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Section 1557 of the Affordable Care Act
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Dear BSOF Members,


I want to make sure everyone is aware of new regulatory requirements that take effect October 19th concerning non-discrimination, Section 1557 of the Affordable Care Act.    These regulations will impact all physician practices so you need to pay attention to them and take steps to come into compliance.   There is a great deal of information and sample forms and statements on the Office of Civil Rights website.  But these regulations have not received much press so I don’t want you all to be caught off guard.


All of the guidance from the Office of Civil Rights has been posted on their website:


I have attached a few documents that I pulled down from the OCR website including the list of the top 15 non-English languages present in Florida, sample statements, notices, and taglines.   These 15 languages are the required tag lines you will need to post in your office.


Sample CE Tagline English
Sample CE Statement English
Sample CE Notice English
Resources for Covered Entities Top 15 Languages 
OCR Guidance on Access to Services for LEP Beneficiaries


If your practice has over 15 Employees you have to adopt a grievance procedure and name a compliance coordinator in the practice.   If you are under 15 employees, you still have to comply with all the rest of the requirements…..but those over 15 employees also have to have those two specific measures in place.   The Final Rule does provide in the Appendix a model grievance procedure that covered entities can use. 


I have also attached the form that all practices are supposed to return to the OCR stating that you are aware of the requirements for compliance.  HHS 690 Assurance Compliance Form


The BSOF leadership will discuss additional ways we can assist our members in compliance including sharing sample language access plans and other items. 


Section 1557 of the ACA sign in lobby with 15 Tag lines- Florida Bones - DOC

Section 1557 of the ACA sign in lobby with 15 Tag lines- Florida Bones - PDF




Clock Ticking on Next Regulatory Tsunami for Physicians


October 19th is the deadline for hospitals, physicians, and other covered entities to come into compliance with the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Final Rule implementing Section 1557 of the Affordable Care Act (ACA).   Section 1557 expands upon existing protections against discrimination based on race, color, national origin, sex, age or disability in health programs with a new wave of regulation and potential liability for all covered entities. 


According the HHS the goal of Section 1557 of the ACA is to “advance equity and reduce health disparities by protecting some of the populations that have been most vulnerable to discrimination in the health care context”.  


In practice, Section 1557 is a significant expansion of regulations and an enormous unfunded mandate that will hit independent physicians extremely hard.


The Florida Orthopaedic Society recommends that physicians take immediate action to review the final rules and determine the steps they need to take to become compliant.  Failure to do so will expose the practice to potential complaints of discrimination or civil action filed against them by the patients they are attempting to serve. 


Some of the bureaucratic highlights of the new regulations include: 


·         Covered entities must post in their business locations notices of nondiscrimination and taglines in at least the top 15 non-English languages spoken in the State where the entity does business.   For Florida that list of languages ranges from Spanish to Thai and includes Tagalog and Gujarati.  OCR has provided samples for entities to use.

·         “Small-sized significant communications” from the entity are required to include the nondiscrimination statement and taglines in at least the top two non-English languages in the State.  For Florida that would be Spanish and French Creole.

·         Covered entities are encouraged to develop and implement a language access plan.

·         Entities with 15 or more employees must have a formal grievance procedure and a compliance coordinator responsible for handling compliance and complaints.

·         All programs and activities provided through electronic and information technology must be accessible with appropriate auxiliary aids for individuals with disabilities.

·         To monitor compliance, OCR will require covered entities to keep records and submit compliance reports when necessary.

·         Entities must also complete and return an Assurance of Compliance form to the OCR stating they understand their obligations under the new rules. 


Entities should note that the list above is not an exhaustive list and should refer to the entire rule for full compliance.


While the new regulations are not a departure from the intent of existing nondiscrimination policies, the burden for compliance is significantly ratcheted up.


Given the nature of the services rendered by physicians, the “four-factor analysis” that OCR recommends conducting to determine if a service is significant enough to be impacted by the regulations will require careful review and consideration.


As a society we must stand in support of all efforts to eliminate discrimination wherever it exists.  However, we cannot be blind to the significant cost and impact the regulatory burden is having on the delivery of health care in our nation.   


All of the guidance from the Office of Civil Rights has been posted on their website:







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