By: Matt Earl
 
Over the past two years, few healthcare regulations have generated as much confusion as the Affordable Care Act’s nondiscrimination requirements under Section 1557. From the publication of the Department of Health and Human Services’ (HHS) 2024 Final Rule, multiple federal court challenges, and subsequent guidance from HHS, many providers have been left wondering which requirements remain in effect and which no longer apply.

While recent court decisions have narrowed portions of the 2024 Final Rule, Section 1557’s requirements remain fully in force. As a result, healthcare providers that receive federal financial assistance should continue to maintain robust nondiscrimination compliance programs.
 
What Is Section 1557?

Section 1557 of the Affordable Care Act prohibits discrimination in covered health programs and activities on the basis of:

• Race
• Color
• National origin
• Sex
• Age
• Disability

The law applies broadly to healthcare providers, suppliers, insurers, and other organizations receiving federal healthcare funding. Since its enactment, HHS has issued multiple regulations interpreting and implementing these requirements, often resulting in litigation and shifting compliance obligations.
 
The 2024 Final Rule and Subsequent Litigation

In May 2024, HHS issued a comprehensive revision to its Section 1557 regulations. Among other changes, the rule expanded notice requirements, language-access obligations, employee training requirements, grievance procedures, and the scope of protections related to sex discrimination.

Soon after the rule was published, several states and private parties challenged portions of the regulation in federal court. The most significant decisions came in Tennessee v. Kennedy, where courts concluded that HHS exceeded its statutory authority in certain aspects of the regulation.

In response, HHS formally acknowledged that portions of the 2024 Final Rule have been vacated and are no longer enforceable. Specifically, HHS stated that it will not enforce those provisions that expanded the definition of sex discrimination to include gender identity discrimination under Section 1557. Even so, providers should not interpret these rulings as authorization to change their treatment of patients or relax their nondiscrimination efforts. The current position of HHS is better understood as another pendulum swing in healthcare regulation as different administrations advance different policy priorities. Regardless, healthcare providers should continue to maintain strong nondiscrimination practices and provide equitable access to care for all patients.
 
What Should Providers Continue to Do?

Although portions of the 2024 rule have been invalidated, most Section 1557 compliance obligations remain intact.

Healthcare providers should continue to:

1. Maintain Nondiscrimination Policies
   Covered entities should have written policies affirming that they do not discriminate based on protected characteristics and describing how patients may access accommodations and file complaints.
2. Designate a Section 1557 Coordinator (When Required)
   Organizations with fifteen or more employees generally remain responsible for designating a coordinator responsible for overseeing compliance efforts, maintaining records, investigating complaints, and coordinating accommodations.
3. Train Employees
   Staff members who interact with patients should understand the organization’s nondiscrimination obligations and know how to respond when patients request accommodations, language assistance, or disability-related services.
4. Maintain Grievance Procedures
   Organizations subject to the coordinator requirement should continue using procedures that allow patients and other individuals to submit discrimination complaints and receive prompt review.
5. Language Access Remains a Major Compliance Priority
   Language access remains an area that has not been significantly impacted by the recent litigation.
   Providers must continue taking reasonable steps to ensure meaningful access for individuals with limited English proficiency. Depending on an organization’s patient population, this may require interpreter services, translated documents, or other language assistance measures.
   Importantly, patients generally cannot be required to furnish their own interpreters except in limited emergency circumstances.
   For pharmacies and DME suppliers serving diverse patient populations, language-access compliance remains one of the most frequent areas of OCR scrutiny.
6. Disability Accommodations Continue to Be Required
   Likewise, providers must continue providing appropriate auxiliary aids and services necessary to ensure effective communication with individuals with disabilities.

Examples include:

• Qualified sign-language interpreters
• Written materials in accessible formats
• Screen-reader compatible electronic documents
• Large-print documents
• Other reasonable communication accommodations

These obligations derive not only from Section 1557 but also from longstanding federal disability-rights statutes, including Section 504 of the Rehabilitation Act.
 
What Do the Court Decisions Mean for Providers?

The recent court rulings do not eliminate Section 1557 compliance obligations. They simply narrow specific portions of the 2024 regulations relating to HHS’s interpretation of sex discrimination. HHS has expressly stated that it will continue enforcing the remainder of Section 1557 and associated civil rights laws.

For most pharmacies, DME suppliers, and other healthcare businesses, the practical takeaway is straightforward:

• Continue maintaining nondiscrimination policies.
• Continue offering language assistance services.
• Continue providing disability accommodations.
• Continue employee training and complaint procedures.
• Monitor federal and state developments as additional regulatory changes are likely.

 
Looking Ahead

Section 1557 has experienced nearly a decade of regulatory revisions, litigation, and policy changes under successive presidential administrations. The recent Tennessee v. Kennedy decision represents another chapter in that continuing evolution rather than the final word.

Additional regulatory revisions from HHS remain possible, and future court decisions may further shape the scope of Section 1557 obligations. However, despite the uncertainty surrounding some aspects of the rule, the core principle remains unchanged: healthcare providers receiving federal funds must ensure equal access to care and avoid unlawful discrimination.

For healthcare providers, the safest course remains maintaining a comprehensive nondiscrimination compliance program while closely monitoring future developments from HHS and the courts. Any form of discrimination can place a tremendous strain on a provider’s ability to provide care. The litigation and regulatory rulemaking have little practical effect on the day-to-day obligations for providers to avoid discrimination, and a robust nondiscrimination compliance program is the best way to ensure all patients receive equal access to care while minimizing regulatory risk, reducing the likelihood of complaints and investigations, and demonstrating the organization’s commitment to delivering high-quality, patient-centered healthcare.

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For legal guidance on healthcare regulatory and compliance matters, contact Matt Earl at mearl@bf-law.com or 385-509-6583. Matt represents pharmacies, DME suppliers, hospitals, physicians, and other healthcare providers, providing practical counsel on audits, investigations, enforcement actions, compliance programs, and risk management in an increasingly complex regulatory environment.

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This article is for informational purposes only and does not constitute legal advice or establish an attorney-client relationship. This article was prepared on a specific date, and the law may have changed since it was written. You should contact your attorney to obtain advice with respect to your specific legal issue and needs.

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