{"abstract":"The Department of Health and Human Services (HHS or the Department) is issuing this proposed rule on Section 1557 of the Affordable Care Act (ACA) (Section 1557). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Section 1557(c) of the ACA authorizes the Secretary of the Department to promulgate regulations to implement the nondiscrimination requirements of Section 1557. The Department is also proposing to revise its interpretation regarding whether Medicare Part B constitutes Federal financial assistance for purposes of civil rights enforcement and to revise nondiscrimination provisions to prohibit discrimination on the basis of sexual orientation and gender identity in regulations issued by the Centers for Medicare & Medicaid Services (CMS) governing Medicaid and the Children's Health Insurance Program (CHIP); Programs of All-Inclusive Care for the Elderly (PACE); health insurance issuers and their officials, employees, agents, and representatives; States and the Exchanges carrying out Exchange requirements; agents, brokers, or web-brokers that assist with or facilitate enrollment of qualified individuals, qualified employers, or qualified employees; issuers providing essential health benefits; and qualified health plan issuers.","action":"Notice of proposed rulemaking; notice of Tribal consultation.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND 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Secretary"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2022/08/04/2022-16217.html","cfr_references":[{"chapter":null,"citation_url":null,"part":"438","title":42},{"chapter":null,"citation_url":null,"part":"440","title":42},{"chapter":null,"citation_url":null,"part":"457","title":42},{"chapter":null,"citation_url":null,"part":"460","title":42},{"chapter":null,"citation_url":null,"part":"80","title":45},{"chapter":null,"citation_url":null,"part":"84","title":45},{"chapter":null,"citation_url":null,"part":"86","title":45},{"chapter":null,"citation_url":null,"part":"91","title":45},{"chapter":null,"citation_url":null,"part":"92","title":45},{"chapter":null,"citation_url":null,"part":"147","title":45},{"chapter":null,"citation_url":null,"part":"155","title":45},{"chapter":null,"citation_url":null,"part":"156","title":45}],"citation":"87 FR 47824","comment_url":null,"comments_close_on":"2022-10-03","correction_of":null,"corrections":[],"dates":"Comments: Submit comments on or before October 3, 2022.","disposition_notes":null,"docket_ids":["Docket ID: HHS-OS-2022-0012"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":null,"comment_start_date":null,"updated_at":"2023-02-27T21:27:17.979-05:00","comment_url":"https://www.regulations.gov/commenton/CMS_FRDOC_0001-3373","allow_late_comments":null,"id":"CMS_FRDOC_0001-3373","comment_end_date":null,"regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS_FRDOC_0001","title":"Recently Posted CMS Rules and Notices."},{"supporting_documents":[{"title":"TLDEF_2021_Medicaid_Regulations_and_Guidance","document_id":"HHS-OS-2022-0012-4141"},{"title":"TLDEF_2021_Medicaid_Regulations_and_Guidance_Nebraska","document_id":"HHS-OS-2022-0012-4133"},{"title":"TLDEF_2022_State_Health_Insurance_Laws_and_Guidance_States_with_Explicit_Guidance","document_id":"HHS-OS-2022-0012-4131"},{"title":"Gupta_2021_Health_Consumers_Want_Digital","document_id":"HHS-OS-2022-0012-4125"},{"title":"HHS_CMS_Medicare_Administrative_Contractors","document_id":"HHS-OS-2022-0012-4117"},{"title":"HHS_CMS_Parts_of_Medicare","document_id":"HHS-OS-2022-0012-4114"},{"title":"Sun_2022_Negative_Patient_Descriptors_Documenting_Racial_Bias","document_id":"HHS-OS-2022-0012-4110"},{"title":"Karliner_2017_Convenient_Access_Professional_Interpreters_Hospital","document_id":"HHS-OS-2022-0012-4094"},{"title":"MacDorman_2021_Racial_Ethnic_Disparities_Maternal_Mortality","document_id":"HHS-OS-2022-0012-4086"},{"title":"HHS_AHRQ_2020_Improving_Patient_Safety_Systems_LEP_Patients","document_id":"HHS-OS-2022-0012-4078"}],"agency_name":"HHS","documents":[{"comment_count":85280,"comment_start_date":"2022-08-04","updated_at":"2023-02-27T21:27:18.354-05:00","comment_url":"https://www.regulations.gov/commenton/HHS-OS-2022-0012-0001","allow_late_comments":null,"id":"HHS-OS-2022-0012-0001","comment_end_date":"2022-10-04","regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":329,"id":"HHS-OS-2022-0012","title":"Nondiscrimination in Health Programs and Activities"}],"document_number":"2022-16217","effective_on":null,"end_page":47920,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2022/08/04/2022-16217.xml","html_url":"https://www.federalregister.gov/documents/2022/08/04/2022-16217/nondiscrimination-in-health-programs-and-activities","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2022-16217?publication_date=2022-08-04","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2022-08-04/2022-16217/mods.xml","not_received_for_publication":null,"page_length":97,"page_views":{"count":67173,"last_updated":"2026-06-24 08:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-16217.pdf?1659039317","publication_date":"2022-08-04","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2022/08/04/2022-16217.txt","regulation_id_number_info":{},"regulation_id_numbers":[],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":0,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS_FRDOC_0001","supporting_documents_count":0,"docket_id":"CMS_FRDOC_0001","document_id":"CMS_FRDOC_0001-3373","regulation_id_number":null,"title":"Recently Posted CMS Rules and Notices.","checked_regulationsdotgov_at":"2023-02-28T02:27:17Z"},"regulations_dot_gov_url":null,"significant":null,"signing_date":null,"start_page":47824,"subtype":null,"title":"Nondiscrimination in Health Programs and Activities","toc_doc":"Nondiscrimination in Health Programs and Activities","toc_subject":null,"topics":["Administrative practice and procedure","Advertising","Advisory committees","Aged","Brokers","Citizenship and naturalization","Civil rights","Consumer protection","Education","Grant programs-health","Health","Health care","Health facilities","Health insurance","Health maintenance organizations (HMO)","Health records","Hospitals","Indians","Individuals with disabilities","Intergovernmental relations","Loan programs-health","Medicaid","Medicare","Organization and functions (Government agencies)","Public assistance programs","Religious discrimination","Reporting and recordkeeping requirements","Sex discrimination","State and local governments","Sunshine Act","Taxes","Technical assistance","Women","Youth"],"type":"Proposed Rule","volume":87}