Are You a Lightning Rod for a Civil Rights Violation?
In the wake of regulatory reversals, legal challenges, presidential executive orders, and political turbulence over the past decade, many healthcare organizations may have missed critical updates to federal civil rights regulations. With deadlines now past in 2024, 2025, and additional compliance dates in 2026, failure to understand and operationalize these requirements leaves organizations exposed and potentially vulnerable—not just to reputational risk, but to enforcement actions.
Protecting civil rights is a bedrock principle in U.S. healthcare, consistently upheld across administrations regardless of party. Violating the rights of individuals with an illness or disability—whether physical, mental, intellectual, or developmental—is a lightning rod for government scrutiny and enforcement.
Core Federal Civil Rights Laws
Preserving civil rights in the delivery of health care is an extremely sensitive and critical issue, grounded and reinforced by a complex web of intersecting laws to which health care providers receiving federal financial assistance (i.e., Medicare, Medicaid, etc.) are obligated to follow, e.g., the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA).
Building on these long-standing federal laws, are two healthcare-specific regulations that have recently undergone significant revisions:
- Section 504 of the Rehabilitation Act of 1973 (45 CFR Part 84) prohibits disability discrimination in federally funded healthcare programs.
- Section 1557 of the Affordable Care Act (45 CFR Part 92) prohibits discrimination based on race, color, national origin, sex, age, and disability—with expanded protections finalized in May 2024.
Compliance Deadlines
Section 1557 imposed staggered deadlines throughout 2024, with final training requirements due July 2025.
Rehab 504 also had phased in deadlines with most provisions effective in 2024, and digital accessibility and diagnostic equipment deadlines extending to 2026.
Section 1557: Expanded Protections and Operational Impact
Originally passed in 2016 section 1557 of the ACA has been under fire ever since. Intended to address discrimination in health care by mandating “meaningful access” to services, the law requires covered entities to provide language assistance services (translation, interpretation, etc.) to individuals with Limited English Proficiency (LEP).
The changes to 1557 included an expanded definition of “sex” to include gender identity, sexual orientation, sex characteristics, and pregnancy-related conditions, although these changes have now been contested. The dispute over the broader definition has been a political ping pong ball since 2016 and is currently facing legal challenges and other non-enforcement notices. Regardless of how the word “sex” is eventually defined, the rest of the 1557 changes are in effect.
Also opposed over the last ten years, but fully in effect, is the need to include taglines which are statements, required to be provided in the top 15 languages spoken by LEP individuals in each relevant state(s), informing them that free language assistance services are available. Taglines must be included in certain patient communications, on websites and portals, and in conspicuous physical locations.
Section 1557 is also now also applicable to Medicare Part B providers and includes provisions allowing covered entities to invoke federal conscience protections.
Other Operational Requirements Under Section 1557
- Designate a 1557 Coordinator to coordinate compliance activities
- Post and distribute a “Notice of Language Assistance Services” and ensure access is provided digitally and with assistive devices
- Revise written policies and procedures to reflect expanded nondiscrimination protections
- Include taglines in publications, websites, and physical locations
- Evaluate AI tools for discriminatory outcomes
- Train employees on updated policies and procedures
Rehab 504: Strengthening Disability Protections
Originally passed in 1977 and revised in 2024, Section 504 aligns with the ADA by prohibiting disability-based discrimination, and clarifies and strengthens obligations to:
- Provide effective communication via auxiliary aids and services and real-time access for individuals who are deaf, hard of hearing, blind, or have any other type of physical or mental impairment
- Ensure interactions are in the most integrated setting appropriate
- Give primary consideration to, or honoring individual preferences for communication methods
Rehab 504 also advances the use of technology to websites, mobile apps, and other digital tools and requires them to be accessible to those with disabilities. Specifically, covered entities must meet the WCAG 2.1 Level AA standards by May 11, 2026 (or May 10, 2027 for organization with 15 or less employees.) https://www.w3.org/TR/WCAG21/
A significant enhancement, about which your clinical and medical staff should be educated, are medical treatment protections. These protections are aimed at preventing discrimination in medical decision making, or based on judgments about quality of life, or on perceiving individuals as a “burden.”
An additional requirement of Rehab 504, with a deadline of July 8, 2026, requires covered entities to implement accessible medical diagnostic equipment such as mammography machines, weight scales, and exam tables to meet the Access Board’s Standards. eCFR :: 36 CFR Part 1195 — Standards for Accessible Medical Diagnostic Equipment.
In short, the operation changes required under Rehab 504 require covered entities to:
- Designate a Rehab 504 coordinator
- Provide and distribute to individuals seeking health care services a “Notice of Nondiscrimination”
- Update written nondiscrimination policies and procedures
- Draft or revise grievance procedures for disability-related complaints
- Evaluate your physical spaces, diagnostic equipment in light of the designated standards
- Asses your digital platforms such as kiosks, mobile apps, and websites and address identified deficiencies to ensure they meet WCAG standards
- Train employees in all these measures and your updated policies and procedures
Enduring Civil Rights Protections
While some of the broader concepts introduced in the 2024 revisions to Section 1557 and Section 504 may continue to face legal and political challenges, one principle remains unwavering: the obligation to protect those with LEP and individuals with disabilities from discrimination in healthcare.
Enforcement Is Real—and Often Unexpected
Civil rights investigations are typically initiated at the state level, most often triggered by a complaint from a patient or their family – and government investigators are very sensitive to patient complaints of discrimination! Healthcare organizations are frequently caught off guard when they receive notice of investigation—and when that happens, you can expect a thorough and detailed review of your civil right practices.
If You Haven’t Acted Yet, the Time Is Now
The sheer number, intersection, and, in certain areas, redundancy of federal civil rights laws—combined with the recent regulatory updates—make drafting and updating compliance policies a complex task. If your organization has not yet incorporated the 2024 and 2025 changes into your civil rights compliance framework, now is the time.
We’ve Done the Heavy Lifting for You
At Wild Consulting, we understand the time demands and the difficulty in drafting and coordinating these policies and procedures. That’s why we’ve developed comprehensive, ready-to-implement policies, procedures, and supporting documentation to help you meet your obligations with confidence, available at Civil Rights Laws – Wild Consulting, Inc., Your Partner in Healthcare Compliance
If you have questions or would like to talk through the requirements in more detail, I’d love to connect. Reach out anytime at 262.993.4747 or kirsten@wildconsultinginc.net
