Section 1557
Frequently Asked Questions
1. What is Section 1557 of the Affordable Care Act?
2. What will happen if the Affordable Care Act is repealed?
3. Am I subject to Section 1557 of the Affordable Care Act?
4. What is “Federal Financial Assistance?”
5. What if my practice has less than 15 employees?
6. What is required and prohibited under the Section 1557 regulations?
7. Are there any resources that can help my practice comply with Section 1557?
8. What does it mean to discriminate on the basis of sex?
9. Who can be assigned as a Civil Rights Coordinator for my practice?
10. What notices, taglines, and statements does Section 1557 regulations require me to provide?
11. Where can I find or purchase the required Notices and Taglines?
12. Am I required to provide translators/interpreters in all 15 languages?
13. What are acceptable Language Assistance Services for patients with limited English
proficiency (LEP)?
14. What are acceptable Auxiliary Aids for patients and individuals with disabilities?
15. Am I required to use text telephones (TTYs)?
16. Does the AOA recommend companies that provide Language Assistance Services or
Auxiliary Aids, such as interpreter services and video remote Interpreting services?
17. Are there any specific requirements for video remote interpreting services?
18. Can the patient’s family and friends serve as Language Assistance Services or Auxiliary
Aids?
19. Who is responsible for paying for Language Assistance Services and Auxiliary Aids?
20. Does HIPAA apply to Language Assistance Services and Auxiliary Aids?
21. What are the penalties for Violating the Section 1557 Rules?
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This FAQ is for informational purposes only & is not intended as a comprehensive guide. As
always, the AOA strongly recommends that you seek legal counsel to ensure that your practice is
compliant with section 1557 of the ACA and all other Federal, state, & local requirements.
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Section 1557
Frequently Asked Questions
1. What is Section 1557 of the Affordable Care Act?
Section 1557 of the Affordable Care Act applies several existing civil rights laws to practices
that accept “Federal Financial Assistance.” Section 1557 and its regulations prohibit practices
from discriminating on the basis of race, color, national origin, sex, age, or disability.
2. What will happen if the Affordable Care Act is repealed?
Section 1557 is part of the Affordable Care Act (ACA). If the ACA is repealed, then practices
would not have to comply with Section 1557 requirements. However, many practices would still
be subject to the Civil Rights Laws that Section 1557 is based on. For example, Title VI of the
Civil Rights Act of 1964 (Title VI)—which prohibits discrimination based on race color or
national origin—would still apply to entities who receive Federal Financial Assistance.
Therefore, your practice must comply with Title VI, regardless of whether Section 1557 of the
ACA is repealed or not.
3. Am I subject to Section 1557?
Practices of ANY SIZE are subject to Section 1557 regulations if they accept “Federal Financial
Assistance.” For more details on what constitutes “Federal Financial Assistance,” click here.
4. What is “Federal Financial Assistance”
“Federal Financial Assistance” can be Medicare Advantage payments, community health center
prospective payments, or grants from the National Institutes of Health (NIH). It can even be state
programs that are partially Federally funded, such as Medicaid payments. Medicare Part B
payments are not considered “assistance.” For more details on what constitutes “Federal
Financial Assistance,” click here.
5. What if my practice has less than 15 employees?
Regardless of your practice size, accepting any kind of “Federal Financial Assistance” subjects
you to Section 1557 regulations. However, practices with fewer than 15 employees are not
required to create Grievance Procedures or assign a Civil Rights Coordinator. You still need to
comply with the remaining requirements. The 15-employee threshold includes part-time
employees.
If you have fewer than 15 employees and choose not to have a coordinator or set of grievance
procedures, you should edit the Notices of nondiscrimination to reflect the changes you made.
You must still post the Notices of nondiscrimination and Taglines, include them in your
significant communications, and comply with all other Section 1557 regulations.
Remember, you will still need to have an employee as a contact person for patients to request the
services they need, and someone in your practice will still need to ensure that your practice is
complaint with the remaining Section 1557 requirements.
6. What is required and prohibited under the Section 1557 regulations?
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Section 1557
Frequently Asked Questions
Section 1557 and its regulations prohibit discrimination on the basis of race, color, national
origin, sex, age, or disability in health care settings that receive “Federal Financial Assistance.”
Section 1557’s regulations apply the below civil rights prohibitions, requirements, and
enforcement mechanisms to practices that accept Federal Financial Assistance.
 Title VI of the Civil Rights Act of 1964 (Title VI),
 Title IX of the Education Amendments of 1972 (Title IX),
 The Age Discrimination Act of 1975 (Age Act),
 Section 504 of the Rehabilitation Act of 1973 (Section 504),
7. Are there any resources that can help my practice comply with Section 1557?
The HHS links listed below explain how each civil rights statute is applied to health care settings
and provides training materials for your office. Your Civil Rights Coordinator(s) should review
all the material below and ensure that your practices’ policies and procedures are compliant with
all the civil rights requirements. The AOA recommends that practices consult with a legal expert
to ensure compliance
 Civil Rights Resources for Providers
 Title VI of the Civil Rights Act of 1964 (Title VI),
o Prohibits discrimination based on race, color, national origin
o http://www.hhs.gov/civil-rights/for- individuals/race/index.html
 Title IX of the Education Amendments of 1972 (Title IX),
o Prohibits discrimination based on sex in educational institutions
o http://www.hhs.gov/civil-rights/for- individuals/sex-discrimination/index.html
 The Age Discrimination Act of 1975 (Age Act),
o Prohibits discrimination based on age
o http://www.hhs.gov/civil-rights/for- individuals/age-discrimination/index.html
 Section 504 of the Rehabilitation Act of 1973 (Section 504),
o Prohibits discrimination based on disability
o http://www.hhs.gov/civil-rights/for- individuals/disability/index.html
 Section 1557 of the ACA
o Section 1557 regulations have specific requirements not found in the above civil
rights laws. Section 1557 requirements take precedent over duplicative
requirements in the above civil rights laws (e.g., the notice requirements for
Section 1557 takes precedent over the 504 notice requirements, and practices do
not have to post both notices).
o Summary: Final Rule Implementing Section 1557 of the Affordable Care Act
o 1557 training materials
o 1557: Protecting Individuals against Sex Discrimination
o 1557: Ensuring Meaningful Access for Individuals with Limited English
Proficiency
o 1557: Ensuring Effective Communication with and Accessibility for Individuals
with Disabilities
8. What does it mean to discriminate on the basis of sex?
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Section 1557
Frequently Asked Questions
Discrimination on the basis of sex includes discrimination on the basis of gender identity and sex
stereotyping. Practices must treat individuals consistent with their gender identity.
9. Who can be assigned as a Civil Rights Coordinator for my practice?
The Section 1557 regulations does not have specific requirements on who can be a Civil Rights
Coordinator. The assigned employee should be responsible for ensuring that your practice is
fully compliant with Section 1557, coordinate investigations into grievances filed against the
practice, and be the contact person for patients needing Language Assistance Services and
Auxiliary Aids. As long as they are capable of fulfilling those duties, any employee can be the
coordinator. Furthermore, being the coordinator does not have to be the sole duty of the selected
employee. The employee can be an existing human resource personnel, an optometrist, a
paraoptometric staff member, etc. The practice and the Civil Rights Coordinator also have the
freedom to select more than one Civil Rights Coordinator (e.g., practices can have one
Coordinator per location) or assign specific responsibilities to different employees (e.g., One
employee can be responsible for coordinating Language Assistance Services while another
responsible for coordinating investigations).
However, when determining whether a civil rights violation occurred, the Department of Health
and Human Services can consider all relevant factors. Assigning an employee who cannot handle
the responsibility (e.g., someone who isn’t qualified or someone who will be overworked if they
take on the coordinator responsibilities) will probably be viewed as a negative factor if the
practice is ever under investigation. Employees assigned as a “Civil Right Coordinator” should
have the time and professional capacity to ensure compliance and investigate any grievances that
may be filed.
10. What notices, taglines, and statements does Section 1557 regulations require me to
provide?
Copies of the Notice of Nondiscrimination and Taglines that alert individuals with limited
English proficiency (LEP) to the availability of language assistance services. Both need to be
printed as a hard copy in a conspicuous-sized font in in public spaces of the office or facility. If
you have a website, the notice and tagline should posted online in conspicuous location on your
website and accessible from the home page. For both the office and the website, only the
Language Taglines need to be available in the top 15 languages spoken by individuals with
limited English proficiency of the practice location's state. If you have multiple locations, you
should fulfil the notice/tagline requirements for each facility.
You can find a sample “Notice of Nondiscrimination” (here). You must tailor the notice to
include your practice’s information and reflect the specific-nondiscrimination policies that you
implement. For example, if you have less than 15 employees and choose not to assign a Civil
Rights Coordinator, your notice should reflect that. If you edit the sample notice or create your
own notice, the notice MUST include the following information:

The practice does not discriminate on the basis of race, color, national origin, sex, age, or
disability in its health programs and activities;
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Frequently Asked Questions
Appropriate Auxiliary Aids and services are available, including qualified interpreters for
individuals with disabilities and information in alternate formats, free of charge and in a
timely manner, when such aids and services are necessary to ensure an equal opportunity
to participate to individuals with disabilities;
The practice provides language assistance services, including translated documents and
oral interpretation, free of charge and in a timely manner, when such services are
necessary to provide meaningful access to individuals with limited English proficiency;
How patients can access the above services
Availability of Grievance Procedures
How to file discrimination complaints with HHS’ Office of Civil Rights
You can find samples of the langue assistance Taglines here. The notice must communicate in
non-English languages that the Language Assistance Services are available free of charge to the
patient. The Taglines must be in the top 15 languages spoken by individuals with limited English
proficiency of the relevant State or States. You can find the top 15 languages spoken in your
state here. Sample notices can be found in 64 languages here.
The notice and 15 language Taglines must also be provided in significant publications and
significant communications that are targeted to your patients and the public. The regulations do
not define or provide examples of what constitutes a “significant” communication. Each practice
needs to determine which of its communications and publications with respect to its activities are
significant.
For significant communications that are small in size (e.g., brochures or postcards), you can
provide an abridged notice and Taglines only in the top two languages spoken by individuals
with limited English proficiency of the relevant State or States. The following is an example of
the abridged Notice and Taglines that should be included in small-sized communications:
[Name of covered entity] complies with applicable Federal civil
rights laws and does not discriminate on the basis of race, color,
national origin, age, disability, or sex.
ATTENTION: If you speak [insert language], language assistance
services, free of charge, are available to you. Call 1-xxx-xxx-xxxx
(TTY: 1-xxx-xxx-xxxx).1
For all significant communications, practices can exhaust their already-printed materials before
incorporating the above notice and tagline requirements. Any newly-printed significant
communications needs to be produced with the required notices and Taglines.
11. Where can I find or purchase the required Notices and Taglines?
The Department of Health and Human Services has provided samples of the Notice of
Nondiscrimination and Taglines that alert individuals with limited English proficiency (LEP) to
the availability of language assistance services.
1
This tagline must be printed in the top two languages spoken by individuals with limited English proficiency of the
relevant State or States
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Section 1557
Frequently Asked Questions
Because the notices and Taglines must be completed with your practices’ contact information
and reflect your practices’ specific nondiscrimination procedures, the AOA does not provide any
ready-made notices or Taglines for purchase or download. Furthermore, the Taglines must be
specifically printed in the top 15 languages spoken by individuals with limited English
proficiency of the relevant State or States.
 Click here for sample Taglines translated to 64 languages
 Click here to view the table of the top 15 languages by state
If you are having trouble with the PDF formatting, you can also find the sample notices and
Taglines in appendices of the final rule: 81 FR 31472, May 18, 2016.
12. Am I required to provide translators/interpreters in all 15 languages and American
Sign Language?
Interpreters are technically not required for every patient with limited English proficiency or
disability (See HHS’ FAQ # 11). The rules require that you take reasonable steps to provide
meaningful access to patients that your practice is likely to encounter. Therefore, a translator is
required when it is a reasonable step to provide access to your patient with limited English
proficiency. However, not all patients will need an interpreter and practices may be able to
reasonably provide meaningful access using other types of “Language assistance services” and
“Auxiliary Aids.” For example, video remote interpreting services, video relay services, or
qualified staff (employees who are proficient in the patient’s language and capable of
interpreting) may be sufficient to provide “meaningful access” to many patients.
If the patient insists that particular type of language assistance service or auxiliary aid is
necessary, such as a translator, not providing that service may result in a grievance filed against
your practice.
Whatever services or aides you choose to use, ensure that the proper privacy and HIPAA
safeguards are in place. For example, if you subscribe to a translation service, you must obtain a
Business Agreement with that service.
13. What are acceptable Language Assistance Services for patients with limited English
proficiency?
HHS provides examples of Language assistance services, however, the list is not exhaustive.
Unlike the disability requirements, practices are not required to accommodate patient’s
companions with limited English proficiencies.
All Language Assistance Services used to comply with Section 1557 rules must meet the
following requirements:
 provide meaningful access to the patient with Limited English Proficiency (§ 92.201(a))
 be free of charge, (§ 92.201(c))
 be accurate and timely, (§ 92.201(c)) AND
 protect the privacy and independence of the individual with limited English proficiency.
(§ 92.201(c))
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Frequently Asked Questions
It is up to the practice to determine whether the service is accurate, timely, and provides
meaningful access. What is reasonable also depends on the level English proficiency of the
patient. A simple app that translates words might reasonably provide access to a patient that is
familiar with but limited in English. Patients who are less proficient may require a more
sophisticated technology or an interpreter.
14. What are acceptable Auxiliary Aids for patients and individuals with disabilities?
HHS provides examples of Auxiliary Aids (click on the links for the list of examples); however,
the list is not exhaustive. Practices are to take appropriate steps to ensure that their
communications to patients and their companions with disabilities are as effective as
communications with others. Your practice must give primary consideration to the requests of
individuals with disabilities.
All Auxiliary Aids MUST be provided in:
 accessible formats,
 a timely manner,
 a manner that protects the privacy and independence of the individual with a disability.
15. Am I required to use text telephones (TTYs)?
You are required to use text telephones (TTYs) or equally effective telecommunications system
to communicate with individuals who are deaf or hard of hearing or with impairments. A practice
must respond to telephone calls from a telecommunications relay service in the same manner that
it responds to other telephone calls.
Practices using automated-attendant systems (e.g., voice mail or messaging) or an interactive
voice response systems for receiving and directing incoming telephone calls, that system must
provide effective real-time communication with individuals using Auxiliary Aids and services,
including TTYs and all forms of FCC-approved telecommunications relay system, including
Internet-based relay systems.
16. Does the AOA recommend companies that that provide Language Assistance Services
or Auxiliary Aids, such as interpreter services, video remote Interpreting services or
etc?
The AOA does not have a list of companies that it recommends or endorses. We suggest that you
contact the professional organizations of these services for a referral. For any services that you
choose, ensure that they are aware of and comply with the requirements set forth by Section
1557, the civil rights requirements that Section 1557 regulations are based on, and HIPAA.
17. Are there any specific requirements for video remote interpreting services?
If you choose to provide video remote interpreting services to communicate with disabled
individuals or patients with limited English proficiency, those services must provide:
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Frequently Asked Questions
Real-time, full- motion video and audio over a dedicated high-speed, wide-bandwidth
video connection or wireless connection that delivers high-quality video images that do
not produce lags, choppy, blurry, or grainy images, or irregular pauses in
communication;
A sharply delineated image that is large enough to display the interpreter's Start Printed
face and the participating individual's face regardless of the individual's body position;
A clear, audible transmission of voices; and
Adequate training to users of the technology and other involved individuals so that they
may quickly and efficiently set up and operate the video remote interpreting.
18. Can the patient’s family and friends serve as Language Assistance Services or Auxiliary
Aids?
You can NOT rely on the following people to interpret or facilitate communication for individual
with limited English proficiency OR disabilities:
 The patient themselves (you cannot require that the patient provide their own interpreter)
 Patient’s adult friends or family, EXCEPT:
o In emergencies where no interpreter is available
o Where the patient specifically requests that their friend or family member be their
interpreter
 A minor child to interpret (EXCEPT in emergencies where no interpreter is available)
 Unqualified staff.
19. Who is responsible for paying for Language Assistance Services and Auxiliary Aids?
The patient cannot be charged for any Language assistance services and Auxiliary Aids used to
comply with these regulations. You are responsible for the cost of these services.
20. Does HIPAA apply to Language Assistance Services and Auxiliary Aids?
Any service you use to comply with Section 1557 should adhere to HIPAA requirements. If you
are using an employee as language assistance service or auxiliary aid, ensure that the employee is
trained and aware of the HIPAA requirements. If you are using third-party services, such as a
video relay service or an interpreter service, you must have a business associates agreement for
each entity you use. For example, if you are using independent translators, you must have a
business associate for each translator. If you are using subscription service, then you need to
have one business associate agreement with that service company, and that company should
ensure its translators comply with HIPAA.
You should also ensure that any mobile application you use does not transmit or store protected
health information, unless you employ the proper safeguards and/or a business associates
agreement with the mobile app company.
For more information about HIPAA please see AOA’s HIPAA page and HHS’ FAQ #760.
21. What are the penalties for violating the Section 1557 rules?
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Section 1557
Frequently Asked Questions
The penalties for non-compliance and grievances are the same as the civil rights laws that they
are based on, along with compensatory and administrative damages (See § 92.301) For an
overview of how HHS has enforced civil rights law in the past please see:
http://www.hhs.gov/civil-rights/for-providers/compliance-enforcement/index.html
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The above FAQ is for informational purposes. As always, the AOA strongly recommends that
you seek legal counsel to ensure that your practice is compliant with section 1557 of the ACA
(1557) and all other Federal, state, and local requirements.
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