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Section 1557 of the Affordable Care Act – Systems Covered

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Written by: Beth Crutchfield

This is the third article in a five-part series on accessibility and the Affordable Care Act. Please click here for parts onetwofour and five

Section 1557 requires covered entities to make all health programs and activities provided through electronic and information technology accessible. This requirement is wide ranging and broadly relates to any aspects of the health care program or service provided in a digital form. This would include:

  • Access to an online appointment system
  • Accessible electronic billing and statements
  • Comparison of health plans offered through a health insurance marketplace
  • Information on the specific plan and benefits provided

It is important to note that OCR very clearly does not limit the application of the regulations to websites. In fact, anything that falls under the broad scope of electronic and information technology as defined under Section 508 would fall under the scope of the regulation. In practice this includes:

  • Websites
  • Web applications
  • Mobile applications
  • Kiosks
  • Electronic documents and statements
  • Any electronic communication—most notably e-mail communication

The covered programs and activities are limited to those that are directly related to consumers and, in general, not applicable to employee or provider facing systems. The rulemaking text does, however, note that employees of virtually all covered organizations are likely under other statutes and regulations, most notably Title I of the ADA and Section 504 of the Rehabilitation Act. So while the application of Section 1557 is limited to consumers, broader requirements are likely applicable to access to electronic and information technology under other laws and requirements.

Are the marketing activities associated with covered plans covered?

A variety of regulations already relate to how covered plans can be marketed. Section 1557 includes this requirement:

45 CFR §92.207(b)(2) [A covered entity shall not…] Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, or disability in a health-related insurance plan or policy, or other health-related coverage;

This builds on existing regulations that govern marketing practices including 45 CFR 156.225 (b) that prohibits qualified health plans from employing “marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs.” In addition, 45 CFR 147.104(e) prohibits a health insurance issuer from employing marketing practices or benefit designs that discriminate based on present or predicted disability.

Want to Learn More?

If you’d like to learn more about Section 1557, which programs and activities it covers, and how to be compliant with the requirements, download our free whitepaper.

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