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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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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Register now for the 2019 Annual Session and look forward to an intensive learning experience with renowned lecturers addressing traditional topics such as Class II and Class III treatment, biomechanics, anchorage/TADs and esthetics. *

Other half-day lecture series will cover newer and diverse topics such as 3D printing/in-house aligners, finishing, sleep apnea, retention/lingual orthodontics and impacted canines/missing teeth. Two half-day lecture series will focus on pre-adolescent treatment.
 
Highlights of the Doctors Scientific Program will include the 2019 Salzmann, Angle and Mershon lectures:
 
Jacob A. Salzmann Lecture
Dr. Hugo De Clerck will present the 2019 Salzmann Lecture, “Miniplate Skeletal Anchorage: An Update and New Perspectives.” A frequent lecturer at orthodontic meetings worldwide, Dr. De Clerck was formerly a professor and Chairperson at the Department of Orthodontics at the Universite Catholique de Louvain. He is now an adjunct professor at the University of North Carolina at Chapel Hill and maintains a private practice in Brussels, Belgium. His research interests include skeletal anchorage, biomechanics and orthopedics, with his most recent publications in the AJO-DO having addressed bone-anchored maxillary protraction.

Edward H. Angle Lecture
Dr. Peter Buschang will present the 2019 Angle Lecture, “30 Years of Achievements - Our Proudest Moments.” An anthropologist with a PhD degree, Dr. Buschang is Regents Professor and director of orthodontic research at Texas A&M University Baylor College of Dentistry, where he has taught since 1988. He has published over 260 peer-reviewed articles, numerous book chapters, and several books, with his achievements having garnered honorary memberships in both the AAO and the Edward H. Angle Society. Dr. Buschang has also given past Annual Session lectures and presented an AAO webinar (view his archived lectures).

John Valentine Mershon Lecture 
The 2019 Mershon lecture will be given by Dr. Greg Huang, who is a professor and Chair of the Orthodontic Department at the University of Washington School of Dentistry. Dr. Huang will present, “Results from the National Dental PBRN Adult Anterior Openbite Study.” 

Dr. Huang led the AAO Practice Based Research Network Committee (AAO-PBRN), formed in 2013 to encourage orthodontic research in network settings, especially in the National Dental Practice Based Research Network (National Dental PBRN). The adult anterior openbite study was the first project to be approved and the AAO began recruiting member participants in 2015. At the 2018 Annual Session, Dr. Huang presented information about orthodontists and patients participating in the openbite study, as described in a current article in The Angle Orthodontist. His 2019 Annual Session lecture will include results of the study.

* Click here for schedule information for the Doctors Scientific Program as well as the Collaborative Concepts for Doctors and Team and Orthodontic Team programs.
 
Nov. 5, 2018

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Following the recent unexpected passing of Dr. William Proffit, the 2019 Annual Session Planning Committee designated the lecture period during which Dr. Proffit was to speak as the William R. Proffit Memorial Lecture (Sunday, May 5, 10:20-11:20 a.m.).  Dr. Kevin O’Brien of Manchester, United Kingdom has accepted an invitation to give the lecture and will present, “Standing on the Shoulders of a Giant: A Retrospective on Bill Proffit.”

Dr. O’Brien is a professor of orthodontics at the University of Manchester Health Science Center, where he received his dental degree and completed the orthodontic residency program. He also lectures internationally and is an active researcher who has published more than 150 articles in peer-reviewed publications. In addition, he publishes Kevin O’Brien’s Orthodontic Blog, which is read internationally and focuses on scientific topics and discussion pertinent to the specialty.

Enjoy rich learning experiences at the 2019 Annual Session, May 3-7 in Los Angeles, the center of the U.S. film and television industry. Share the excitement of ticketed special events at renowned venues, including:

Opening Ceremonies at the Microsoft Theatre. The music and theatre venue in downtown Los Angeles holds one of the largest indoor stages in the United States;
The International Reception (open to all registrants) will take place on The Terrace at L.A. Live, a modern, outdoor mezzanine known for its views of downtown Los Angeles and the iconic Hollywood sign. The Terrace is located on the rooftop of the Iconic GRAMMY Museum® L.A. Live. The museum pays tribute to American musical heritage and is a space where all aspects of music are experienced, explored and celebrated.
The AAO Celebration at Microsoft Square L.A. LIVE, LA’s sports and live entertainment district surrounding the STAPLES Center and Microsoft Theater.

Watch your in-box for a notification on November 5 that Annual Session registration has opened. Lecture information - including the Doctors Scientific Program, Collaborative Concepts for Doctors & Team and the Orthodontic Team Program – will also be available.
 
Nov. 2, 2018

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On September 28 the Iowa Dental Board voted on proposed amendments to Iowa Administrative Code 520-Chapter 28 “Advertising,” and “Designation of Specialty.” The Board voted unanimously to adopt the amendments to the specialty advertising regulations, which was the desired result, especially since previously the Iowa Dental Board had considered removing its specialty advertising regulations altogether.
 
The Board’s vote marked the final chapter of the AAO’s work in the state on the specialty advertising issue. Thanks to the AAO’s Component Legal Support Fund, the AAO has worked with the Iowa Dental Board since 2017 to revise, rather than remove, Iowa’s specialty advertising laws.

AAO Attorney Sean Murphy attended the September 28 meeting with Dr. Marc Welge and Dr. Tom Stark.  Both Mr. Murphy and Dr. Stark provided comments to the Board in favor of Iowa retaining its specialty advertising laws.  The AAO’s and Iowa orthodontists’ long-term efforts paid off as the Board voted in favor of retaining Iowa’s specialty advertising laws.
 
The AAO Component Legal Support Fund, established by a vote of the 2015 House of Delegates, provides grants to component organizations to assist with state legal and legislative issues that impact orthodontic practices.  To date, the CLSF is assisting over 20 components with their issues, which primarily involve specialty advertising.
 
Please note, every orthodontist (as a citizen of and licensed dental provider in his or her state) and orthodontic patient has the right, independently and individually, to express his or her opinion on any dental issue to his or her state dental board and elected officials. If you feel so compelled, you may contact your state’s dental board. Contact information for state dental boards can be found by clicking  here.   


 
 
Oct. 23, 2018

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AAO leaders were surprised and saddened upon learning about the sudden death of Dr. Raymond George Sr. of Lincoln, Rhode Island on October 15 at age 79.  Dr. George served the specialty in many capacities including his term as president of the AAO (2008-09).

Dr. George received his dental degree from the Tufts University School of Dental Medicine and completed the orthodontic residency program at Boston University. He served as a captain in the Army Dental Corps from 1966 to 1968 and became a Diplomate of the American Board of Orthodontics in 1975.

After entering orthodontic practice in East Providence, Rhode Island and South Attleboro, Massachusetts, Dr. George became active in organized dentistry and orthodontics.  Joining the AAO Board of Trustees in 1999 as the representative from NESO, he was a member of numerous AAO councils, committees and task forces. His presidency culminated with the 2009 AAO Annual Session in Boston.

In addition, Dr. George was president of the Northeastern Society of Orthodontists (NESO), the Rhode Island Dental Society, the College of Diplomates of the American Board of Orthodontics, the East Component of the Edward H. Angle Society of Orthodontists and the AAO Foundation. He served on the AAO Insurance Company Board of Directors from 2005-2018. 

A guest lecturer at many orthodontic departments, including those at Tufts, Harvard University, Boston University and the University of Pennsylvania, Dr. George also lectured at numerous meetings in the United States, Canada and Mexico on surgical orthodontics, functional appliance therapy and temporomandibular disorders. He co-authored two articles that appeared in the AJO-DO.

The Massachusetts Association of Orthodontists presented the Frederick M. Moynihan Memorial Award to Dr. George for his dedicated service and outstanding contributions to the field of orthodontics.

Dr. George’s funeral took place on October 20 at St. George’s Maronite Catholic Church, 1493 Cranston Street in Cranston, Rhode Island.  In lieu of flowers, his family requested memorial contributions to St. Jude’s Children’s Hospital.
Oct. 23, 2018

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Dr. Jeff Rickabaugh, Speaker of the AAO House of Delegates, will hold the virtual meeting of the House of Delegates* on Tuesday, December 4, 2018 from 7 pm – 8 pm Central Time.  

The meeting will be informational in nature. It is intended to inform delegates and other AAO leaders about the progress of certain issues since the HOD meeting that took place in May in Washington, D.C. during the 2018 Annual Session.

The virtual HOD meeting is open to all interested AAO members. If you are not a current delegate or alternate delegate and would like to receive dial-in instructions for the virtual HOD meeting, please contact Lisa Chandler (lchandler@aaortho.org).
 
Delegates are those leaders who were elected at fall constituent meetings as either delegates or alternates. Preferably, virtual HOD participants will be the same leaders who will attend the 2019 HOD, which will take place May 3 and May 6 in Los Angeles in conjunction with the 2019 Annual Session.

 
* The virtual meeting of the House of Delegates is mandated by policy to occur annually.
 
Oct. 23, 2018

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