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1 1 (September 2, 2022)

handle is hein.crs/goveiry0001 and id is 1 raw text is: Congressional_______ A Research Service Proposed HHS Rule Addressing Section 1557 of the ACA's Incorporation of Title IX September 2, 2022 The Department of Health and Human Services (HHS) recently issued a Notice of Proposed Rulemaking (NPRM) implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 sets out the ACA's antidiscrimination requirements applicable to certain health care-related entities. HHS previously issued Section 1557 regulations in 2016 and again in 2020, but aspects of both rules were challenged and enjoined in litigation. The U.S. Court of Appeals for the Fifth Circuit issued a ruling on August 26, 2022, upholding a district court's permanent injunction related to the 2016 rule. While the 2022 NPRM proposes various changes, this Legal Sidebar discusses HHS's position on several legal issues that arose in this earlier litigation and that are addressed in the 2022 NPRM, over how to interpret the precise scope and meaning of Section 1557's incorporation of another statute-Title IX of the Education Amendments of 1972 (Title IX). Title IX, among other things, prohibits discrimination on the basis of sex in federally funded education programs or activities. As detailed below, the 2022 NPRM proposes interpreting Section 1557's cross-reference to Title IX to prohibit gender identity and sexual orientation-based discrimination by covered health care-related entities. The NPRM also proposes construing Section 1557 to not incorporate Title IX's religious exemption or its abortion neutrality provision. This Sidebar begins with a discussion of the unique textual features of Section 1557 that have given rise to some of these legal questions, before turning to the NPRM's discussion of its interpretations and concluding with potential considerations for Congress. Section 1557 of the ACA Section 1557 contains antidiscrimination requirements that apply to various health care-related entities, such as hospitals and medical facilities that receive federal financial assistance, as well as programs or activities administered by an Executive Agency or any entity established under this title. In defining unlawful discrimination, Section 1557 uses a unique statutory phrasing. While other major federal civil rights statutes narratively proscribe unlawful conduct based on protected characteristics in the statutory text, Section 1557 sets out its requirements by cross-referencing four other civil rights statutes. Specifically, Section 1557(a) provides that an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of Congressional Research Service https://crsreports.congress.gov LSB10813 CRS Legal Sidebar Prepared for Members and Committees of Congress

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