Purpose, enforcement, and relation to other civil rights laws
Section 1557 of the Affordable Care Act prohibits discrimination on the grounds of race, color, national origin, sex, age, or disability by dental practices receiving federal financial assistance, in all their operations. The Section 1557 regulations were amended effective August 19, 2020. The new regulations are simplified and eliminate requirements such as taglines and notices of nondiscrimination. Section 1557 applies the protections, requirements and enforcement of four underlying statutes to federally funded healthcare:
- Title VI of the Civil Rights Act of 1964
- Title IX
- The Age Discrimination Act of 1975
- The Rehabilitation Act of 1973
The regulations under the underlying statutes include requirements such as notice, recordkeeping and access to records, and prohibitions on intimidation and retaliation. Section 1557 applies such requirements to covered dental practices.
Section 1557 is enforced by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), the same federal agency that administers HIPAA. OCR has the authority to receive and handle complaints, initiate and conduct compliance reviews, conduct investigations, make enforcement referrals to the Department of Justice, and take other remedial action it deems necessary.
Individuals may also be entitled to bring lawsuits alleging violation of Section 1557.
Section 1557 does not invalidate or limit other federal civil rights laws, such as Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, or Section 504 of the Rehabilitation Act of 1973, which may also apply to certain dental practices. Section 1557 does not supersede state laws that provide additional protections against discrimination.
Accessibility standards for buildings and facilities
A dental practice covered by Section 1557 must comply with certain standards for accessibility to the dental office. A qualified professional advisor can help dental practices determine how they must comply, particularly when planning or engaging in new construction or alterations.
The Section 1557 facility accessibility requirements are available at 45 CFR Section 92.103.
In general, the applicable standards depend on when the construction or alteration was commenced, and the standards applicable to, and with which the construction or alteration conformed, at the time.
A dental practice may be permitted to depart from certain technical and scoping requirements by using other methods as long as the dental practice provides substantially equivalent or greater access to, and usability of, the dental practice.
A dental practice applying for federal financial assistance, such as Medicaid or CHIP reimbursement, must submit an assurance form stating that the dental practices health programs or activities will be operated in compliance with Section 1557. The dental practice may incorporate this assurance by reference in subsequent applications to the U.S. Department of Health and Human Services for federal financial assistance.