Are Chiropractors Required or Released From ACA Section 1557?

Yet another compliance requirement potentially darkens the doors of chiropractic practices and is accompanied by an audit threat that is causing a bit of a stir in the profession.  But, there is potential good news here for many, possibly even most, chiropractors in regards to Section 1557.  Here are the basic facts:

What is Section 1557?

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. (Click link above for full details) Section 1557 builds on some long-standing Federal civil rights laws and extends the nondiscrimination protections to individuals participating in many federal health programs – including parts of Medicare.

The basic requirement of the Section 1557 law is that consumers cannot be denied health services or health coverage or discriminated against in other ways in health services or coverage because of their race, color, national origin, sex, age, or disability.

For example, the Section 1557 rule includes prohibitions on gender identity discrimination as a form of sex discrimination, enhances language assistance for people with limited English proficiency, and requires effective communication for individuals with disabilities.  Overall, the proposed rule ensures consumers have the equal access to health care and health coverage provided by the Affordable Care Act.

How Section 1557 May Apply to Chiropractors

Of concern to the chiropractic profession is the fact that the Section 1557 Rule applies to any health program or activity, any part of which receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients – which may include chiropractors. It also applies to any health program that HHS itself administers.

The Section 1557 Final Rule was published October 17, 2016 and requires covered entities (which may include chiropractic practices) will be required to post notices of nondiscrimination and taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services. What that means practically is that required chiropractic offices will have to publish a notice in at least the top 15 languages stating that they are non-discriminatory AND they have to provide FREE (uggh) language assistance services in at least the top 15 languages as well.

In addition, all “significant” publications and communications directed at the public must include such notice. In guidance accompanying the release of the Final Rule, OCR indicated that it views “significant communications” as including the following:

  • Outreach, education and marketing materials (this includes your website);
  • Patient handbooks, brochures, etc
  • Notices requiring a response from individuals;
  • Written notices such as those pertaining to rights or benefits;
  • Consent and complaint forms;
  • Written notices of eligibility criteria, rights, denial, loss or decreases in benefits or services; and
  • Applications to participate in services or programs.

Which Chiropractors Are Required to Comply With Section 1557?

 There is a little confusion on the issue of who is covered primarily because the OCR is using the term “covered entity” differently in respect to Section 1557 requirements than say HIPAA’s definition of a covered entity.

At the most basic level, Section 1557 is required of providers who receive Medicare Parts A, C and D payments. This is good news for Chiropractors as our payments come through Part B and are therefore NOT subject to Section 1557 requirements based on Part B alone (as answered by the OCR in the FAQ document here).

However, Section 1557 also applies to those who receive some sort of Federal Assistance. Most applicable to chiropractors, this would include Meaningful Use payments and Medicaid payments.

So, even though you would be exempted as a chiropractor who received Part B Medicare funds, you may be subject to Section 1557 requirements because you accept Meaningful Use or Medicaid money!

If you don’t want to wade through the entire Section 1557 Final Rule and the many summary sheets released by the department of Health and Human Services here, then check out a quick summary of everything on the Health Law Update blog.

One additional note: chiropractors should also be aware that the final rule goes into effect 60 days after publication in the Federal Register, there are already plans in the works to make Section 1557 on the audit target list beginning January 1, 2017. So, get moving on getting compliant now!

What You Need to Do Next

If you have not accepted any Meaningful Use money or any Medicaid payments, congratulations!  As a Part B provider (this is where Medicare’s chiropractic services are covered), you are exempt from the Section 1557 requirements. Whew – one less thing to do!

If you are a chiropractor required to do Section 1557 because you have accepted Meaningful Use money or because of Medicaid payments, there are a few basic steps you can take quickly to be compliant.

  • Post a notice of non-discrimination in your office in a conspicuous place. The Office of Civil Rights (OCR) has free materials designed to assist you in publishing the notifications of non-discrimination required from Section 1557. Clicking the links here to access those materials.
  • Post taglines in the top 15 languages stating the availability of free language assistance services. Again, the OCR has examples translated into the top 15 languages for you.
  • Chiropractors with 15 or more employees must also have a civil rights grievance procedure and an employee designated to coordinate their compliance efforts.
  • Provide Contact Info for the chiropractic employee responsible for Section 1557 compliance

Finally…if you are asking “why” it’s probably a lesson to learn. All of these incentive payments we’ve seen over the years come with strings attached.  This is just one of them.  You don’t get anything for free and these days, even what you earn can be taken back with audits.  So be prepared.

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