Section 1557: Deadlines Approach, But Long-Term Prognosis Unclear Under Executive Orders

Section 1557 of the Affordable Care Act mandates nondiscrimination in health care programs managed or funded by the Department of Health and Human Services (HHS), with upcoming deadlines for compliance set for May and July 2025. However, uncertainties remain regarding enforcement and future regulatory guidance, especially concerning provisions related to transgender discrimination and foreign language assistance.

Background

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. These rules apply only to “covered entities,” which include entities that are managed or funded by HHS, for example, Medicare and providers receiving Medicare funds, state health insurance exchanges, and Medicare Advantage plans. In final regulations issued last year, HHS outlined numerous new Section 1557 compliance obligations for covered entities.

Upcoming Deadlines

According to the final regulations, covered entities are required to complete the following tasks by May 1, 2025:

• review patient care decision-making support tools for potential bias;
• adopt internal policies and procedures for compliance with Section 1557; and
• train relevant employees on the new Section 1557 policies and procedures (although an inconsistency in the regulations suggests that this deadline for adopting policies and conducting the necessary training may be July 5, 2025).

The deadline for health care providers that receive only Part B Medicare funds is May 6, 2025. By July 5, 2025, covered entities are required to distribute a new notice to inform individuals of the availability of non-English assistance. The new notice replaces the old foreign language “taglines” that were required under previous versions of the Section 1557 regulations. Some employers have already redesigned their notices to meet this requirement when they met earlier Section 1557 notice deadlines in the fall.

Questions Remain

Key components of the final Section 1557 regulations are at odds with the new administration’s policy goals, leaving covered entities questioning the extent to which HHS intends to enforce the final regulations. 

For example, under the previous administration, Section 1557 was interpreted to prohibit discrimination against transgender individuals. However, executive orders issued by the President have made it clear that the current administration is unlikely to support rules that prohibit discrimination against transgender individuals in the health care setting. Likewise, Section 1557 contains robust requirements for providing assistance in foreign language. However, these rules likely conflict with recent executive actions declaring English to be the official language of the United States. It seems likely that the new administration will, like the first Trump administration, interpret parts of the statute narrowly and eliminate some of the notification and procedural requirements.

Absent further guidance, covered entities should work with their counsel to determine the next steps for compliance with Section 1557. Attorneys in our Employee Benefits and Executive Compensation Group are staying informed about new developments and are available to provide advice.