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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With Hurricane Florence having caused catastrophic flooding in the Carolinas and still causing new flooding in South Carolina, the AAO anticipates that members’ practices will be impacted.  Due to the lengthy impact of the storm and resulting electrical outages, the AAO has extended the deadline for applications to the Disaster Relief fund for those impacted to March 31, 2019.  (The normal Disaster Relief Fund deadline is three months after the initial event.)

Members whose practices have been impacted by natural disasters* may apply to see what assistance the AAO can provide via the association’s Disaster Relief Fund, which is supported by budgetary allocations and donations. During 2017, the fund received nearly $200,000 in donations and through the first few months of 2018, assisted members affected by 2017 hurricanes that hit Texas, Florida and Puerto Rico. The AAO is now preparing to receive applications for assistance from members affected by 2018 hurricanes.

Please click here to learn how to apply for assistance or make a contribution to help your colleagues whose offices may have been damaged or destroyed. If you are in touch with a colleague whose office has been impacted, please share this information with him or her.

* Assistance is also available to members impacted by man-made disasters such as fires or civil disorders.

 
Sep. 25, 2018

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AAO Members are now eligible to receive a discount on a yearly membership to the Dental Trauma Guide, which covers treatment guidelines for primary and permanent teeth. The website is developed in cooperation with University Hospital of Copenhagen and the International Association of Dental Traumatology (IADT). The normal membership rate is $30 per year and the Dental Trauma Guide is offering a membership rate of $10 per year, per user, to AAO members.

The world-leading, web-based tool for evidence-based dental traumatology, The Dental Trauma Guide is based in the University Hospital of Copenhagen (Rigshospitalet) and is a research-based non-profit organization.
Access Discount Program Information
Sep. 20, 2018

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Dr. Arif Alvi has been elected as the 13th president of the country of Pakistan. Dr. Alvi completed the orthodontic residency program at the University of the Pacific in 1984. 

Dr. Eugene Roberts, professor emeritus of the Department of Orthodontics at the Indiana University – Purdue University School of Dentistry, was a faculty member at the University of the Pacific when Dr. Alvi was an orthodontic resident at the university.

“The major thing that stands out in my memory of Dr. Alvi is that he had a strong interest in interdisciplinary practice which was very forward-thinking at that time,” says Dr. Roberts. “He had already completed the residency program in prosthodontics at the University of Michigan, entered practice, and then discovered how important orthodontic treatment is in many cases involving prosthodontics. He therefore made the decision to complete an orthodontic residency. He went on to establish a large interdisciplinary practice in Pakistan, headquartered in Karachi.

“The last time that I was in touch with him was several years ago when he invited me to speak at the Asia Pacific Dental Congress,” Dr. Roberts continues. “I was aware that he was interested in local politics as well as dental leadership - but had not realized he had an interest in national politics until he became a member of the Pakistani parliament.”

Dr. Jetson Lee of San Francisco was a senior dental student at the University of the Pacific when Dr. Alvi was a second-year resident. Dr. Lee got to know the graduating residents, including Dr. Alvi, through frequent visits to the orthodontic clinic. An alumni leader who has stayed in touch with many of his fellow graduates, Dr. Lee was in contact with Dr. Alvi just before the Pakistani presidential election. They discussed via email some of the challenges of Dr. Alvi’s career in orthodontics that may have helped him prepare for the stresses of political leadership.

“In an email that Dr. Alvi sent the day before the election, he reflected on some of the experiences in his orthodontic career, including coming to the United States in 1992 for his Orthodontic Boards - only to have his briefcase with all original X-rays and data snatched at the airport in New York City,” says Dr. Lee, who is now in private practice and an adjunct associate clinical professor at UOP, as well as committee chair for the Orthodontic Chapter of the dental Alumni Association. 
 
“So, he had to wait another year to take his Boards and present other cases.”

Dr. Alvi is described in the Economic Times as a close ally of the current Prime Minister of Pakistan, Imran Khan, and as the son of Dr. Habib-ur-Rehman Elahi Alvi, the dentist of Jawaharlal Nehru, the first Prime Minister of India.

Wikipedia expands on Dr. Alvi’s political and dental careers, noting that he served in the National Assembly of Pakistan from 2013-18 and had previously been active in local politics and party leadership.  He was an active leader in dentistry in his country, serving as president of the Pakistan Dental Association and of the Asia Pacific Dental Federation. He served as Dean of the orthodontic faculty of the College of Physicians and Surgeons of Pakistan and is a Diplomate of the American Board of Orthodontics.






 
 
 
Sep. 20, 2018

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With the dangerous force of Hurricane Florence approaching the Eastern United States and Pacific storms strengthening, the AAO anticipates that members’ practices will be impacted.

Members whose practices have been impacted by natural disasters* may apply to see what assistance the AAO can provide via the association’s Disaster Relief Fund, which is supported by budgetary allocations and donations. During 2017, the fund received nearly $200,000 in donations and through the first few months of 2018, assisted members affected by 2017 hurricanes that hit Texas, Florida and Puerto Rico. The AAO is now preparing to receive applications for assistance from members affected by 2018 hurricanes.

Please click here to learn how to apply for assistance or make a contribution to help your colleagues whose offices may have been damaged or destroyed. If you are in touch with a colleague whose office has been impacted, please share this information with him or her.

* Assistance is also available to members impacted by man-made disasters such as fires or civil disorders.

 
Sep. 13, 2018

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If you are attending the 2018 American Dental Association Annual Session (October 18-22 in Honolulu), you and your guest are invited to join AAO leaders at the 2018 AAO Dessert Reception.

AAO members who live nearby, or who are in Honolulu for other reasons are also welcome to attend the reception.  Please RSVP by September 20, 2018 by clicking on the link below.

Date:  Saturday, October 20, 2018

Time:  9 pm – 11 pm

Location:  Hilton Hawaiian Village, Coral 3 Ballroom

Click here to RSVP
 
Sep. 6, 2018

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The AAO is offering Faculty Fellowship Awards for the first time since the 2009-10 academic year. The 2018 House of Delegates adopted a resolution to reinstate the Faculty Fellowship Awards Program by offering three, two-year funded Fellowships of $60,000 per year for 2019, 2020 and 2021.

The AAO conducts annual surveys of Faculty Fellowship Award recipients who received funding from 2007-2010.  The 2018 HOD resolution’s original draft by the Council on Orthodontic Education (COE) notes that survey results “show that of the 20 former Fellows, all but one has remained in academics. The remaining 19 orthodontic faculty members have generated 153 years of teaching and current indicators suggest they will stay in orthodontic program settings for the foreseeable future.”

The COE cited concerns based on recently released American Dental Education Association statistics reflecting 2015-16, indicating large numbers of dental and dental specialty faculty members are nearing retirement. The new Faculty Fellowship Awards program was developed to help stimulate interest in academic careers among today’s young orthodontists.

Applications for the first group of Faculty Fellowship Awards are being accepted, with all materials due by February 1, 2019.
Access Faculty Fellowship Awards and the Application*


* The page also includes a link to the AAO Foundation Faculty Awards page and information about AAOF awards, which have an application deadline of November 16, 2018.


 

 
Sep. 6, 2018

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