New Rule Restores & Advances Important Health care Civil Rights Protections for Older Adults

Civil rights, health care rights law, rainbow flag with heart and stethoscope

In late April 2024, the U.S. Department of Health & Human Services’ Office for Civil Rights (HHS OCR) finalized changes to regulations governing the Health Care Rights Law (HCRL), also referred to as Section 1557 of the Affordable Care Act. These changes restore critical civil rights protections, including provisions for limited English proficient older adults, streamlined procedures for age-related complaints, reinstated prohibitions against discrimination based on race, color, national origin, sex, age, and disability, and clarified protections for LGBTQI+ individuals against sex-based discrimination. It also expands physical and digital accessibility, tackles bias in health technology, and more.

This is great news, and helps ensure some basics in healthcare civil rights — that all people should be treated with respect by their health care providers, have access to quality care and be able to get services and health care information in a language they can understand. These rights are essential for dignity and good health, regardless of one’s age, race, ethnicity, gender identity, or ability.

Here are some highlights of the final rule, as summarized by our partners at Justice in Aging:

  • Restoring and improving notices that inform people of their right to language services and accessibility services at no cost. In 2021, Justice in Aging filed a lawsuit on behalf of Chinatown Service Center and St. Barnabas Senior Services, community-based organizations that provide social services to older adults with LEP, challenging the Trump Administration’s 1557 rule that eliminated the notice of rights and in-language tagline requirements. In restoring these notices, the Biden Administration’s rule cites their lawsuit to show the importance of in-language notices to older adults with LEP.
  • Removing barriers to seeking redress for discrimination based on age. First, the final rule explicitly recognizes that 1557 prohibits discrimination on the basis of intersecting identities, citing for example challenges faced by Latino older adults. Second, the rule removes barriers to filing and resolving Section 1557 administrative complaints based on age. 
  • Prohibiting all Medicare providers from discriminating on the basis of race, color, national origin, age, sex and disability. The final rule establishes, for the first time, that Medicare Part B payments are a form of federal financial assistance subject to Section 1557, as well as Title VI, Title IX, Section 504, and the Age Discrimination Act.
  • Clarifying that LGBTQ+ individuals are protected by Section 1557’s prohibition against discrimination based on sex. Specifically, the final rule codifies in the regulatory text that sex-based discrimination includes sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes.

Restoring protections gutted by the prior administration and helping to increase meaningful access to health care for communities across the country, the 1557 final rule draws on extensive stakeholder engagement, review of over 85,000 comments from the public, the Department’s enforcement experience, and developments in civil rights law.

Additional highlights from the Department of Health and Human Services’ press release include that the rule:

  • Holds HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
  • Requires covered health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.
  • Requires covered health care providers, insurers, grantees, and others to let people know that accessibility services are available to patients at no cost.
  • Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.
  • Respects federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.
  • Respects the clinical judgement of health care providers.
  • Protects patients from discriminatory health insurance benefit designs made by insurers.
  • Clarifies the application of Section 1557 nondiscrimination requirements to health insurance plans.

Given the increasing use of artificial intelligence (AI) in health programs and activities, the rule also clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools. This clarification serves as one of the key pillars of HHS’ response to the President’s Executive Order on Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence.

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Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.