ADA weighs in on proposed rule on Sec. 1557

The ADA is concerned about the effect of proposed Section 1557 requirements on dental offices, especially the regulatory burdens and costs dentists will face if the U.S. Department of Health and Human Services finalizes the requirements of the proposed rule.

In a Sept. 23 letter to the HHS Office for Civil Rights, ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., said the ADA supports nondiscrimination in health care and equal access to care "for all patients without regard to race, color, national origin, sex, age, religion, or disability" but said it believes the rule's proposals are not "the best or most effective way" of ensuring nondiscrimination. Additionally, the ADA is concerned about the regulatory burdens the Section 1557 requirements place on dentists.

Sec. 1557 is the provision of the Affordable Care Act that prohibits health care entities that receive federal financial assistance from discriminating on the basis of race, color, national origin, age, disability and sex.

Regarding the rule's purpose and effective date. Drs. Sabates and Cohlmia said the possible regulatory burden on dentists is particularly concerning because the proposed effective date of these requirements is only 60 days after publication of the final rule.

"Health insurance issuers would have longer to implement the changes, and the same courtesy needs to be extended to dental offices - which have to comply with the requirements imposed on them by insurance companies, as well as by the government," they wrote. "Most dental practices are small businesses that do not have the large staff necessary to familiarize themselves with the Section 1557 requirements and make the changes in a short amount of time."

The ADA expressed particular concern about the requirements in Section 1557 that the Notice of Availability be provided in English and at minimum the 15 most common languages spoken by limited English proficiency individuals in the state. In 2020, the ADA estimated that this requirement cost dental offices $240 million, and the ADA has continued to express concern over those costs. Drs. Sabates and Cohlmia also questioned the effectiveness of this requirement given the small staff size of most dental offices.

"It would be more effective for them to concentrate on providing information in the language(s) other than English that are spoken among their patients or potential patient pool," they wrote. "This is widely variable across the country, with some dental offices never encountering patients who do not speak English while others may encounter patients who speak languages not listed in the state's top 15 spoken languages."

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