into other publications a patient may receive, such as an Explanation of Benefits.

To Whom Does it Apply?

The new Section 1557 regulations apply to nearly every entity providing healthcare, as it applies to every health program or activity that receives HHS funding, every health program or activity administered by HHS, such as the Medicare Part D program, and the Health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces. Covered entities may include hospitals, health clinics, health insurance issuers, state Medicaid agencies, community health centers, physician’s practices and home health care agencies.

Basically, if you work within the medical field in any capacity, you likely fall under the law of Section 1557.

So What Do I Have to Do?

If your practice accepts payment from any HHS program or activity or entity that HHS funds or you accept any Marketplace plans, this applies to you. All practices — regardless of practice size — are required to post the non-discrimination poster and the taglines poster, at the minimum. Under a new requirement, covered entities are required to post information telling consumers about their rights and telling consumers with disabilities and consumers with limited English proficiency (LEP) about the right to receive communication assistance.

For providers with 15 or more employees, at least one employee must be designated to coordinate the entity’s Section 1557 compliance efforts and responsibilities. Included in these responsibilities are investigations of any grievance alleging discrimination. Please go here to read additional specifications regarding practices with 15 or more employees.

Beginning on Oct. 17, 2016, in all “significant publications and vital communications,” providers must post the required nondiscrimination notice as well as specified taglines in at least the top 15 languages spoken by individuals with limited English proficiency in the provider’s state.

So what qualifies as “significant publications and vital communications”? Well, we don’t absolutely know, but we have a good idea. While we never got an exact definition, examples include materials “targeted to beneficiaries, enrollees, applicants, or members of the public, which may include patient handbooks, outreach publications, or written notices pertaining to rights or benefits or requiring a response from an individual.”

So… what does that mean?

This new law would include billing statements and explanation of benefits (EOBs). The Office of Civil Rights (OCR) has indicated it intends to interpret the term broadly while providing entities flexibility to determine which of its communications and publications pertaining to its services are significant.

Regulations

The effective date for the provisions of the final Section 1557 regulation, including those concerning the administration of health insurance or other health-related coverage, is July 18, 2016. Claims processing is considered to be the administration of health plans or health coverage, not a plan design. Thus, it is not affected by the January 1, 2017, application date for benefit design changes in the regulation.

Compliance

Any practice that receives government funding is required to post information to be in compliance with Section 1557 of the Affordable Care Act (ACA) by Sunday, Oct. 16. Patients can sue for non-compliance of this ruling. There is just one Assurance of Compliance form (Form HHS 690), and each covered entity is required to sign, date, and submit the same form. The Assurance of Compliance Form (HHS 690) is found on OCR’s website, at (Form HHS-690).

Obviously, this is quite a bit of new rules, and you can get more than a slap on the wrist if your communications do not fall in line with the newest compliance regulations. Take the guesswork out of updating your patient statements and contact MailMyStatements. Beyond Section 1557 compliance, we offer more billing solutions, including branded payment portals, pay by QR codes, printing and mailing, and statement design.

Read more at https://mailmystatements.com/

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Mr. Hugh Sullivan is considered an industry thought leader and has spoken on numerous occasions at local, regional and national healthcare forums. He is currently a member of the HFMA and ACA International and has served as a board member of WEDI, a nonprofit organization focused on the use of health IT to improve healthcare information exchange.

Hugh has a BS, in Logistics Systems Management, from Colorado Technical University. He enjoys being a husband and father to his wife and three boys as well

Twitter @hughdsullivan

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MailMyStatements is a technology-driven statement, payment, and collection vendor that specializes in simplifying the client billing process. #patientstatements

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