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:
  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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On January 5, Dr. DeWayne McCamish concluded his leadership and executive duties with the AAO by offering to match (up to his legal limit of $5,000) member donations to the AAO’s Political Action Committee (AAOPAC). Dr. McCamish was the 2016-17 president of the AAO and served as interim executive director for the last eight months of 2017.

U.S. members were advised of Dr. McCamish’s Match offer via an email message, and many responded by the January 31 deadline. The Match offer raised a total of $33,234, including Dr. McCamish’s $5,000 contribution. 

“I very much appreciate the responses to my Match offer, which will help the orthodontic specialty with its federal efforts this year,” said Dr. McCamish. 

The AAO Political Action Committee (AAOPAC) was established in 1994 to assist the specialty of orthodontics with its presence in Washington, DC.  The AAOPAC is led by a Board of Directors that includes a representative of each AAO constituent organization.  The 2017-18 Board of Directors includes:
  • Dr. Kevin D. Horner, Chair (MSO)
  • Dr. Phillip J. Beckwith (COGA)
  • Dr. J. Richard Pfeffer (GLAO)
  • Dr. Massimo V. Verduci (MASO)
  • Dr. Philip M. Mansour (NESO)
  • Dr. Michael A. Feinberg (PCSO)
  • Dr. Morris L. Poole (RMSO)
  • Dr. Jennifer Edwards Butler (SAO)
  • Dr. Clark D. Colville (SWSO)
  • Dr. John D. Callahan (AAO Board Liaison)
For more information about the AAOPAC contact pac@aaortho.org.
Mar. 15, 2018

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Dr. Nahid Maleki, president of the AAO, recently contacted the U.S. Senate Committee on Health, Education, Labor and Pensions, advocating for student loan policy reforms as the committee prepares to reauthorize the Higher Education Act (HEA).

A letter from Dr. Maleki to Senators Lamar Alexander and Patty Murray (chairman and ranking member of the committee, respectively) outlines how young orthodontists are negatively impacted by current student loan policies. The letter explains that responses to a recent survey show the average debt for graduating orthodontists is more than $400,000, which impacts, among other things, where they practice and what opportunities they are able to pursue.
AAO policy principles for reauthorization, as listed in the letter, include:
Ensure access to graduate and professional education for students from all backgrounds.
Preserve protections for student borrowers with federal student aid.
Ease the burden of student loan debt, which negatively impacts graduates’ important life decisions and our overall economy.

AAO recommendations for updating the HEA include:
♦ Preserve the in-school interest subsidy for undergraduate borrowers (which makes it possible for undergraduates to defer interest while in school);

♦ Eliminate loan origination fees and reduce rates so the federal government does not profit off of students;

♦ Allow borrowers to refinance their undergraduate and graduate federal student loans whenever borrowing rates are reduced, just as with the home mortgage market;
♦ Allow federal borrowers in dental specialty residencies to defer loan payments, due to the fact that many do not receive stipends or salaries while in residency;
♦ Reject the House of Representatives PROSPER Act cap on annual and aggregate loan limits for such borrowers. The proposed cap is much less than the amount that many orthodontic residents need to borrow. Instead, preserve the Direct PLUS Loan Program for graduate students, under which graduates and parents currently can borrow federally-backed student loans up to the cost of attendance.

View the Complete Letter to the Senate Committee
Mar. 8, 2018

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♦ The February 2018 Practice Management Bulletin offers in-depth perspective on the application of data generated by Gaidge to orthodontic practice, featuring input from Drs. Todd Bovenizer, Robert Bray, Greg Nalchajian, and Ryan VanLaecken.
View the Practice Management Bulletin Feature

♦ Watch the eBulletin for an upcoming AAO Business of Orthodontics Podcast with in-depth discussion of the use of annual aggregate key practice metrics compiled from more than 1,250 locations across the United States and Canada. The data, linked above, are now available to AAO members via a collaboration between Gaidge and the AAO.
Mar. 5, 2018

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More than 80 participants took part in the 2018 Leadership Development Conference last month in Scottsdale, Arizona. Attendees included component, constituent and council leaders, speakers and AAO trustees. Forty component (state) organizations and all eight constituents were represented. The conference was spearheaded by the AAO Component Support and Leadership Development Committee, chaired by Dr. Ken Dillehay, the AAO trustee representing the Southwestern Society of Orthodontists.

Dr. Dillehay joined other attendees in offering short, videotaped comments on the Leadership Development Conference and how it will help participants to better serve their organizations. Additional participants appearing in the video include:

♦ Dr. Jean Asmar, interim president, District of Columbia Society of Orthodontists
♦ Dr. Eric Barnes, secretary-treasurer, Illinois Society of Orthodontists;
♦ Dr. Allen Chance, director-at-large, Tennessee Association of Orthodontists;
♦ Dr. Myron Guymon, AAO trustee representing the Rocky Mountain Society of Orthodontists;
♦ Dr. Ali Husain, president- elect, Delaware;
♦ Dr. Anil Idiculla, chair of the AAO Council on Communications;
♦ Dr. Valerie Martone, secretary-treasurer, Rocky Mountain Society of Orthodontists;
♦ Dr. John Monticello, president-elect, Great Lakes Association of Orthodontists;
♦ Dr. Suzanne Stock, president-elect of the Iowa Society of Orthodontists;
♦ Dr. Emily Willett, new/younger member asked to attend by the Nebraska Society of Orthodontists.

View the Leaders’ Comments Video

During the meeting, participants heard from expert speakers and discussed a range of topics including effective leadership, trends affecting the specialty, legal and administrative issues, diversity, state advocacy, the AAO Consumer Awareness Program, speaker management, parliamentary procedure and facilitating Board meetings.

Learn More and Access Presentations on Conference Topics

Between conferences, constituent and component leaders and other AAO volunteers are encouraged to use the new online Leadership Network. The network, which is available to all AAO members, is a centralized repository of many types of information and resources that the Component Support and Leadership Development Committee identified as being helpful to leaders and volunteers at all levels.
Mar. 5, 2018

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Before, during and after the 2018 Annual Session, enjoy Washington Nationals baseball and cultural events in the nation’s capital. Washington, D.C.’s rich cultural scene offers a wealth of opportunities for fans of the performing arts.

Go Out to the Ball Game
The Washington Nationals Major League Baseball team will have home games (vs. Philadelphia Phillies) on May 4, 5 and 6 during Annual Session. Registrants will have access to tickets at discounts of 17 to 20 percent, depending on the game.

To purchase discounted tickets, click here, then:
♦ Select your preferred game;
♦ Enter ORTHO18 in the Coupon Code box.

* If you are in Washington at any other time during the 2018 baseball season and wish to attend a Nationals home game, the coupon discount code will still apply.

Enjoy Riveting Theatrical and Ballet Performances
Royal Shakespeare Company: Hamlet (North American premiere, The Kennedy Center), May 2-May 6;

True West, by Sam Shepard (The Horowitz Visual and Performing Arts Center's Studio Theatre), April 26-May 13;

Rite of Spring,” an original adaptation of Igor Stravinsky's iconic 1913 ballet (the Dance Loft on 14), April 27 – May 11;

Iron and Coal. A world-premiere theatrical concert by acclaimed composer and performer Jeremy Schonfeld, based on the original concept album Iron & Coal by Jeremy Schonfeld. (The Music Center at Strathmore, May 3- May 4).

Immerse Yourself in the Sounds of the Capital City
Beethoven's Choral  Symphony, Los Angeles Philharmonic, (The Kennedy Center), April 26;

Washington Bach Consort’s Performance of J.S. Bach’s Mass in B Minor, (the historic National Presbyterian Church, where many U.S. presidents have worshipped), April 29;

The Washington National Opera, The Barber of Seville, (The Kennedy Center), April 23 – May 19);

Joshua Redman Quartet (Blues Alley, Washington’s renowned jazz and supper club),  May 3 – May 6;

TAUK (funk, hip-hop, progressive rock, and jazz band, at the 9:30 Club - named by Esquire as the best music venue in the United States), May 4.

The Temptations and the Four Tops, (MGM National Harbor), May 4;

The Washington National Opera, Candide, (The Kennedy Center), May 5-26;
Clarinetist David Shifrin and the Miro Quartet, performing quintets by Mozart and Brahms (International Student House of Washington DC), May 6;

Julia Bullock, soprano, and John Arida, piano (National Gallery of Art, May 6);

 ♦ Shanghai Quartet  and Alexander Fiterstein: String Quartet + Clarinet (JCC of Greater Washington), May 6.
Mar. 2, 2018

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Register now and join your colleagues for the wealth of exceptional learning experiences available at the 2018 Annual Session. Recent additions to the Doctors Scientific Program include:

♦ Dr. Olivier Albert Sorel of Rennes, France, speaking on, “Diagnosis, Prognosis and Control of Adult Orthodontic Treatments Focused on Taking into Account the Shape of the Teeth” and 
♦ Dr. Daniel Rinchuse of Greensburg, Pennsylvania, speaking on, “Learning from Success and Failure of Orthodontic Cases.”

Drs. Sorel and Rinchuse will be speaking on Tuesday, May 8.
Access the Complete Doctors Program Schedule
(Scroll down the linked page to view the schedule.)
“The best way to describe the specialty of orthodontics right now is that it is energized,” says Dr. Larry Wang, serving as 2018 Doctors Scientific Program co-chair along with Dr. Chun-Hsi Chung. “We wanted to tap into this energy and bring it to our nation's capital.

“Doctors Program lecturers will address everything from sleep apnea to customized appliances to accelerated orthodontics,” Dr. Wang continues. “We wanted our attendees to receive valuable pearls on the day-to-day challenges we face in our practices all across the globe.  We selected speakers who could present the very latest techniques and clinical protocols on the correction of Class II and III malocclusions, open bites and asymmetries, impacted teeth and TMD therapy, and much more. There is even a discussion on craniofacial patient discoveries on the International Space Station!" *

Lectures in the Doctors Scientific Program will include:
• Dr. James McNamara on early treatment of transverse problems;
• Dr. Terry Sellke on the future of remote monitoring of orthodontic treatment;
• Dr. Jeffrey Okeson on how orthodontists can help the TMD patient;
• Dr. David Sarver on esthetic smile design and case presentations;
• Dr. William Wilcko on long-term results of periodontally accelerated osteogenic orthodontic procedures;
• Dr. Chris Chang on gummy smile correction;
• Dr. Steven Jay Bowman on improving the predictability of clear aligners.

* In cooperation with the UCLA School of Dentistry and Dr. Kang Ting, an AAO member, the National Aeronautics and Space Administration (NASA) and the Center for the Advancement of Science in Space (CASIS) advanced a study of osteoporosis and bone growth by taking 40 rodents to the International Space Station in June, to live in a microgravity environment. At Annual Session, Dr. Ting and Dr. Jin Hee Kwak will present, “Taking Craniofacial Patient Discoveries to the International Space Station.”

Mar. 2, 2018

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Network, Find Career Opportunities While at the 2018 Annual Session
Make contacts and gain insights helpful to your career planning process at the 2018 Annual Session, May 4-8 in Washington, D.C.  You will find unique opportunities at events that are partly or entirely for residents and younger members.

Register now for Annual Session (or, if you have registered, access your registration to reserve or purchase event tickets).

Career-Related Annual Session Events
Practice Transition Seminar, Friday, May 4 (Convention Center)
This all-day event includes breakfast, lunch and a cocktail reception sponsored by Ziegler Practice Transitions.  Residents’ ticket price is $60. Members in active practice pay $125.  Members who are approaching retirement and planning to sell their practices, and/or bring in partners or associates, will be in attendance. Presentations by expert consultants will include:
  • “Understanding Orthodontic Transitions: Value, Pitfalls and Associations” – Ken Alexander
  • “DSO Panel Discussion” – Representatives from dental service organizations will be joined by industry consultant Roger Hill
  • “Compensation Expectations during Career Transitions: Associates, Buyers and Sellers” – Doug Copple and Shannon Patterson
  • “C.A.D.E.T. (Coverage Agreements for Death/Disability/Displacement in Emergency Transitions” – Dr. Laurance Jerrold.
New Orthodontists and Residents Conference, Sunday, May 6, 2:30 p.m. – 4 p.m. (Marriott Marquis)
During this free program hosted by the AAO Council on New and Younger Members, keynote speaker Andrew Tucker will present, “Planning Your Professional Future.” Mr. Tucker will address student loan debt, how to balance repayment with tax-advantaged savings, and determining when to prepay debt and when to save. Attendees will also learn the pros and cons of private student loan refinancing, balancing student loan debt with home and practice purchases, and strategies to control income taxes despite loan repayment. Following the keynote, attendees will break into roundtable discussions on various topics of interest to new orthodontists.
There is no fee for members attending this event, and no ticket/reservation requirement.

Orthodontic Career Fair, Sunday, May 6, 4 p.m. – 5:30 p.m. (Marriott Marquis)
Network with employers who are hiring orthodontists and learn about opportunities with their organizations. There is no fee for members attending this event, and no ticket/reservation requirement.

Additional Events of Interest
 ● AAO Member Town Hall, Saturday, May 5, 12 noon – 1 p.m. 
Representatives of the Board of Trustees and the Council on New and Younger Members will be available to discuss issues of interest in a new, round-table for format ideal for direct interaction. The event will be easy to access due to its location in the Exhibit Hall café. The event is open to all members with no registration or ticket required.

Orthodontic Residents Reception, Sunday, May 4, 5:30 p.m. – 8 p.m. (Lucky Strike)
Enjoy relaxing with your friends in the unique Lucky Strike atmosphere featuring chef-driven food and drink, and bowling.

There is no fee for student (resident) members attending this event, but a ticket is required and should be reserved in advance via registration. Guest tickets (required) are available for $35. Sponsored by American Orthodontics.

Risk Management for Residents and New Orthodontists, Sunday, May 6, 8 a.m. – 11 a.m. (Convention Center)
During this free program sponsored by the AAO Insurance Company, learn from claims experts how to avoid malpractice risks specific to the new orthodontist. No ticket or advance registration required.

Younger active (in practice) members who attend the above session or the Saturday morning lecture, “Risk Management for Orthodontists,” will receive a 10 percent premium discount on AAOIC professional liability insurance. Simply complete the certificate provided at the event, return it to the program speaker, and the underwriting department will apply the credit.  If your premium for the year has already been paid, your credit will be applied to your next two years’ coverage.  If you have not renewed your policy for the year, the premium discount will appear as a credit on your upcoming renewal notice.

If you are a graduating resident and purchase AAOIC insurance upon entering practice, you will also be eligible for the premium discount based on having attended an Annual Session risk management program.

View the complete Annual Session Events Schedule
Feb. 27, 2018

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