Section 1557 Final Rule: Applicability Timeline

Covered entities with 15 or more employees must designate at least one employee to serve as a “Section 1557 Coordinator” to coordinate their compliance efforts and carry out their Section 1557 responsibilities.

Covered entities must implement written policies and procedures that are designed to comply with the final rule’s requirements. Covered entities with 15 or more employees must also implement written grievance procedures.

Covered entities must train relevant employees on the civil rights policies and procedures required above in accordance with the final rule.

Covered entities must provide and post a notice informing individuals of their civil rights under Section 1557 that meets certain content requirements.

Covered entities must provide a notice informing individuals that free language assistance services and auxiliary aids and services are available to protect individuals with limited English proficiency (LEP) and individuals with disabilities. The notice must be provided in the top 15 languages spoken by individuals with LEP in the relevant state(s) where the entity operates.

Sample notices in English and 47 other languages are available, which are optional to use (providers can also create their own notices).

In providing or administering health insurance coverage or other health-related coverage, a covered entity must not:

1)     Deny, cancel, limit or refuse to issue or renew coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage on the basis of race, color, national origin, age, disability, sex (including the individual’s sex assigned at birth, gender identity, or gender otherwise recorded) or any combination thereof;

2)     Have or implement marketing practices or benefit designs that discriminate on these bases;

3)     Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded;

4)     Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition or other gender-affirming care;

5)     Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage for specific health services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; or

6)     Have or implement benefit designs that do not provide or administer coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.

For requirement 6, by the first day of the first plan year beginning on or after Jan. 1, 2025

This provision imposes an ongoing duty on covered entities to make reasonable efforts to identify uses of patient care decision support tools in its health programs or activities that employ input variables or factors that measure race, color, national origin, sex, age or disability. For each support tool identified, a covered entity must make reasonable efforts to mitigate the risk of discrimination resulting from the tool’s use.