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A Quick Guide to Section 1557 Compliance

Give us five minutes and we’ll fill you in on Section 1557 compliance requirements for things like websites, apps, and electronic documents.

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What is Section 1557 of The Affordable Care Act?

Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on the basis of a variety of different classifications—including disability. Section 1557 is not intended to stand alone. It works in conjunction with other Federal anti-discrimination and civil rights legislation.

This law requires healthcare organizations to make their digital resources and electronic communications accessible to people with disabilities, which includes the aging population.

Does Section 1557 require me to have accessible technology?

Yes—for many healthcare organizations, it does. Section 1557 covers:

  • Any health program or activity—in whole or part—that receives funding from the U.S. Department of Health and Human Services (HHS);
  • Any health program or activity that HHS directly administers; and
  • Health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces.

Re-read that last bullet! All plans offered by issuers that participate in the health insurance Marketplace must be Section 1557 compliant.

Contact us to learn about the benefits of Section 1557 compliance.

What technology is included in Section 1557 requirements?

Section 1557 requires covered entities to make accessible any aspects of the healthcare 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

The Office for Civil Rights (OCR) is clear that any electronic and information technology (as defined under Section 508) would fall under the scope of Section 1557. This includes:

  • Websites, web applications, and 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.

What makes my technology Section 1557 compliant?

Let’s use a website as an example. When a website is accessible, it can be used by:

  • someone who is blind who uses software that reads websites out loud
  • someone who is hard of hearing who turns on captions when they watch videos
  • someone with a hand tremor who uses voice command software instead of a keyboard and mouse

When coded correctly, websites work for all of these people. But oftentimes, websites are not coded with accessibility best practices in mind. It’s often an honest oversight due to lack of training. Sometimes it’s a goal pushed to “later.” Either way, people with disabilities are running into barriers when they use technology.

These barriers prevent them from locating a doctor, accessing online patient portals, researching insurance plans or hospitals, and so much more.

By what standards does Section 1557 grade accessibility?

Section 1557 doesn’t prescribe a particular technical standard. In the absence of clear regulations, the best practice is to achieve conformance with the Web Content Accessibility Guidelines (WCAG), Level AA.

WCAG has four guiding principles:

  • Perceivable. Information can be perceived in multiple ways; for example non-text content has alternative text, or videos have captions or audio descriptions.
  • Operable. User interface and navigation functionality is available from a keyboard, as well as other input modalities like speech recognition and gestures.
  • Understandable. Content is readable and understandable to the broadest possible audience, and appears and operates in predictable ways.
  • Robust. Content is compatible with current and future tools, including browsers, assistive technologies, and other user agents.
The 4 Principles of WCAG - Perceivable, Operable, Understandable, Robust

How do people with disabilities use technology?

Are you glad we asked this question for you? It’s okay if you don’t have any idea how a blind person uses the web or a mobile app. Assistive technology bridges the gap between a person’s abilities and the content they want to access.

We have an entire series of articles dedicated to demystifying the world of assistive technology.

How do I test my website for Section 1557 compliance?

If you’ve never tested your site before – or you’ve only used free tools – you will want to set up an audit with an accessibility expert. During the audit process, there will be automated testing, manual testing, and functional testing by people with disabilities using the WCAG success criteria.

At the end of the audit process, you will receive a report with your overall level of WCAG compliance and a list of accessibility issues that need remediation. Depending on your relationship with your vendor, they can provide training or helpdesk support, or even code side-by-side with your developers.

Get a free risk assessment (mini audit) of your website this week.


Connect with a Section 1557 Compliance Specialist