HHS proposes broad rules to prohibit discrimination in health care

Washington – What’s 308 pages and discusses everything from pregnancy to Medicare Part B? This is a proposed rule by the Department of Health and Human Services (HHS) to implement the nondiscrimination portion of the Affordable Care Act (ACA).

Proposed rule, published on August 4 in the Federal Register , implements ACA Section 1557, which Addresses nondiscrimination in health care. Katie Keith, J.D., MPH, director of health policy and legal initiatives, said the Biden administration has interpreted that part of the bill very broadly, which means the rule will cover more The current administration of broader health care providers at the Georgetown University Law Center in Washington. For example, it will “apply for the first time to Medicare Part B providers and will require physicians not to discriminate on all of these fronts,” she said.

Maryanne Tomazic, JD, MPH, Clinical Lecturer, Center for Innovation in Health Law and Policy, Harvard Law School, Cambridge, MA agrees. “This proposed rule is stronger and is a welcome change for many,” she said, adding that it expanded protections for several groups, including “LGBTQIA people. Discrimination in the health care system is based on It manifests in a variety of ways; patients may face physical or language barriers when they try to obtain care. Some patients have health insurance that will explicitly exclude care related to gender dysphoria or other diagnoses.”

“We’re also seeing patients with insurance plans grouping drugs used to treat a certain chronic disease (like HIV) and putting those drugs on the most expensive formularies, leaving patients and providers without Affordable treatment options,” Tomazic said. “The proposed rule would result in a very strong final rule to prevent these situations, and if not, it explains how people can seek remedies.”

The government is also requiring the non-discrimination clause to apply to The entire organization, even if a specific provision applies only to a portion of the entity, which is different from the Trump administration’s interpretation. Under the Trump administration, the idea was “if you sell [an ACA] market program, it means you can’t discriminate there, but under Biden it applies to all of these larger and broader product,” Keith said. “They said, ‘We want to apply in a very comprehensive way.'”

As for applying these provisions to physicians who are enrolled in Medicare Part B, “I don’t know that this brings How many physicians and Part B providers,” because many physicians may have been included in other provisions, Keith added. “But they just wanted to put it on hold and say Part B was included.”

Tomazic said HHS has in the past been sceptical about including Part B in non-discrimination rules. “To determine whether someone must comply with nondiscrimination protections, the agency looks in part on whether they are receiving federal financial assistance,” she explained. “In the past, they excluded those who received Medicare Part B payments because Part B was considered a For payments made to beneficiaries, the beneficiary first pays out-of-pocket for those services. This rule acknowledges that the plan is structured differently these days because providers, if they participate in Part B, bill [Medicare] directly and receive pay-as-you-go” or indirectly participate in the program because their patients receive Part B funding.

The proposed rule also aims to address discrimination related to pregnancy, including termination of pregnancy, said Nicole Huberfeld, J.D., a professor of health law, ethics and human rights at the Boston University School of Public Health. By soliciting comments on this part of the proposed rule, “It seems to me that they are trying to figure out how the Supreme Court’s Dobbs ruling affects discrimination on the basis of sex, including pregnancy every aspect of it.” Huberfeld was referring to the recent Supreme Court ruling overturning Roe v. Wade .

The proposed rule also requires some health care entities to appoint a “1557 coordinator, so there’s a compliance issue,” Huberfeld said. “Policies should be clearly defined, including for people with limited English proficiency, and there should be training. I think large entities will incorporate Section 1557 into their compliance programs.”

Huberfeld It also noted that the rule could interact with state laws restricting the treatment of transgender children. “I think there may be conflict there,” she said.

Tomazic noted that the rule also addresses discrimination in clinical algorithms used in medical decision-making. “While these algorithms help shape these health care decisions, we need to be critical of what these tools are based on. If the underlying theory itself is flawed or biased, the use of algorithms to make decisions about care can be discriminatory or even discriminatory. would exacerbate existing disparities.”

An example cited in the proposed rule is a measure of renal function known as an estimate of glomerular filtration rate (eGFR); providers sometimes would use an algorithm that “has adjusted for race and ethnicity, and because of that adjustment…it may inappropriately prevent black patients from certain treatment options, such as being on a transplant list, “she says.

She encourages providers to send their comments on the rule; comments are due October 3rd. “Rules based on the discrimination people face have the potential to be more effective. Healthcare professionals are able to understand what patients face when they navigate the healthcare system. They know what it’s like to be denied coverage…it’s for them is an opportunity to improve the economic barriers that their patients experience in the health care system—or they themselves experience.”

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  Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare industry associations, and federal agencies. She has 35 years of experience in healthcare policy. follow