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Sec. 1557 and employee health plans

November 09, 2016

By Jennifer Garvin

Washington — Does your dental practice have an employee health plan?

Is your dental practice covered by the final rule under Section 1557 of the Affordable Care Act?

If the answer to both questions is yes, then your employee health plan must comply with applicable provisions of the final rule beginning Jan. 1, or if later, on the first day of the plan year or policy year.

Section 1557 is the part of the ACA that prohibits entities that receive federal financial assistance from discriminating on the basis of race, color, national origin, age, disability and sex.

The final rule issued under Section 1557 by the U.S. Department of Health and Human Services, which applies to dental practices that receive certain funding from HHS such as Medicaid or Medicare Advantage reimbursement, includes specific prohibitions for health plans, such as denying coverage or categorically excluding or limiting all health services related to gender transition.

The requirement that a covered dental practice's employee health benefit program comply with the final rule applies whether the employee health benefit program is self-insured or fully insured by the dental practice, whether or not the dental practice creates a separate legal entity to administer the program, and whether or not the dental practice pays any cost of the benefits.

The final rule, which applies to covered dental practices' employee wellness programs and long-term care plans as well as employee health benefit programs, also requires covered dental practices to make technology accessible to individuals with disabilities if used by employees for a health program, wellness program or long-term care plan unless doing so would result in undue financial and administrative burdens.

Although the final rule generally does not otherwise apply to a covered dental practice's employees or the technology they use, other federal, state or local employment laws may apply to claims of employment discrimination or require that technology be accessible to employees with disabilities.

For more information, including a list of frequently asked questions, visit the Office for Civil Rights website.

For more information about Section 1557, visit ADA.org/1557.