Health Care Non-Discrimination Final Rule Places New Requirements on Certain Physicians and Facilities

On May 13, 2016, the U.S. Department of Health and Human Services (HHS) issued a final rule implementing the prohibition of discrimination under section 1557 of the Affordable Care Act (ACA) of 2010.

The final rule, entitled "Nondiscrimination in Health Programs and Activities," is aimed at advancing equity and reducing health disparities by protecting some of the populations that have been most vulnerable to health care discrimination. The rule is effective July 18, 2016.

Section 1557 of the ACA prohibits discrimination based on race, color, national origin, sex, age, or disability in certain health programs and activities receiving Federal financial assistance. This prohibition also includes discrimination based on pregnancy, gender identity, and sex stereotyping. In addition to implementing Section 1557's prohibition on sex discrimination, the final rule also enhances language assistance for people with limited English proficiency and helps to ensure effective communication for individuals with disabilities.

Coverage under the rule

The rule covers:

  • Any health program or activity, any part of which receives funding from HHS (such as hospitals that accept Medicare or doctors who accept Medicaid)
  • Any health programs that HHS itself administers
  • Health insurance marketplaces and issuers that participate in those marketplaces

Protections under the rule

The final rule requires that women be treated equally with men in the health care they receive and also prohibits the denial of health care or health coverage based on an individual's sex. The final rule also requires covered health programs and activities to treat individuals consistent with their gender identity.

Covered entities must take reasonable steps to provide meaningful access to each individual with limited English proficiency eligible to be served or likely to be encountered in their health programs and activities. 

The final rule requires that covered entities post notices of nondiscrimination and taglines that alert individuals with limited English proficiency to the availability of language assistance services. To reduce burden and costs, the Office of Civil Rights (OCR) has translated a sample notice and taglines for use by covered entities into 64 languages.

The final rule requires each covered entity to post taglines in at least the top 15 non-English languages spoken in the state in which the entity is located or does business. Those requirements are modified for small sized significant communications such as postcards; for these, the final rule requires entities to post a nondiscrimination statement and taglines in at least the top two non-English languages spoken by individuals with limited English proficiency in the state.

The final rule also requires covered entities with 15 or more employees to have a grievance procedure and a compliance director. The final rule includes an Appendix that provides a model grievance procedure for covered entities. Entities with fewer than 15 employees are not required to have a grievance procedure or compliance coordinator.


PAMED's Quick Consult fact sheet explains the new requirements and offers details on what physicians, practices, and other health care organizations need to do to be in compliance. Get the Quick Consult.

Additional resources include:

Leave a comment

Return to the art of medicine - MACRA

norcal mutual opioids advertisement
Norcal Mutual

Learn More