We Need to Talk: It’s About Section 1557 of the Affordable Care Act and How It Impacts Your Dental Practice

Does your practice receive reimbursements from Medicare? Medicaid? C.H.I.P.? How about Tricare? If so, you need to read how this new law Section 1557 will impact your practice!

Regardless of how you feel about it one thing is certain – the Affordable Care Act (ACA) is full of surprises! Let’s look at Section 1557.

The Section 1557 final rule mandates non-discrimination of persons with disabilities (i.e. hearing impairment, speech impairments and etc.) and those with Limited English Proficiency (LEP). The law applies to insurance plans on the Health Information Exchanges, hospitals, physicians/dentists who receive money from federally funded healthcare programs (i.e. Medicare, Medicaid, C.H.I.P, Tricare, the EHR Incentive Program and etc.).

Participating providers are required to ensure effective communication with and accessibility for individuals with disabilities. This includes posting a notice of non-discrimination (in the office and on the homepage of the practice website), providing communication assistance for persons with hearing and speech disabilities, providing interpreter/translator services for LEP persons, providing printed materials in non-English languages, establishing a section1557 compliance officer, creating a grievance policy, and (of course) employee training on what all this means.

TOO MUCH? Join us for a FREE Webinar! We will share all of the pertinent information and help you prepare for Section 1557 Implementation! Click here to Register.

Back in Time

The future of compliance training – is in the past! Much of the course content for participating provider compliance training is rooted decades to centuries in the past. Really!

Participating providers must provide employee training on American civil rights (i.e. Title VI of the Civil Rights Act and Section 504 of the Rehab Act of 1973 and other decades’ old statutes). The human rights afforded by these acts are the foundation of today’s regulations. Training needs to include how employees should help identify what communication/ language assistance patients may need, how to access those services, the provider’s grievance policy, and how patients can file a complaint (internally and with the Office for Civil Rights (OCR)).

For more information on Title VI: http://www.hhs.gov/civil-rights/for-individuals/special-topics/needy-families/civil-rights-requirements/index.html

For more information on Section 504: http://www.hhs.gov/civil-rights/for-individuals/disability/

Then, thanks to section 6401 of the ACA, participating providers and their staff need to complete Fraud, Waste and Abuse (FWA) training as it pertains to billing federally funded healthcare programs. A major law at the core of FWA is the False Claims Act, which can be traced back to the American Civil War (1863 to be exact). So, you see, the future compliance training really is rooted in the past.

Section 1557 Compliance Dates

Section 1557 has two significant compliance dates – July 18th, 2016 and October 18th, 2016. Here are the details!

  • July 18, 2016 – Providers were required to post a Notice of Non-discrimination for federal healthcare program beneficiaries/ caregivers in their offices and on their websites.

The notice must specifically state the dental practice:

  • does not discriminate on the basis of race, color, national origin, sex, age or disability;
  • provides auxiliary aids and services, free of charge, in a timely manner, to individuals with disabilities, when such aids and services are necessary to provide an individual with a disability an equal opportunity to benefit from the entity’s health programs or activities; and,
  • provides language assistance services, free of charge, in a timely manner, to individuals with limited English proficiency, when those services are necessary to provide an individual with limited English proficiency meaningful access to a covered entity’s health programs or activities;
  • provides contact information for the employee responsible coordinating compliance with Section 1557;
  • has a grievance procedure where such a grievance procedure is required (only required for dental offices with 15 or more employees), and information on how to file a grievance (regardless of the size of the practice);
  • provides information on how to file a complaint with OCR. (Note: this is the same government entity that investigates and enforces HIPAA violations.)

The notice needs to indicate how an individual can access the aids and language services indicated. This includes spoken non-English languages and sign language services for persons with hearing impairment.

TOO MUCH to sort through? Join us for a FREE Webinar! We will share all of the pertinent information and help you prepare for Section 1557 Implementation! Click here to Register.

Interestingly, the Non-discrimination notice must be posted in English. It is only a recommendation that practices post this notice in the most common non-English language(s) spoken in the geographic area of the dental practice. Dental Compliance Specialists, LLC recommends that affected dental offices post Notices of Non-discrimination in English and Spanish. OCR provided a sample notice in several non-English languages.

toolbox copy

An abbreviated version of the non-discrimination notice must be prominently posted on ALL communications from the dental practice (marketing materials and such). Finally, the full non-discrimination notice must be posted on the homepage of your website (if your practice has a website).

  • October 18, 2016 – By this date non-English taglines in each of the top 15 non-English languages that may be encountered by your dental practice must be displayed in the office and on the practice’s website. To determine which non-English languages refer to (LEP) demographics for the state and county in which the dental practice is located (www.LEP.gov). A tagline is a short, standardized statement intended to indicate to LEP persons that non-English language services are available at no cost to them. This is a labor-intensive project, which is why OCR extended the compliance date by two months.

Here is a sample tagline: “If you, or someone you’re helping, has questions about dental services at (Insert Name of Practice), you have the right to get help and information in your language at no cost. To talk to an interpreter, call (insert phone number of practice).” Now imagine this reprinted in 15 additional languages on the homepage of your website! From a marketing standpoint this Totally Sucks!

Interpreter/ Translator Service Requirements

The Centers for Medicare and Medicaid Services (CMS) indicated states are not required to reimburse participating providers for the cost of language services. Some state Medicaid programs provide language services; but so do not. In those cases, providers are still obligated to provide communication/ language services to those with disabilities and bear the costs [i]. There is no indication which Tricare and Medicare plans provide language services, providers will need to check with their patient’s plans. Unfortunately, there is no increase in reimbursement to coincide with these new requirements. This is like getting a handshake and a simultaneous kick in the butt. Thanks for nothing, right?

Here is a breakdown of state Medicaid programs (whether provide or reimburse for translators/ interpreters):

State Oral / Sign Language Interpreter Services Provided Contact #(s)
Indiana Yes Hoosier Care Connect (MHS) Member Services (877) 647-4848
Kansas Yes ·  Evolve Dental, Inc. (855) 896-7293

·  Scion Dental (855) 878-5372 or (855) 866-2623

·  Sunflower Health Plan (877) 644-4623

·  United Healthcare Community Plan (877) 542-9238

Michigan Yes Delta Dental of Michigan (866) 558-0280
Missouri No N/A
New Mexico Yes Molina Healthcare of New Mexico Member Services (800) 580-2811
Ohio No N/A
Oklahoma Yes Oklahoma Health Care Authority (OHCA) – (800) 987-7767
Pennsylvania Yes Dental Care Plus (855) 343-7401
Tennessee Yes CoverKids DentaQuest (855) 291-3766
Texas Yes ·   DentaQuest (800) 516-0165

·   MCNA (855) 691- 6262

(NOTE: Providers to verify accuracy of information provided)

If your state Medicaid program does not provide languages services dental providers are required to provide a competent interpreter/translator at the provider’s expense; in these situations the state will not reimburse the provider. Again, as per federal law, providers may not charge patients/ caregivers (directly or indirectly) for language services. Those that do could face dealing with OCR and that will most certainly hurt your pocket book far more than coughing up a few bucks for language services.

Dentists practicing in states/dental plans where language services are not provided dental providers have a few options:

  1. Employ staff to provide competent [ii] language interpreter/translator services.
  2. Hire an interpreter/ translator (Allian Interpreter)
  3. Use a interpreter phone service (i.e. Language Line, Alta Language Services, Allian Interpreter, Certified Languages International)[iii]

Here is information for those practicing dentistry in states where interpreter services are provided:

  1. In every state that provides interpreting services delivers those services through the Managed Care Organizations (MCO’s).
  2. When dealing with a LEP person, providers and Medicaid patients or their caregivers can access language services by calling the Member Services line of the MCO (in every case is a toll-free number and is easy to locate using a Google search (i.e. “DentaQuest Member Services #” or similar).
  3. Dentists (or their staff) should document that the patient/ caregiver required language assistance (and who it was provided by).

Need Help?

Non-discrimination/ LEP compliance materials are available from the ADA (they are D-I-Y). If you prefer Done-For-You resources call us at (817) 755-0035

Information for Our Clients

We prepared materials to bring you into compliance with Section 1557. By the time you read this article you should have them. We are developing civil rights training to compliment your compliance efforts. We will notify you by e-mail when the training is available on Compliance Hub. As you put your new tools to use don’t hesitate to contact us with any questions!

[i] Translation and Interpretation Services, https://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/translation-and-interpretation.html, accessed 07/25/2016.

[ii] A competent interpreter/ translator is someone who can read and write English and the non-English language they are using. Providers must reasonably determine who is (and who is not) competent to serve in this capacity. OCR gives no guidance on this determination. If providers rely on non-employee interpreters/ translators they need to ensure the interpreter/ translator has signed a code of ethics, confidentiality statement, and a HIPAA Business Associate Agreement (BAA).

[iii] Dental Compliance Specialists, LLC has no relationship with any of these vendors. The mention of these organizations is not an endorsement. Dental practices should do their own due diligence on these and any other vendors before making a suitable selection.

[iv] Dental Compliance Specialists, LLC does not provide language services.

A former Law Enforcement Officer/ Dental Board Investigator, Mr. Duane Tinker is the CEO of Dental Compliance Specialists. Mr. Tinker and his compliance specialists provide compliance consulting, auditing and training services for dentists and Dental Service Organizations nationwide on compliance risks including OSHA, HIPAA, Dental Board rules/ regulations, state radiology rules, DEA and state drug regulations, and Medicaid. He often speaks for dental societies and study clubs. Mr. Tinker can be reached at (817) 755-0035 or click here to email.

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