Section 1557 FAQs
My group/practice does not have a physical location per se – we provide services in other facilities (ie radiology, anesthesiology, ER physicians, etc.). Do the 1557 requirements apply to us?
Presumptively, these groups are subject to the Section 1557 regulations and will need to comply with the administrative requirements. At a minimum (assuming more than 15 employees), they will need to designate an employee to coordinate compliance efforts and adopt grievance procedures. Regarding the facility posting requirements, if the covered entity is not operating the facility, it can probably rely on the covered entity that does. If, however, the covered entity has a physical location "where it interacts with the public," it will need to do the physical posting. Regarding other notice requirements however, the covered entity will still have to have taglines and the nondiscrimination notice on all “significant publications and significant communications” and on its website, if it has one. If compliance obligations are not spelled out in service agreements between the hospital and the group/practice, that discussion should take place. This would include the LEP and other provisions that the facility probably has (or will have) in place. The group/practice should consult with a healthcare attorney to ensure that all compliance requirements are met.
I understand I have to put the disclosure statement and taglines in my “significant” printed materials. What constitutes "significant" printed materials?
“Significant” printed materials are an important document of which the patient needs to be aware. A document that if a person did not get, there would be substantial consequences to them – for example a notice of a treatment plan or a termination of coverage.
Where do I post the notice and language taglines in my practice?
The Notice of Nondiscrimination Poster and the Interpreter Services Taglines Poster should be posted in a prominent and easily noticeable place within the practice. Having the notice and tag lines in a binder would not be considered adequate as prominent posting.
Where can I find HHS's FAQs?
HHS has an FAQ section on their website. The link is below:
We do not accept Medicaid - do we have to comply with the Section 1557 requirements?
Section 1557 applies to any provider receiving federal financial assistance (“FFA”) from the Department of Health and Human Services (“HHS”), such as Medicaid and Medicare Parts A, C and D as well as grants and credits from HHS such as meaningful use payments. While care reimbursed by Medicare Part B is outside of HHS Office for Civil Rights’ (“OCR”) enforcement of the Section 1557 regulations, providers receiving other forms of HHS payments are subject to the law. As a practical matter, very few providers are not subject to the Section 1557 regulations.
Further, 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 program that HHS itself administers;
- Health Insurance Marketplaces and issuers that participate in those Marketplaces, whether state or federally funded.
Additionally, if a practice participates in government sponsored incentive programs (Meaningful Use, ACO, Patient-Centered Medical Home, PQRS, etc.) they would be subject as well. These would be considered “activities” funded by HHS.
If a practice does not accept Medicaid or Medicare Part A, C, or D, it will most likely be the health exchanges or the incentive programs that will cause a practice to be included in compliance.
When a deaf patient comes in, are we required to provide a sign language interpreter or can we use written notes?
According to HHS, “Consistent with existing requirements, Section 1557 requires covered entities to take appropriate steps to ensure that communications with individuals with disabilities are as effective as communication with others. Section 1557 also requires covered entities to provide appropriate auxiliary aids and services, such as alternative formats and sign language interpreters, where necessary for effective communication.”
A practice should be careful when making a blanket policy since there is a lot to consider:
- Effectiveness of the method of communication with the proposed auxiliary aid or without it.
- Nature and complexity of communication
- Nature of treatment or procedure
- Size of practice or facility
- Cost of alternatives
- Number of patients who will require these aids
- Patient’s preferences
We are a small/single provider practice and cannot afford to provide interpreter services. Can we opt out?
There is nothing in the ruling that excludes a practice based on size. It is the responsibility of all covered entities to develop a relationship with an interpreter service to provide services for Limited English Proficient patients.
Can we depend on a patient’s minor child, adult child, or family member/friend for interpretation?
No. In the case of a minor child, a practice can only rely on a minor to interpret in the event of an emergency where the patient could suffer immediate harm. Adult children, family members or friends can only provide interpretation in an emergency when a patient could suffer harm or if the patient prefers and they can competently provide these services.
Does Section 1557 non-discrimination only apply to Medicare or Medicaid patients?
If your practice is considered a covered entity under the guidelines, you must provide these services to all patients regardless of insurance coverage.
Has SVMIC developed a sample Grievance Procedure that we can use?
SVMIC has not developed a sample Grievance Procedure, but HHS did develop one. You can download it from this link: