The U.S. Department of Health and Human Services (HHS) issued final regulations on the nondiscrimination rules set forth in Section 1557 of the Affordable Care Act. The new rules apply to certain group health plans, as well as many health care providers.
Key provisions include:
- The nondiscrimination rules apply to employer-sponsored group health plans that receive funding from HHS, including Medicare Advantage Plans and plans that receive retiree drug subsidies (Medicare Part D).
- Plans that are subject to the rules must take specific administrative compliance measures that include designating an individual to coordinate compliance (if the employer has more than 15 employees), establishing written policies and procedures, and issuing notices to plan participants.
- The regulations address controversial and emerging topics, including coverage for gender transition and gender-affirming care. Health plans may not categorically exclude or limit coverage for services pertaining to gender transition or gender-affirming care, although restrictions for nondiscriminatory reasons, including those based on medical necessity, religious beliefs, or conscience may continue to apply.
The new rules took effect July 5, 2024; however, a number of the practical measures and administrative tasks for covered health plans have delayed effective dates through July 5, 2025. Employers will need to consider whether and how the rules apply to their programs and activities and take appropriate measures for compliance. Contact