WHAT IS THE FINAL RULE IMPLEMENTING SECTION 1557 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT?


Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA).[1]  The final rule implementing Section 1557 prohibits discrimination on the basis of race, color, national origin[2], sex, age, or disability in health programs or activities that receive Federal financial assistance or are administered by an Executive agency or any entity established under Title I of the ACA.[3]  The Section 1557 final rule makes it unlawful for any health care provider that receives federal funding to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability.[4]  Sex discrimination includes, but is not limited to, discrimination on the basis of sex; pregnancy, childbirth and related medical conditions; gender identity[5]; or sex stereotyping.[6],[7]  The Section 1557 final rule also enhances language assistance for people with limited English proficiency and helps to ensure effective communication for individuals with disabilities.[8]

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) enforces Section 1557.[9]  When OCR finds violations, a health care provider will need to take corrective actions, which may include revising policies and procedures, and/or implementing training and monitoring programs.[10]  Health care providers may also be required to pay monetary damages.[11]  Section 1557 also allows individuals to sue health care providers in court for discrimination.[12]

To learn more about Section 1557, please feel free to visit the Office of Civil Rights’ (OCR’s) website at http://www.hhs.gov/civil-rights/for-individuals/section-1557 or call the Office of Civil Rights at 1-800-368-1019.  The full text of the final rule implementing Section 1557 is available by clicking here.  In addition, answers to frequently asked questions about the final rule for Section 1557 can be found at http://www.hhs.gov/sites/default/files/2016-05-13-section-1557-final-rule-external-faqs-508.pdf.

 

If you DO NOT receive any federal funding (i.e. Medicaid, CHIP, grants, property, Medicare Parts A, C and D Payments, tax credits, cost-sharing subsidies under Title I of the ACA, etc, then Section 1557 final rule does not apply to you and you can stop reading.    [13]

  1. Educate yourself and your staff about Section 1557.
    1. A Presenter’s Guide on Section 1557 can be found on the OCR’s site at: http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf
    2. A Staff slideshow about Section 1557 can be found on the OCR’s site at:
      http://www.hhs.gov/sites/default/files/section1557-training-slides.pdf
  2. You are required to post Notices and Taglines [COMPLIANCE DATE – 10/16/16].  The following must be posted in your office, on your website, and in any office publications or communications:
  1. You may not exclude, deny or limit treatment or services based on an individual’s age (e.g. you cannot deny a 62-year-old patient treatment, stating you only treat patients under 60).[18]
 
  1. You cannot ask for a guardian’s/family member’s/companion’s citizenship or immigration status when he or she applies for your health services for an eligible patient.[19]
 
  1. You cannot deny treatment based on an individual’s sex, including their gender identity or sex stereotyping.[20]  For instance, you must treat individuals consistent with their gender identities, including with respect to access to facilities, such as bathrooms and patient rooms.[21]   For more information on this requirement, visit http://www.hhs.gov/sites/default/files/1557-fs-sex-discrimination-508.pdf.
 
  1. You must make reasonable changes to policies, procedures, and practices where necessary to provide equal access for individuals with disabilities, unless doing so would impose an undue financial burden on you or fundamentally alter your program.[22]  For example an office must modify its “no pets” policy to permit an individual with a disability to be accompanied by a service animal.[23]  Additionally, an office must allow an individual with an anxiety disorder to wait for an appointment in a separate, quiet room if the individual is unable to wait in a patient waiting area because of anxiety.[24]  For more information on this requirement, visit http://www.hhs.gov/sites/default/files/1557-fs-disability-discrimination-508.pdf.
 
  1. You must make all health programs and activities provided electronically (e.g., through online appointment systems, electronic billing, etc.) accessible to individuals with disabilities, unless doing so would impose an undue financial burden on you or fundamentally alter your program.[25]  For example, a doctor’s office that requires patients to make appointments only online must modify its procedures so that a person with a disability who cannot use the required method can still make an appointment.[26]  For more information on this requirement, visit http://www.hhs.gov/sites/default/files/1557-fs-disability-discrimination-508.pdf.
 
  1. You should ensure newly constructed and altered facilities are physically accessible to individuals with disabilities, using the standards for physical accessibility set forth in the 2010 Americans with Disabilities Act, “Standards for Accessible Design.”[27]  For more information on this requirement, visit http://www.hhs.gov/sites/default/files/1557-fs-disability-discrimination-508.pdf.
 
  1. You must provide effective means of communication to individuals with disabilities, including both patients and their companions.[28]  You must provide auxiliary aids and services (free of charge and in a timely manner) when necessary to individuals with disabilities to ensure those individuals have equal opportunity to participate and benefit from your health programs or activities.[29]  Auxiliary aids  and services include such things as:  (i) qualified sign language interpreters, (ii) large print materials, (iii) text telephones (TTYs), (iv) captioning, (v) screen reader software, (vi) video remote interpreting services.[30]  You may not:
    • Require an individual to provide his or her own interpreter.
    • Rely on a minor child to interpret, except in a life threatening emergency where there is no qualified interpreter immediately available. 
    • Rely on interpreters that the individual prefers when there are competency, confidentiality, or other concerns.
    • Rely on unqualified staff interpreters.
    • Use low-quality video remote interpreting services.[31]
 
  1. For individuals with limited English proficiency,[32] you are required to offer (free of charge and in a timely manner) a qualified interpreter when oral interpretation is a reasonable step to provide an individual with meaningful access to your health programs and activities.[33]  You must adhere to certain quality standards in delivering language assistance services. [34]  For instance, if a patient prefers and requests to have a family member or friend interpret for them, that is allowed as long as the companion agrees to interpret, your reliance on the companion is appropriate under the circumstances, and there are no competency or confidentiality concerns.[35]  In addition, you may not:
    • Require an individual to provide his or her own interpreter
    • Rely on a minor child to interpret, except in a life threatening emergency where there is no qualified interpreter immediately available
    • Rely on interpreters that the individual prefers when there are competency, confidentiality, or other concerns
    • Rely on unqualified bilingual or multilingual staff
    • Use low-quality video remote interpreting services.[36]

      For more information on this requirement, visit http://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf.
 
  1. Section 1557 also prohibits discrimination in your practice’s employee health benefit programs.[37]
 
  1. Do you have 15 or more employees?
    1. NO:  you can stop reading
    2. YES:  in addition to the requirements above, you must have a civil rights grievance procedure and designate an employee as a compliance coordinator.[38]  A model grievance procedure can be found in Appendix C of the following:  https://www.federalregister.gov/articles/2016/05/18/2016-11458/nondiscrimination-in-health-programs-and-activities?utm_campaign=subscription+mailing+list&utm_medium=email&utm_source=federalregister.gov#h-141.
 
[2] “The term ‘national origin’ includes, but is not limited to, an individual’s, or his or her ancestor’s, place of origin (such as a country), or physical, cultural, or linguistic characteristics of a national origin group.”  See http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf, at p. 12.
 
[5] “Gender identity means and individual’s internal sense of gender, which may be male, female, neither, or a combination of male and female.”  See http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf, at p. 8.  “An individual need not have sought medical treatment or have undergone specific processes to be transgender.”  Id.
 
[6] “Sex stereotypes mean stereotypical notions of masculinity or femininity.”  See http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf, at p. 8.
 
[32] “An individual with [limited English proficiency] is an individual whose primary language is not English and who has a limited ability to read, speak, or understand English often because they are not originally from the United States.”  See http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf, p. 12.
 
 
Jan. 16, 2017

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AAO attorney Trey Lawrence recently attended a hearing before the North Carolina State Board of Dental Examiners regarding specialty advertising regulations proposed by the North Carolina Board and provided comments on those proposed regulations.

Previously, the AAO had worked to persuade the Board to adopt proposed regulations regarding who may practice or advertise as specialists.  Specifically, the AAO supports requirements that those practicing and/or advertising as “specialists” have completed a post-doctoral advanced dental education program of at least two full time-years, that is accredited by the ADA Commission on Dental Accreditation (CODA).  After previously adopting proposed regulations that were a significant step in this direction, the North Carolina Board considered further revising the proposed regulation in October.

The proposal is to more specifically define which accrediting organizations or programs meet requirements for advertising or practicing as a “specialist.” 
 
Thanks to the AAO Component Legal Support Fund, the Legal Department has been assisting North Carolina with this issue and is pleased to report that via the Board’s proposed revisions, AAO members’ concerns are being heard. Click here to view a copy of the letter the AAO submitted to the North Carolina Board in support of the proposed regulation.

You (as a citizen of and licensed dental provider in your state) have the right, independently and individually, to express your own opinions about public health and safety issues to your state dental board. If you feel so compelled, contact your state's dental board to discuss such matters with them.  Contact information for state dental boards can be found at https://www.aaoinfo.org/aao/state-dental-board-info.  

Likewise, if you have patients who believe they have been injured or otherwise harmed by dental services or advertising, you can inform them about the process by which the patient can file a complaint with your state's dental board, should they wish to do so, https://www.aaoinfo.org/aao/state-dental-board-info.  

If you are aware of a dental board hearing regarding orthodontics, please feel free to inform the AAO, by sending an email to feedback@aaortho.org.
 
 
 
 
Dec. 7, 2018

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Due to the popularity of the 2019 Winter Conference, rooms at the headquarters hotel, the JW Marriott Marco Island Beach Resort, have sold out.  Registration remains open for the meeting, “Sleep Apnea and Orthodontics: Consensus and Guidance,” which will be January 25-27 in Marco Island, Florida.
 

New registrants are encouraged to check with other Marco Island hotels to secure rooms prior to registering.

- View the complete conference schedule

- Register for the 2019 Winter Conference


- View conference information, including early registration rates.
(Registration fees include scheduled breakfasts, lunches and snack breaks. The Early Registration discount is in effect through December 28.)

Archived Lecture Orders Being Accepted
Many Winter Conference lectures will be recorded for the AAO Conference Archives. Click here to access the Conference Archives order page, listing pre-conference purchase rates for web access only, for the USB drive and for the combined web-plus-USB package. On-site purchases may be made at the conference for an additional $20; after the conference, prices will increase by $40.

Dec. 5, 2018

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The Associated Press (November 7, 2018) reported that five dentists were elected or re-elected to the U.S. House of Representatives on Election Day (November 6). The successful candidates included:

● Dr. Brian Babin, a Republican from Texas’ 36th District;
● Dr. Drew Ferguson, a Republican from Georgia’s 3rd District;
● Dr. Paul Gosar, a Republican from Arizona’s 4th District;
● Dr. Mike Simpson, a Republican from Idaho’s 2nd District;
● Dr. Jeff Van Drew, a Democrat from New Jersey’s 2nd District.

Dr. Ferguson is moving into leadership within the Republican party, having been appointed Chief Deputy Whip for the 116th Congress.

The AAO Political Action Committee supported Drs. Babin, Ferguson, Gosar, Van Drew and other successful candidates in the 2018 election.
Learn More about the AAO-PAC
 
Nov. 30, 2018

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The feeling that a beautiful, healthy smile brings is not always easy to describe in words, so a new AAO social media series is presenting it as an experience.

More than 15 million consumers viewed ads and short videos in the new AAO Facebook/Instagram series, "That Feeling When ..." from September 22-November 22. Over 600,000 viewers responded to the series by spending time on the AAO consumer website, aaoinfo.org, where visitors may access a variety of information and utilize the Find an Orthodontist locator.
 
Many consumers on Facebook and Instagram also demonstrated engagement via Likes, Shares and comments.  The series’ two top performers, “That Feeling When You Rock Your Very First Orthodontic Check-up,” and “That Feeling When You Show Off Your Beautiful Smile” resulted in the following metrics:

That Feeling When You Rock Your Very First Ortho Check Up (click to view)
Impressions: 35,590,847 (number of times the ad was sent to individual news feeds)
Reach: 5,628,711 (number of times that the ad was viewed by Facebook/Instagram users)
Engagements: 360,662 (Likes, Shares, comments and clicks through to the AAO website)
 
That Feeling When You Show Off Your Beautiful Smile (video; click to view)
Impressions: 18,418,503
Reach: 6,335,219
Engagements: 2,067,629

Metrics for the entire Facebook/Instagram series from September 22-November 22 were:

Impressions: 88,085,000
Reach: 15,773,076
Engagements: 3,797,576
 
That’s not all! The series is also running across other digital platforms. On Snapchat, for instance, the ads reached nearly 20 million consumers.
 
The series is part of the Consumer Awareness Program, an all-digital marketing initiative developed under the leadership of the AAO Council on Communications. Follow the CAP on social media to stay up-to-date on current campaigns.

Additional ads and short videos in the series are linked below. Stay tuned for new social media ads and videos that will be launching in coming weeks.
 
- That Feeling When You Show Off That New Smile
 
- That Feeling When You Show Off That New Smile 2
 
- That Feeling When You Rock Your Very First Ortho Check Up 2
 
- That Feeling When You Rock Your First Ortho Check Up (video)
 
- Did You Know? The Recommended Age For An Ortho Check-up is 7 (video)
 
- Did You Know? Wires Used For Braces Were Developed by NASA (video)


 
Nov. 30, 2018

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Dr. John T. Lindquist, orthodontist, inventor, entrepreneur and past AAO president died on October 27 at age 93.

An U.S. Navy inductee during World War II, Dr. Lindquist studied at Tufts University and then was sent by the Navy to the Indiana University School of Dentistry. He also completed the IU orthodontic residency program and in 1953, became a full-time instructor in the Orthodontic Department. He served in the U.S. Navy and the Indiana National Guard for many years, reaching the rank of Major.

After starting his practice in Indianapolis, Dr. Lindquist became active in organized dentistry and orthodontics.  He was president of the AAO in 1988-89, presiding over the 1989 Annual Session in Anaheim, California. Dr. Lindquist also served as a director of the American Board of Orthodontics and was a leader, board member and/or president of the Edward H. Angle Society of Orthodontists, the Charles H. Tweed Foundation and the Great Lakes Association of Orthodontists (GLAO), which awarded him its Dr. David C. Hamilton Distinguished Service Award.  He spoke internationally at orthodontic meetings, including those of the French, Japanese, British and Brazilian societies.

In addition, Dr. Lindquist was a founding shareholder of Orthodontic Supply Corporation and Research Inc. and worked with the company on new product development and processes. Early in his career he had lectured before the Edward H. Angle Society on an original indirect band technique and continued working to innovate and improve the practice of orthodontics throughout his life. After retiring from practice in 2002, Dr. Lindquist was assigned rights to a U.S. patent for a product that his company marketed.

Dr. Eugene Roberts, professor emeritus of orthodontics at Indiana University and Purdue University in Indianapolis, was a friend of Dr. Lindquist and is compiling historical information about Dr. Lindquist’s career and leadership within the specialty.

“Dr. Lindquist was one of the first orthodontists trained at Indiana University,” said Dr. Roberts. “As the teacher of both Jim Baldwin and Charles Burstone, John Lindquist was my biomechanics ‘grandfather’.  He worked to advance our specialty in many ways, including playing an important role in the history and evolution of edgewise orthodontics.  I am not sure there is a precedent for the broad influence that Dr. Lindquist had on orthodontics:  R&D, manufacturing, private practice, clinical standards and political leadership.”

As an AAO board member and president, Dr. Lindquist was noted for his strong leadership capabilities.  Dr. Terry Pracht, AAO president for 2004-05 and current chairman of the AAO Insurance Company, also developed a friendship with Dr. Lindquist and enjoyed learning from him.

“When I was first elected as a Director of the GLAO during the early 1980s, John was a relatively new AAO Trustee for our constituent organization,” says Dr. Pracht. “He did an excellent job of bringing us all of the important issues and worked with us on developing resolutions to the AAO House of Delegates.  He was a great orthodontist, leader and friend.”

Dr. Lindquist’s funeral took place on November 3. In lieu of flowers, his requested memorial contributions to the AAO Foundation or to the Mayo Clinic. Online condolences may be shared by visiting www.flannerbuchanan.com.

View Dr. Lindquist’s Obituary
 



 
Nov. 20, 2018

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The Practice Opportunities & Careers site is no longer active; however, it will remain open through the end of December for existing users to access their seeker profiles, inactive opportunities, or messages.
 
Please visit the AAO Career Center at https://careers.aaoinfo.org/ to search or post job opportunities, locum tenens, practices and equipment for sale, and office space for rent or lease. Registering as an employer or seeker can be completed in just a few minutes by following these steps:

The Practice Opportunities & Careers site is no longer active; however, it will remain open through the end of December for existing users to access their seeker profiles, inactive opportunities, or messages.

Please visit the AAO Career Center at https://careers.aaoinfo.org/ to search or post job opportunities, locum tenens, practices and equipment for sale, and office space for rent or lease. Registering as an employer or seeker can be completed in just a few minutes by following these steps:

The 2019 Annual Session, May 3-7 in Los Angeles, will bring AAO members and other meeting attendees to sunny California and the center of the U.S. film and television industry.

Welcoming more than 47 million visitors per year, the LA hospitality industry is eager to help visitors from every part of the world enjoy the city. Plan to take some time during your stay to enjoy the LA experience. Our suggestions include:

Famous Pacific beaches. Whether you like sunbathing, surfing, people-watching, playing or a unique cultural experience, LA beaches have something for everyone:
- Visit laid-back and friendly Malibu (west of LA) to access Zuma Beach and Malibu Lagoon State Beach, known as “Surfrider Beach” for its waves.
- At renowned Venice Beach, waves and sand are surrounded by an artistically oriented, bohemian-style town;
- Iconic Santa Monica State Beach offers a unique combination of sand, sea and mountain views with walking and biking paths.

Tours of television and movie studios. Popular studios include:
- Universal Studios LA, which is both a theme park and a working studio offering tours of sets;
- Warner Brothers Studios in Burbank, which offers visits to sound stages, sets and back lot streets. Some of the many popular television shows produced by the studio include “Friends,” “The Gilmore Girls” and “Big Bang Theory.”

 ● Unique and classic LA sites. Some of the most famous LA destinations include:
- The Hollywood Walk of Fame, the legendary Hollywood sidewalk emblazoned with stars and celebrity names;
- Santa Monica Pier, a well-known seaside destination featuring amusement park rides, shops and restaurants as well as an aquarium;
- Rodeo Drive in Beverly Hills, renowned for its upscale shopping and frequented by celebrities;
- Sunset Boulevard, an iconic, 22-mile road long known for vibrant nightlife and famous landmarks;
- Disneyland. The first Disney theme park now offers eight themed "lands" with rides, shows and costumed characters;
- The J. Paul Getty Museum, with its world-renowned visual arts collection (locations in Los Angeles and Malibu).

Annual Session tours will include visits to some popular LA destinations. Watch your in-box for an eBulletin later this year announcing that Annual Session tour registration has opened.

● Learn more about Los Angeles.

Learn about the 2019 Annual Session Doctors Scientific Program.

Register for Annual Session and make hotel reservations.*

* After registering, you will receive a confirmation email with a link to reserve your hotel accommodations.
 
Nov. 5, 2018

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