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R esearch Service
Implications of the HHS Notice of Proposed
Rulemaking on Section 1557 and Medicare
Part B
November 17, 2022
On July 25, 2022, the Department of Health and Human Services (HHS) announced a Notice of Proposed
Rulemaking (NRPM) under Section 1557 of the Patient Protection and Affordable Care Act (ACA).
Section 1557 contains various antidiscrimination requirements that apply to certain health care programs,
including those that receive federal financial assistance. On several occasions since the ACA became
law in 2010, HHS has proposed regulations, which have since become the subject of litigation and public
controversy, under Section 1557. While HHS proposes a number of regulatory changes regarding Section
1557's antidiscrimination requirements in the latest NPRM, this Sidebar discusses a significant change in
its proposed treatment of Medicare Part B as federal financial assistance. The NPRM proposes to
reverse HHS's longstanding position that Medicare Part B does not constitute federal financial
assistance. If this proposed change were adopted, it would subject all Medicare Part B providers,
including outpatient providers, suppliers, and ambulance services, to Section 1557's antidiscrimination
requirement.
Background
Section 1557 provides that a person shall not ... be subjected to discrimination under[] any health
program or activity, any part of which is receiving Federal financial assistance, including credits,
subsidies, or contracts of insurance, or under any program or activity that is administered by ... any
entity established in this title . . . . The NPRM proposes to define health program or activity broadly to
include an entity that assists individuals in obtaining health services, provides health insurance coverage,
and educates health care providers, provides clinical care, or undertakes health research. For the
enforcement of its provisions, Section 1557 references four other federal civil rights statutes: Title IX of
the Education Amendments of 1972, Title VI of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act, and the Age Discrimination Act of 1975. Section 1557, like all of these predecessor
antidiscrimination statutes, conditions the receipt of federal financial assistance, on the recipient's
agreement not to discriminate.
Congressional Research Service
https://crsreports.congress.gov
LSB10860
CRS Legal Sidebar
Prepared for Members and
Committees of Congress](ViewImageLocal?handle=hein.crs/govejkq0001&div=1&collection=&method=preview&ext=.png&size=3)