Health-related facilities that receive Federal financial assistance (e.g., Medicare or Medicaid reimbursement) have been required to comply with Federal, as well as State, non-discrimination laws in the provision of services. In the Federal context, these protections are found in various Federal civil rights laws, including Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975. Now comes Section 1557 of the Patient Protection and Affordable Care Act (Section 1557) and the now effective final regulations of the U.S. Department of Health and Human Services (HHS) implementing Section 1557, which extend these non-discrimination protections to individuals participating in any health program or activity which receives HHS funding.

Under the HHS final regulations, any entity that operates a health program or activity any part of which receives Federal financial assistance (a “covered entity”) with 15 or more employees must now post conspicuous non-discrimination notices. These notices must also include advisements on the availability of auxiliary aids and language assistance services. Covered entities must also publish “taglines,” i.e., short statements written in non-English languages that advise of the availability of language assistance services free of charge, in at least the top 15 languages spoken by individuals with limited English proficiency in the covered entity’s State of operation.

The notice and taglines must be in “a conspicuously-visible font size” and be included in (a) significant publications and significant communications targeted to beneficiaries, enrollees, applicants, and members of the public (excepting postcards and tri-fold brochures deemed by HHS to be “small-sized”); and (b) conspicuous physical locations within the covered entity that are accessible by the public.

In those “small-sized” publications and communications, the covered entity must post, again in “conspicuously-visible font size,” (a) a statement that the covered entity does not discriminate on the basis of race, color, national origin, sex, age, or disability in its health programs and activities; and (b) taglines in at least the top two languages spoken by individuals with limited English proficiency in the covered entity’s State of operation.

Each covered entity with 15 or more employees must also designate at least one employee responsible for carrying out the covered entity’s responsibilities under Section 1557 and the HHS regulations, including the investigation of any grievance. In that regard, each covered entity must adopt a grievance procedure that incorporates appropriate due process standards and provides for prompt and equitable resolution of grievances. To the extent that you already have a grievance procedure that addresses allegations of discrimination, we would encourage you to review that procedure to ensure that it is consistent with the HHS regulations implementing Section 1557.

The complete text of the HHS regulations implementing Section 1557 is available at http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr92_main_02.tpl. HHS samples of the required notice (and nondiscrimination statement), tagline, and grievance procedure are located at Appendices A, B, and C, respectively.