Section 1557: What your practice needs to know
What is Section 1557?
Section 1557 is the civil rights provision of the Affordable Care Act (ACA) that prohibits
discrimination on the grounds of race, color, national origin, sex, age, or disability in certain
health programs and activities. On May 18, 2016, the Office for Civil Rights (OCR) under the
Department of Health and Human Services (HHS) released a final rule implementing Section
1557. Many of the provisions in the final rule already exist in other federal nondiscrimination
rules, such as the Civil Rights Act and the Americans with Disabilities Act. OCR’s rule applies
these pre-existing nondiscrimination requirements to health care and creates new protections in
order to implement Section 1557.
Does it apply to my practice?
This rule applies to every health program or activity that receives funding from or is
administered by HHS, and the health insurance marketplaces and all plans offered by issuers
that participate in those marketplaces. Covered entities under this rule may include physician
practices, hospitals, health clinics, health insurance issuers, state Medicaid agencies,
community health centers and home health care agencies.
If your practice’s ONLY source of federal funds is through Medicare Part B, then this rule would
not apply to you. HHS intends the rule to apply broadly and estimates that it would cover
“almost all” licensed physicians because they accept federal financial assistance from sources
other than just Medicare Part B. For instance, if you receive Medicare Parts A, D or Medicaid
payments, this rule would apply to you. Additionally, if you are receiving a Meaningful Use
incentive payment, this rule also applies to you.
What must practices do:
Ensure “Meaningful Access” for those with Limited English Proficiency (LEP) by adhering to the
following requirements by October 17, 2016:
1. Notice and tagline requirement:
 Practices must post a notice of nondiscrimination in English and may combine the
content of the Sec. 1557 notice with other notices required under other federal laws.
 Practices must post taglines in the top 15 languages in the state where your practice
does business indicating the availability of language assistance. HHS has
determined the top 15 languages for each state.
 Note: According to OCR, in many circumstances, a binder holding the 15 taglines
may not be sufficient to provide prominent or conspicuous notice.
 MGMA tip: The language of the tagline should be in the language to which it refers.
For example: Español (Spanish)
2. Where must the notices and taglines be posted?
a. Physical location: Notices must be posted in a sufficiently prominent and
noticeable place in your physical office.
b. Sec. 1557 requires the top 15 language taglines in your state to be posted on all
significant publications or communications.
i. What is a significant publication or communication?
Advancing Leaders. Advancing Practices.TM
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1. An important document of which the patient needs to be aware. A
document that if a person did not get, there would be substantial
consequences to them – for example a notice of a treatment plan
or a termination of coverage.
ii. If electronic, the publications or communications must have a link to the
notice of nondiscrimination and 15 taglines on bottom.
iii. If paper mail, the publications must have the statement of
nondiscrimination and taglines. If a small piece of paper mail like a
postcard, it only needs the statement of nondiscrimination and the top 2
language taglines.
c. Website:
i. Notice of Nondiscrimination and top 15 taglines should be at the bottom
of your website. See example from HHS.gov:
Ensure effective communication with and accessibility for individuals with disabilities through:
1. Communication:
a. Ensure communications with individuals with disabilities are as effective as
communication with others;
b. Provide appropriate auxiliary aids and services such as qualified sign language
interpreters where necessary for effective communication.
2. Use of technology:
a. Must make all programs and activities provided through electronic and information
technology accessible to individuals with disabilities unless doing so would impose
undue financial or administrative burdens.
3. Most of this information is consistent with existing requirements under the ADA,
including physical accessibility of the building and office space for those with disabilities.
Protecting individuals against sex discrimination by guaranteeing:
1. Access to facilities:
a. Individuals must be treated consistently with their gender identity. For example, a
hospital may not room a transgender woman with a cisgender (gender identity
that corresponds with their biological sex) man.
2. Access to care:
a. Providers may not deny or limit treatment for any health services that are
ordinarily or exclusively available to individuals of one gender based on the fact
that person seeking such services identifies as belonging to another gender.
b. Examples:
i. A transgender woman who still biologically has a prostate, must be
eligible for and receive a prostate exam.
ii. A transgender man who still has biologically female anatomy must be
eligible for and receive a pap smear or any other service eligible to
cisgender women.
Advancing Leaders. Advancing Practices.TM
1717 Pennsylvania Ave. NW, #600
Washington, DC 20006
T 202.293.3450
F 202.293.2787
mgma.org
c. Providers cannot deny healthcare to a patient based on a patient’s sex, gender
identity or sex stereotyping. You cannot deny a patient care solely because they
are transgender.
What should practices do now:
1. LEP and language access plan:
a. Practices should not wait until an LEP patient comes into the office to develop a
plan to address LEP patient needs.
b. Practices should create a language access plan that includes the top 15
languages in the state as well as any additional languages frequently used in the
practice.
c. Practices should consider signing up with a language assistance call center to
help with the translation of documents as well as telephonic or in-person
interpretation when needed.
d. Practices should consider having commonly used documents translated for
frequently used languages.
How is it Sec. 1557 enforced?
Sec. 1557 has been in effect since the enactment of the ACA in 2010. OCR is responsible for
receiving and investigating discrimination complaints under Sec.1557. OCR will use a flexible,
context-specific analysis to determine any violations on a case-by-case basis. For example, with
LEP, they will consider the frequency of the languages used and the resources of the entity
when looking at the obligations.
Additional HHS Resources:
HHS Summary and Fact Sheets
Training materials for your staff
Disclaimer:
This rule incorporates existing civil rights laws and enforcement is reviewed on a case by case
basis. This document does not constitute legal advice and should not be consider a substitute
for such advice. If you need specific questions answered, please contact a knowledgeable
health care attorney in your area.
Advancing Leaders. Advancing Practices.TM
1717 Pennsylvania Ave. NW, #600
Washington, DC 20006
T 202.293.3450
F 202.293.2787
mgma.org
Resource for Entities Covered by Section 1557 of the Affordable Care Act
Estimates of at Least the Top 15 Languages Spoken by Individuals with Limited English Proficiency for the 50 States, the District of Columbia, and the U.S. Territories.
Covered entities may use this information to implement the tagline requirement at § 92.8(d)(1)-(2)
of the Section 1557 rule (45 C.F.R. pt. 92), although nothing in the rule requires a covered entity to
use this particular resource. For more information about this resource and the data used, refer to
the Frequently Asked Questions on these topics.
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
State
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AL
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AK
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
AZ
Language
Spanish ....................................................................
Chinese ....................................................................
Korean .....................................................................
Vietnamese .............................................................
Arabic ......................................................................
German ...................................................................
French ....................................................................
Gujarati ...................................................................
Tagalog ....................................................................
Hindi ........................................................................
Laotian ....................................................................
Russian ....................................................................
Portuguese ..............................................................
Turkish* ..................................................................
Japanese .................................................................
Tagalog ....................................................................
Spanish ....................................................................
Korean .....................................................................
Hmong ....................................................................
Russian ....................................................................
Chinese ....................................................................
Samoan* .................................................................
Laotian ....................................................................
Japanese .................................................................
Ilocano* ..................................................................
Vietnamese .............................................................
Ukrainian* ...............................................................
Thai .........................................................................
German ...................................................................
Polish .......................................................................
Spanish ....................................................................
Navajo .....................................................................
Chinese ....................................................................
Vietnamese .............................................................
Arabic ......................................................................
Tagalog ....................................................................
Korean .....................................................................
French .....................................................................
German ...................................................................
Russian ....................................................................
Japanese .................................................................
Persian (Farsi) ..........................................................
Syriac* .....................................................................
Serbo-Croatian* .....................................................
Thai .........................................................................
Estimate
75,000
5,405
4,554
3,708
1,440
1,411
1,278
888
856
818
681
586
516
505
484
7,021
5,975
2,219
1,944
1,392
1,008
870
743
737
535
516
505
474
247
223
457,022
20,627
14,028
12,996
7,166
6,109
4,759
2,978
2,896
2,353
2,308
2,262
2,110
2,000
1,779
Resource Released by the U.S. Department of Health and Human Services, Office for Civil Rights, August 2016
1
ENGLISH
ATTENTION: If you speak English, language assistance services, free of charge, are available
to you. Call 1-800-535-9250 (TTY: 1-800-535-9250).
SPANISH
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame
al 1-800-535-9250 (TTY: 1-800-535-9250).
CHINESE
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-535-9250（TTY：1800-535-9250）
KOREAN
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-535-
9250 (TTY: 1-800-535-9250)번으로 전화해 주십시오.
VIETNAMESE
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-
535-9250 (TTY: 1-800-535-9250).
ARABIC
‫ (رقم‬800-535-9250-1 ‫ اتصل برقم‬.‫ فإن خدمات المساعدة اللغوية تتوافر لك بالمجان‬،‫ إذا كنت تتحدث اذكر اللغة‬:‫ملحوظة‬
.)800-535-9250-1 :‫هاتف الصم والبكم‬
GERMAN
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: 1-800-535-9250 (TTY: 1-800-535-9250).
FRENCH
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1-800-535-9250 (ATS : 1-800-535-9250).
GUJARATI
ુ ના: જો તમે ગજ
ુ રાતી બોલતા હો, તો નન:શલ્ુ ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે .
સચ
ફોન કરો 1-800-535-9250 (TTY: 1-800-535-9250).
TAGALONG
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika
nang walang bayad. Tumawag sa 1-800-535-9250 (TTY: 1-800-535-9250).
HINDI
ध्यान दें: यदद आप ह दिं ी बोलते हैं तो आपके ललए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-800-535-9250 (TTY:
1-800-535-9250) पर कॉल करें ।
LAOTIAN
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ,
ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-535-9250 (TTY: 1-800-535-9250).
RUSSIAN
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните 1-800-535-9250 (телетайп: 1-800-535-9250).
PORTUGUESE
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800535-9250 (TTY: 1-800-535-9250).
TURKISH
DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz.
1-800-535-9250 (TTY: 1-800-535-9250) irtibat numaralarını arayın.
JAPANESE
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-5359250（TTY:1-800-535-9250）まで、お電話にてご連絡ください。