AMARILLO, TX – This article is Part 2 of 2 concerning health care providers’ obligations under the nondiscrimination provisions of the Affordable Care Act and its implementing regulations. Part 1 addressed notices the new rules require to be posted publicly and provided to patients. Part 2 addresses the other requirements the rule imposes on providers.

Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) makes it unlawful for any health care provider that receives federal funds to discriminate against an individual on the basis of the individual’s race, color, national origin, sex, age, or disability. Section 1557 incorporated existing civil rights laws and protections against discrimination directly into the health care setting and empowered the Department of Health & Human Services (DHHS) to promulgate rules to effectuate the prohibitions on discrimination in health care.

In 2024, DHHS promulgated a Final Rule updating and expanding the obligations and requirements for health care providers to ensure they comply with Section 1557’s prohibition on discrimination in the provision of health care services. Under the new rule, found at 45 CFR § 92, health care providers must do the following:

• Adopt policies and procedures regarding nondiscrimination.
• Train employees on the policies and procedures regarding nondiscrimination.
• Designate a Civil Rights Coordinator.
• Provide free-of-charge language assistance services (qualified interpreter and translation services) to ensure meaningful access to health care services for individuals with limited English proficiency.
• Provide free-of-charge auxiliary aids (qualified interpreter services, braille, screen readers, larger text documents, recordings) to ensure meaningful access to health care services for individuals with disabilities.
• Provide patients with a notice of nondiscrimination. The notice should also be publicly posted in the provider’s place of business and website.
• Post publicly and provide patients with a notice of the availability of free-of-charge language assistance services and auxiliary aids.

Section 1557 Coordinator, Written Policies and Procedures, & Employee Training
Any health care provider which employs fifteen or more individuals and receives federal funds must designate a “Section 1557 Coordinator” or “civil rights coordinator.” The coordinator may be an employee with other responsibilities, but the coordinator must have the authority to carry out the following responsibilities:

• Receiving, reviewing, and processing grievances, filed under the provider’s grievance procedure.
• Coordinating the covered entity’s recordkeeping requirements.
• Coordinating effective language access and auxiliary aid procedures, including obtaining qualified translation services, interpretation services, and other accommodations required for individuals with disabilities or limited English proficiency.
• Coordinating and conducting training of relevant employees.

By July 5, 2025, a health care provider must implement written policies and procedures to comply with the nondiscrimination requirements and set forth the procedures for patients to obtain language assistance or communication aids required under the rule. At a minimum, the policies and procedures must state:

• The entity does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), sex, age, or disability;
• The entity provides language assistance services and appropriate auxiliary aids and services free of charge, when necessary for compliance with section 1557 or this part;
• The entity will provide reasonable modifications for individuals with disabilities; and
• The current contact information for the Section 1557 Coordinator (if applicable).

If an entity employs fifteen or more individuals, the policies and procedures must also set forth procedures which enable an individual to submit a complaint alleging any violation of the nondiscrimination requirements and provide for prompt and equitable resolution of any complaint submitted.

Any employees whose roles or responsibilities entail interacting with patients or members of the public must also be trained on the policies and procedures within thirty days of their implementation. Similarly, any new hire must receive training on the nondiscrimination policies. The entity should document this training and maintain the records for at least three years.

Provide free-of-charge Language Assistance and Auxiliary Aids
As part of their nondiscrimination obligations, health care providers must provide free-of-charge language assistance services to individuals with limited English proficiency or other disabilities which limit or hinder their ability to communicate. This includes the provision of a “qualified interpreter” that can translate “effectively, accurately, and impartially” to and from the patient’s primary language. Except in emergencies, the patient cannot be required to provide their own interpreter.

Similarly, for individuals with disabilities that limit or hinder their ability to communicate, providers must offer free-of-charge communication and auxiliary aids  that allow the individual to communicate as effectively as the provider would with nondisabled individuals. This includes utilizing proficient interpreters to perform live interpretation, translation to braille, and other accommodations necessary to comply with the providers’ nondiscrimination obligations.

Future Enforcement
The future enforcement of the provisions of the rule remains an open question. In 2020, the first Trump administration repealed several notice requirements previously implemented under Section 1557, so providers may expect to see the current administration take a similar approach and repeal the requirements discussed above or simply refuse to enforce them. We have seen potential indications of this already. For example, in late 2024, DHHS published a sample Notice of Language Assistance that was translated into 47 languages. The sample Notice has been removed from DHHS’s since the new administration took office in early 2025.

The new administration will likely modify the existing rule and its requirements, but providers who fail to comply with the rule’s current requirements risk being subjected to patient complaints, agency investigations, and noncompliance penalties.For assistance with complying with the new notice requirements, contact the experienced attorneys at Brown & Fortunato.

Todd A. Moody, Esq., is an attorney with the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers and other health care providers throughout the United States. Mr. Moody can be reached at (806) 345-6332 or [email protected].

Matthew D. Earl, Esq., is an attorney with the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers and other health care providers throughout the United States. Mr. Earl can be reached at (806) 345-6360 or [email protected].