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1 1 (May 28, 2024)

handle is hein.crs/govepdy0001 and id is 1 raw text is: HHS Finalizes Rule Addressing Section 1557 of the ACA's Incorporation of Title IX May 28, 2024 On May 6, 2024, the Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a final rule implementing Section 1557 of the Affordable Care Act (ACA). Through reference to another law, Title IX of the Education Amendments of 1972 (Title IX), Section 1557 prohibits (among other things) sex discrimination by health programs and activities that receive federal funding. HHS previously issued Section 1557 regulations in 2016 and again in 2020. The 2024 rule makes various changes from the 2020 rule and from the proposed rule that HHS issued in 2022. This Sidebar discusses the 2024 rule's approach to several legal issues that have arisen, and been litigated, over how to interpret the precise scope and meaning of Section 1557's incorporation of Title IX. As detailed below, the 2024 rule interprets Section 1557's cross-reference to Title IX to prohibit gender identity and sexual orientation discrimination by covered health programs. The rule differs from the proposed rule announced by HHS in its 2022 Notice of Proposed Rulemaking (NPRM) as to how HHS intends to apply the prohibition on gender identity discrimination, particularly when individuals seek gender transition or other gender-affirming care. Consistent with the 2022 NPRM, the 2024 rule construes Section 1557 to not incorporate Title IX's religious exemption or its abortion neutrality provision. The final rule does contain more specific guidance and stronger safeguards than HHS originally proposed for entities seeking to invoke federal conscience and religious protections. This Sidebar begins by discussing the unique textual features of Section 1557 that have given rise to some of these legal questions, before turning to the 2024 rule and concluding with considerations for Congress. Some material in this Sidebar is adapted from CRS Legal Sidebar LSB10813, ProposedHHSRule Addressing Section 1557 of the ACA 's Incorporation of Title IX, by Christine J. Back (2022), which provides further background on the 2022 NPRM. Section 1557 of the ACA Section 1557 prohibits certain forms of discrimination by, among other entities, any health program or activity that receives federal financial assistance. (For more information on covered entities, see CRS Legal Sidebar LSB11160, The Scope ofACA Section 1557: Health Program or Activity, by Hannah- Alise Rogers (2024)). In defining unlawful discrimination, Section 1557 uses unique statutory phrasing, and the way Section 1557 is drafted has had significant implications for how the law has been interpreted. Congressional Research Service https://crsreports.congress.gov LSB11169 CRS Legal Sidebar Prepared for Members and Committees of Congress

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