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The U.S. Department of Health and Human Services along with its Centers for Medicare & Medicaid Services and Office of Civil Rights have finalized two rules that strengthen civil rights in health care, specifically related to Medicare Part B in the Affordable Care Act, and portions of the federal Rehabilitation Act.

The rules, aimed at widening prohibitions against discrimination, address gaps in prior regulations and bring provisions in line with legislative and judicial developments since the passage of both laws.

Nondiscrimination Policies Extended to Medicare Part B in ACA

The final rule issued by HHS around the ACA's nondiscrimination provisions expands the act's definition of "federal financial assistance" to include Medicare for the purpose of civil rights enforcement (42 U.S.C. 18116). The addition is a significant one, because it now means that providers receiving Medicare Part B funds will be treated the same as all other provider types named in the act and face possible enforcement actions if they discriminate on the basis of race, color, national origin, sex, disability, or sexual identity. That list includes providers participating in Medicaid, Medicare Advantage, and the Children’s Health Insurance Program, aka CHIP, as well as those working in hospitals, nursing homes, and human or social service agencies.

The rule also requires covered entities to receive training on policies related to educating patients on the language assistance services that are available to them. HHS also specifically addresses nondiscrimination in telehealth services, ensuring that these services are accessible to individuals with disabilities.

In an HHS fact sheet, the department characterizes the final rule as one that "will help ensure nondiscriminatory access to care for all, including women, people with disabilities, LGBTQI+ people, people with limited English proficiency, people of color, and people regardless of age." More than 85,000 comments were received on the proposed version of the rule.

Rehabilitation Act Antidiscrimination Provisions Extended to Medicare Part B

In a similar move, HHS also finalized a rule that now includes Medicare Part B providers among the entities prohibited from discrimination based on disability in the Rehabilitation Act. Those prohibitions were already in place for federally funded health and human services programs including hospitals, state and local nursing homes, local human or social service agencies, and nursing homes, as well as providers participating in Medicaid and CHIP.

Additional policies finalized in this rule will also better define accessibility for websites and mobile applications, adopt standards for accessible medical diagnostic equipment such as exam tables, and ensure that medical treatment decisions are not based on negative biases or stereotypes about an individual’s disability. It's the first time this portion of the Rehabilitation Act has been updated since 1977, and reflects legislative and judicial changes that have occurred over the ensuing 47 years.

APTA commented in support of the rule changes when they were proposed.

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