Who: Health insurance issuers, health care providers, Third Party Administrators (TPAs), and group health plans (including some self-funded plans).
When: On September 8, 2015, the HHS Office of Civil Rights (OCR) proposed a Rule and requested comments no later than November 9, 2015. The Rule will be effective 60 days after being finalized.
What: Affordable Care Act (ACA) section 1557 provides that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity.
Executive Summary: HHS proposed a Rule to advance Health Equity and reduce disparities in health care. The proposed rule prohibits discrimination based on an individual’s race, color, national origin, sex, age or disability under a health program or activity. Previously, the Office for Civil Rights did not include sex as a potential discriminatory concern in health plans.
Sexual Anti-Discrimination: Under the Rule (1) individuals cannot be denied health care or health coverage based on their sex, including their gender identity; (2) individuals must be treated consistent with their gender identity, including access to facilities; (3) sex-specific health care cannot be denied or limited only because the person seeking such services identifies as belonging to another gender; and (4) explicit categorical exclusions in coverage for all health services related to gender transition are discriminatory.
Disability Services: The Rule includes requirements for auxiliary aides and services for those with disabilities, including alternative formats for written materials and sign language interpreters.
Language Services: The Rule requires language assistance for those with limited English proficiency, such as oral interpreters and written translations. Affected entities could be required to post a notice of consumer rights regarding communication assistance and provide some information in up to 15 languages.
Legal Exposure: The Rule provides for a private right of action and damages for violations to the same extent that such enforcement mechanisms are provided for under the current federal civil rights laws, making it clear that individuals have the ability to file a lawsuit. The Rule may bypass existing administrative processes for settling complaints and open the door to direct legal exposure for affected entities.
Certification of Compliance: Under the Rule, each entity participating in a Federal or State Marketplace would need to certify compliance for all policies and services provided (including any administrative services organization or TPA services), whether inside or outside of the Marketplace offerings.
Actions: The broad inclusive nature of the proposed Rule means that insurers, employers, TPAs and health care providers need to seek legal and compliance advice to determine if any changes are needed to their products, services and their own employee benefits. Those entities wanting to impact the final ruling must submit comments by November 9, 2015.
The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and a contributor to the Client Community newsletter. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult your legal advisers to determine the laws and regulations impacting your business. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.