NonDiscrimination

As a result of violations of ACA Section 1557 nondiscrimination rules,

a health plan may revoke an agent or broker's appointment with the health plan. Health plans can face consequences as a result of violations of Section 1557 nondiscrimination rules. For example, health plans may be faced with termination of their ability to conduct federally funded lines of business (such as those related to Medicare) and such violations can result in the payment of compensatory damages.

Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an individual's age,

Charge higher premiums As a general rule, Section 1557 prohibits a covered entity (such as a health plan) from excluding, denying, or limiting benefits and services based on an individual's age. This would include primary care benefits and services.

Which Medicare programs are covered by ACA Section 1557?

Parts A, C, and D, but not B. Correct: Federal financial assistance triggers Section 1557 coverage and compliance. Federal financial assistance for purposes of Section 1557 includes grants, property, Medicaid, and Medicare Parts A, C, and D payments but not Part B. HHS does not consider Medicare Part B payments to physicians to be federal financial assistance and thus Part B does not fall within the parameters of Section 1557. Federal financial assistance for purposes of Section 1557 also includes tax credits and cost-sharing subsidies under Title I of the ACA.

ACA Section 1557 rules for disability concern

Policies and procedures, physical access, and communication. Correct: Under Section 1557, covered entities (such as health plans) must take actions that include: (1) Making reasonable changes in policies, procedures, and practices where necessary to provide equal access to individuals with disabilities; (2) Ensuring newly constructed and altered facilities are physically accessible to individuals with disabilities; and (3) Providing effective communication with individuals with disabilities, including patients and their companions.

Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)?

Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex. Correct: Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age, and sex and applies them to federally funded health programs and those administered by HHS. These laws include Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments Act of 1972 (sex), Section 504 of the Rehabilitation Act of 1973 (disability), and the Age Discrimination Act of 1975 (age).