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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Since early 2018, the New Hampshire Board of Dental Examiners has been considering whether to revise its current rules related to recognizing dental specialties. The current version of New Hampshire’s rules relies on the definition of recognized specialties as defined by the American Dental Association (ADA). At a meeting in November 2018, the matter (whether to revise the current rules or continue using the ADA list of specialties) was finally brought to a vote but resulted in a tie. As a result, the Board voted again at both its December and January meetings, producing a tied result in each round with the Board uncertain which alternative language would be used should the rules be revised.

The AAO Legal Team has been monitoring New Hampshire’s decision whether to revise its specialty rules. The AAO’s Gianna Hartwig, on behalf of the AAO, provided the Board Administrator with a letter outlining possible language that could be used should the Board decide to revise its specialty rules, specifically encouraging regulations that require those who are advertising as “specialists” to have successfully completed a post-doctoral program in a specialty area of dentistry consisting of at least two full-time years and which is accredited by an accrediting agency that is recognized by the U.S. Department of Education (i.e. CODA).

The letter was given to each Board member before voting at the February 4th meeting. Citing the AAO’s letter for providing clarity, the Board voted in favor of beginning the process of revising its dental specialty rules and to consider the proposed language. A copy of the letter can be viewed here. The AAO will continue to monitor specialty advertising developments in New Hampshire as the Board starts the process of considering and drafting new language.

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 (including specialty advertising rules) 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
 
 
Mar. 5, 2019

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AAO leaders were saddened to hear of the passing of Dr. John M. Faust Sr. at age 97 on January 9.

Dr. Faust of Hattiesburg, Mississippi served as president of the AAO for 1979-80, presiding over the 1980 Annual Session in New Orleans. He was also a trustee of the American Dental Association, president of what is now the Southern Association of Orthodontists, and president of the Mississippi Dental Association. Dr. Faust practiced orthodontics in Hattiesburg from 1951 until his retirement in 1982.
 
A Captain in the United States Army during World War II in the Philippines and Japan, Dr. Faust graduated from the University of Tennessee School of Dentistry, where he completed his dental degree and orthodontic residency. He received the 1976 Outstanding Dental Alumnus Award from the University of Tennessee Dental Alumni Association.

“During my time on the AAO Board with Dr. Faust, I thought he was one of the most astute individuals that we had in leadership,” says Dr. Russell Greer of Nicholasville, Kentucky, who served as AAO president for 1987-88. “I always respected his opinions and valued his thoughts on any issue that we were addressing.”

During their time on the Board together, Dr. Greer worked with Dr. Faust on initiatives such as advocating the AAO’s position against an American Dental Association House of Delegates resolution.

“Dr. Faust was supportive of me as I presented the AAO’s information at a Reference Committee hearing, and our input helped defeat the resolution,” says Dr. Greer.  “After we both moved off the Board, we spoke by phone occasionally. My wife and I also travelled to Dr. Faust’s hometown for an event in his community recognizing him, and we really enjoyed that visit. Dr. Faust was one of the best friends that I made through my AAO involvement. He was a great man and a great leader.”

View Dr. Faust’s Obituary
 
 
Feb. 15, 2019

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The AAO has and continues to work diligently to advocate on Canadian members’ and orthodontic patients’ behalves. Through the AAO Component Legal Support Fund, money was devoted to hire the Toronto law firm of Norton Rose Fulbright Canada. The firm worked with the AAO’s Sean Murphy to reach out to The Royal College of Dental Surgeons of Ontario (RCDSO) to communicate concerns regarding stores in Ontario that appear to be providing patients with orthodontic treatment absent any in-person evaluation or in-person supervision by a licensed dentist.

It is hoped that the Royal College will take the necessary steps to enforce the laws.  Of course, you are entitled to exercise your rights as a citizen and individually, and independently, contact the Royal College regarding your own thoughts about any public health and safety matter as it pertains to dentistry.  Contact information for Canada’s Dental Regulatory Authorities can be found here, http://www.cda-adc.ca/en/reg_authorities.asp

Other legal and advocacy updates:

- Court Grants AAO’s Motion to File Brief in Support of Alabama Dental Board in Lawsuit Brought by SmileDirectClub
- New Jersey Dental Association Files Lawsuit Against SmileDirectClub
- North Carolina Dental Board Adopts AAO-Proposed Policy Wording for Specialty Advertising
- AAO Addresses SmileDirectClub Efforts in Georgia
- Georgia Dental Board Defends Itself against SmileDirectClub Lawsuit
- Alabama Dental Board Defends Itself against SmileDirectClub Lawsuit
- AAO Responds To SmileDirectClub’s Efforts in Arkansas



 
Feb. 15, 2019

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The North Carolina Board of Dental Examiners recently adopted amendments to the state’s dental specialty advertising policy that align with recommendations made by the AAO as part of an effort made possible by the Component Legal Support Fund.

In early 2018, the North Carolina Board of Dental Examiners proposed changes to 21 NCAC 16p.0105, the state’s regulation pertaining to advertising as a “specialist.”  Specifically, the Board proposed revisions to loosen the rule, which would allow anyone approved by the American Dental Association (including orthodontists) to advertise as “specialists,” as well as permitting those approved by the American Board of Dental Specialties or the Royal College of Dentists of Canada to advertise as “specialists.” 

The AAO legal team participated and advocated throughout the Board’s process of considering changes to the rule, urging that North Carolina patients would best be served by not diluting the “specialty” definition as proposed by the Board.  Specifically, the AAO supports requirements that those practicing and/or advertising as “specialists” have completed a qualifying post-doctoral advanced dental education program in that area.  A qualifying post-doctoral educational program is a full-time postdoctoral advanced dental education program accredited by an agency recognized by the U.S. Department of Education, and specifically, by the ADA Commission on Dental Accreditation (CODA).
 
The AAO’s participation and advocacy during this process included AAO attorney Sean Murphy attending and speaking at the first Board meeting on this topic, and AAO attorney Trey Lawrence attending and speaking at a second Board hearing on these issues, in October 2018.  The AAO legal team also submitted written comments on the proposed revisions to the rule. 
 
On January 17, 2019, the Board voted to adopt the amendments to the specialty advertising regulations that aligned with the AAO’s comments.  This was the desired result and allows North Carolina members to continue advertising as specialists, while ensuring that anyone advertising as a “specialist” has met the CODA-based requirements for the “specialist” designation. 
 
The Board’s vote marked the final chapter of the AAO’s successful work in North Carolina on the specialty advertising issue.  The AAO’s work in North Carolina was made possible through the Component Legal Support Fund, which was established by a vote of the 2015 House of Delegates and 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 and two Canadian provinces with legal and advocacy issues.
 
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. 



 
 
Feb. 8, 2019

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The AAO has been notified that at least one pirate website for hotel reservations has been set up that mimics the 2019 AAO Annual Session site of housing partner OnPeak.

The AAO’s ONLY contracted and approved housing company for the 2019 Annual Session is onPeak.  As the AAO becomes aware of any pirate sites set up by other organizations, the AAO Legal Department sends cease and desist messages to the sponsoring organizations.

To visit the onPeak website safely and book your hotel accommodations at Annual Session, always access housing reservations via the link included in your Annual Session registration confirmation.

Do not search for the reservations site online. You may also reach OnPeak by phone at phone number 866-575-4133 or 312-527-7300.

View the hotels included in the AAO room block by price.

View the Annual Session hotels map.

Learn more about Annual Session and register.

Beware of Credit Card Phishing Calls 
In addition, please be aware that registrants of past AAO constituent meetings received calls from individuals claiming to be from the meetings’ housing partners. The callers stated that the doctors were registered for the meeting, but that their credit card information, arrival and departure dates were never furnished and must be provided immediately in order to secure housing.

The AAO recommends that you advise your receptionist to hang up immediately if such calls come into your office and report the calls to you. If you feel that onPeak may be in need of any of your information, you can check by emailing or calling aaohotelservices@onpeak.co (not .com) or 866-575-4133 or 312-527-7300.

Book Your Annual Session Housing Now 
When you book your hotel reservation within the official AAO housing block you contribute to the success of future Annual Sessions because participant loyalty data drive future negotiations for room rates, extras and special discounts.

 
Feb. 4, 2019

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The AAO Foundation is working to help orthodontic residents experience the 2019 Annual Session.

Each AAO student member (resident) is eligible for a one-time Annual Session attendance gift of $400, which will be issued after the 2019 Annual Session to assist in offsetting the cost to attend.

To apply for the gift, complete the online application and W-9 form.  These forms may be emailed prior to May 2, 2019 to AAOF Executive Director Jackie Bode at jbode@aaortho.org. Or, deliver your completed forms in person at the AAO Foundation booth in the Exhibit Hall.

Either way, the applicant must visit the AAOF booth in the Exhibit Hall to confirm attendance at the meeting.

 
Feb. 4, 2019

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2019 Annual Session speaker Joy Gendusa plans to present an interactive lecture, “YOUR Marketing Report Card: Real AAO Member Campaigns Evaluated Live.”  Members are invited to submit marketing campaign materials developed for your practice for critique during the lecture.

The lecture will focus on examining some of the reasons why marketing materials may – or may not – always produce the desired results. Ms. Gendusa will speak on Monday, May 6 at 2:10 pm as part of the Collaborative Concepts for Doctors and Team series (Business of Orthodontics LIVE!).

Anyone wishing to participate in the materials review should submit examples of up to six of your recent marketing efforts. Examples can be digital or hard copy.

Please submit materials for consideration by February 21, 2019.  Digital materials should be emailed to submissions@postcardmania.com.  Mailed submissions should be sent to:
 
PostcardMania
Attn: Jessica Lalau
2145 Sunnydale Blvd
Clearwater, FL 33765
 
 
Feb. 4, 2019

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Whether you are interested in particular issues coming up before the 2019 House of Delegates (HOD) or are simply curious about AAO leadership and governance, AAO leaders will welcome your attendance at open sessions of the 2019 House of Delegates.

Among a variety of resolutions and agenda items, the 2019 HOD will receive the nomination from the AAO Board of Trustees for the Pacific Coast Society of Orthodontists trustee on the AAO Board, Dr. Norman Nagel, to become the 2020-21 AAO secretary-treasurer. Under AAO bylaws, each successive secretary-treasurer must be nominated in one year and elected the following year – in this case, 2020. The following year, the secretary-treasurer will automatically assume the role of president-elect and then after serving as president-elect for a year, will automatically assume the role of president.

Location for all 2019 HOD business: 
JW Marriott Los Angeles
900 W Olympic Blvd
Los Angeles, CA 90015
(213) 765-8600
WiFi access will be available.

The deadline to submit reports and resolutions is Wednesday, April 3, 2019. Resolution and Report Forms can be found here.

HOD reports and resolutions will be available on the AAO website on or before April 19, 2019. Watch your in-box for an announcement that the reports and resolutions are available for member review.

Open sessions, which may be attended by everyone, will include:
 
∙ Friday, May 3, 2019
- 12:30pm – 3:00pm or until conclusion of business, Gold Ballroom:
First Meeting of the House of Delegates
 
- 3:00pm – 4:00pm, Platinum BC
Members of the Budget Advisory Committee will be available for questions.
 
- 4 pm – 6 pm: Reference Committee Hearings 
Reference Committee #1(Bylaws) - Platinum D
Reference Committee #2 (Policy) - Platinum E
Reference Committee #3 (Budget) - Platinum BC

Monday, May 6
- 12:30pm – 5:00pm (or until business has concluded), Gold Ballroom:
Second Meeting of the House of Delegates (includes discussion and voting on resolutions).

Closed sessions (attendance limited to Delegates, Alternate Delegates, Voting Members of the Board of Trustees, General Counsel and AAO Chief Executive Officer) will include:

Friday, May 3
- 12 noon – 12:30 pm, Gold Ballroom
Closed Session prior to the First House of Delegates Meeting
 
Reference Committee Closed Sessions
- 6:00pm – 10:00pm
Location: Room assignments same as hearing rooms listed above



* All open and closed session times listed are subject to change.
 
Feb. 4, 2019

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