The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#168 Is Your Practice Compliant with the New Section 1557 Rule of the ACA?
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Section 1557 of the Affordable Care Act (ACA) is intended to advance health care equity and reduce disparities in health care that may occur through discriminatory practices, or the inability of health care providers to communicate effectively with patients with Limited English Proficiency (LEP). In this episode the Divas discuss what dental practices must do to come into compliance with the changes in this rule.
Resources:
- Dept. of Health and Human Services (DHHS) Strengthening Nondiscrimination Protections and Advancing Civil Rights in Health Care Through Section 1557 of the Affordable Care Act: Fact Sheet
https://bit.ly/3VYMKhh - ADA Section 1557: All you need to Know Regarding Section 1557 of the Affordable Care Act https://bit.ly/45XFoPw
- ADA – Section 1557: The Basics on What You Must do to Comply https://bit.ly/3S1mmSI
- ADA Section 1557: Individuals with Limited Language Efficiency (LEP) https://bit.ly/4cqGypb
- HealthCare.gov – Affordable Care Act resources https://bit.ly/3VWdRJD
- University of the Pacific School of Dentistry https://bit.ly/45Yd0g5
Welcome.
SPEAKER_02I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_01I'm Linda Harvey. I'm Olivia Wan, and together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I'll be the moderator for this episode. The Compliance Divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You can subscribe to the Compliance Divas Podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Resources that we mentioned during our podcast can be found in the show notes on your podcast app. If you have questions, you can submit them by email at support at thecompliancedivas.com. One side note on resources. Several of the resources we're including in the show notes from today's episode are from the American Dental Association. And some of the information may require you to be a member to access it. So if our listeners are ADA members or employees of ADA members, you can access that information through the doctor's ADA membership. So our topic today is an update to section 1557 of the Affordable Care Act. And section 1557 is intended to advance healthcare equity and reduce disparities in healthcare. In other words, to help prevent discrimination against groups of patients or categories of patients who are covered by healthcare services. A number of years ago, when this section was enacted, many practices needed to make some changes on their websites. They needed to post an anti-discrimination statement for patients. And then there were some questions about exactly which healthcare plans were included and which healthcare entities were included. And now this final rule seeks to strengthen and clarify the non-discrimination protections. So we're going to start off with Ardeva Leslie. And Leslie, can you explain the prohibitions of section 1557 and are their new classes that were not included in the first clarification?
SPEAKER_03Well, Mary, the section you're talking about, 1557 of the Affordable Care Act, prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives federal financial assistance, state-based health insurance exchanges and health and human services health programs and activities, and is one of the government's most powerful tools to ensure non-discriminatory access to health care. So the rule actually provides some clarity on this section 1557 and will help to ensure that non-discriminatory access to care for all, including women, people with disabilities, LG, B, T, Q, I plus people, people with limited English proficiency, people of color, and people regardless of age.
SPEAKER_02Thank you, Leslie. And one of the things that you mentioned, I want to emphasize, and that is any healthcare programs that receive federal assistance. And I think there's a little misunderstanding on the part of some dental practices that they think it's only Medicaid programs that are federally funded, but it is also any kind of healthy child programs. Those are actually funded through Medicaid through the federal government. Medicare Advantage is funded, paid typically by a third-party payer like a Delta Dental or a Blue Cross Blue Shield, but it's actually funded through Medicare. So federally funded Indian Health Service and others. So it is incumbent on practices to know which plans that they participate with or that they accept, whether they are federally funded or federally assisted or not. So, Linda, can you talk a little bit more about this reinstatement of these healthcare programs and what does it mean for dental practices?
SPEAKER_00Mary, essentially what it means is that section 1557 applies to all dental practices as well. And there's three key areas that I would like to approach during our podcast today. And first and foremost is the dental practices must treat all patients the same. They cannot overtly or silently discriminate against any patients. And just preparing for our podcast today, Mary, it brought back to mind decades ago as a practicing hygienist when there was such a plan as known as HMOs. Those were a prepaid type of dental plan in the past, where the doctor signed up with a company or insurance plan, I'll say, and knew that they had X number of patients they were supposed to take care of, and they got a set amount of money per month, regardless of how many patients actually came in for treatment. So I worked for this practice for a short time where any patients who were part of an HMO dental program could not be pre-scheduled. That was our office policy. They could not be pre-scheduled for their six-month recare appointment. So, in short, that was a form of discrimination back then. Very subtle, but it was there. So we have to think about the fact that we have to treat treating team members and patients alike with respect is very important. And then we can expect in return to be treated also with respect. But we do know that on occasion, patients are not always respectful of our time. They don't follow treatment recommendations, or they're verbally abusive to the doctor or the team. And those patients may on occasion be considered for dismissal because there's a bona fide objective reason. There's a breakdown of the patient provider relationship that can be documented, and there's a bona fide reason, of course. And there's a process, as we all know, that you have to follow to dismiss a patient properly. Second, Mary, is facility access. And Leslie mentioned that, I believe. So section 1557 references disability. And patients who have physical handicaps, it's expected that you have handicapped parking areas, a ramp to get into the building if there's any steps. Your doorways have to be wide enough to accommodate a wheelchair. And there has to be a handicapped accessible restroom as well. Over the years, though, I've seen some older practices that are not necessarily compliant with these current building codes because they were grandfathered into the old codes. But once they begin remodeling, then they have to, of course, bring the building into codes or into compliance, as we say. And that would include the handicapped accessibility. The third area, Mary, is the limited English proficiency that Leslie also mentioned. It's important that dental practices take reasonable steps to ensure meaningful access when it comes to language needs. In other words, the office is 100% responsible for providing the interpreters or translators for individuals with limited English proficiency. Now I know this can be a bit challenging, and I'm sure the divas have all seen this because sometimes the expense of a translator outweighs the cost or the fee that's going to be charged for the visit that day. So in which case, maybe the practice can communicate with the patient or their whoever's calling on their behalf and identify if they'd be willing to accept an alternative means of communication that might be more user-friendly for the office as far as finances. But at the very least, an interpretive services has to meet these three criteria. One, they have to adhere to the generally accepted interpreter ethical principles, including patient confidentiality. So where does that bring us with HIPAA? So you may wish for the patient to add that person to add to their HIPAA form for that visit or make a note in the record that you had verbal permission for the patient, for that person to attend with the patient. And three, have the interpreter sign a HIPAA confidentiality form. The second criteria for the interpreter services is that they have to have a demonstrated proficiency in speaking and understanding at least English and the language spoken by the patient. So this is very important that they can communicate effectively both ways. And the third criteria is that they be able to interpret effectively and accurately and impartially using any necessary specialized vocabulary or terminology. So they have to be really proficient. And the word that's used in the in the suction 1557 is qualified. So who's not qualified is someone who's under the age of 18. And typically, we don't want to rely on adult accompanying the patient because we don't know if that adult is going to reliably inform the patient of what we're trying to express about their treatment needs. So sometimes the practice will rely on a team member and who's bilingual, but they also must be qualified. So there's a couple of things to keep in mind here. And I think it's best that offices prepare to meet the needs of patients with limited English proficiency in advance, just like we've talked about divas on our other podcasts, being prepared for active shooters, medical emergencies, unannounced audits, and so forth, preparedness makes a difference, Mary.
SPEAKER_02Oh, you're so right, Linda. And that was a great explanation. And I know a lot of practices that I have talked to struggle with this limited English proficiency issue. And under the Section 1557 original rule, there were some technologies that could be utilized, apps and utilizing FaceTime and so forth. But FaceTime is not HIPAA compliant. But there are apps that are HIPAA compliant. You have a subscription and you can get an interpreter on demand. But those are all things, as you said, Linda, that you have to prepare for in advance because it's not going to work very well if you have to do it on the fly. Although there may be some emergency situations where you need to. So any thoughts from the other divas about this limited English proficiency and maybe utilizing some technology? Leslie?
SPEAKER_03Well, many times when I have an appointment with a healthcare provider, they offer the opportunity to use either an iPad or a tablet or even a cell phone to communicate information that is not heard. I'm hearing impaired myself. And so I need, I'm always questioning whether I heard something right and the spelling of something. So that might be a way to help individuals who maybe would recognize the written word versus understanding the spoken word if they have limited proficiency on language.
SPEAKER_02Absolutely. But again, we need to make sure that whatever apps we use are used on a secure device and that the apps are HIPAA compliant. So it's probably not something that you'd necessarily go to the App Store for Apple or the Google Play Store. It would be something that you would have to access through a professional subscription, but it could be less expensive than an in-person interpreter. Olivia, we'd like to turn to you to discuss what are some basic things that practices must make sure that they're doing.
SPEAKER_01Sure, Mary. The first thing that is required by the rule is to actually take steps to identify and mitigate discrimination when they use patient care decision support tools. So I think it's interesting how that's worded. And what this basically means is that when we use patient care decision support tools, which include both automated and non-automated tools, technology to provide care, we have to make sure that we are balancing the role of technology, but we're not discriminating. So there's different populations of people that we need to make sure that is not discriminating them because of their inability to use these tools. So we would have to take reasonable steps and efforts to mitigate the risk of discrimination that results from using the tools. So in my mind, I'm thinking of you know, what if an iPad is handed to someone to fill out a checklist and it's not in the language that they are accustomed to or familiar with? Or what if it's an elderly individual and they don't know how to use technology? You know, are we prepared to serve those populations of people and not discriminate against them? So I think this probably will come up even more in the medical industry, where in that arena they're using so many more tools for patients to complete, and we will see more and more of this in the dental space. But another important area to assess is have we prepared our practice with the necessary written policies? So we've got to take the time to write out our policies on how we're going to provide language assistance services for people with limited English proficiency. So, as you mentioned, Mary, whether we are using HIPAA compliant apps or if we're working with major insurance companies that provide interpretation, or we have an interpreter, we've identified some of the top languages in our community that we're serving. If we have those people on call, we need to have a plan in place, not waiting to the last minute and someone comes in with an emergency and now we cannot communicate with them. So policies and procedures in place. Also training people and not just having a discussion, but do we have a roster with the topics listed to prove that we've provided training? Because anytime you're using, you know, tax dollars, if we were to be audited, how would we prove to the person auditing us that we actually did provide training? So we need to take the time to complete those rosters, written policies, and then identify and mitigate discrimination when we're using those patient care decision support tools. So I think that pretty much summarizes things they need to do at that level, Mary.
SPEAKER_03That was great, Olivia. Leslie? I want to give a quick tip to our listeners. It's a very helpful set of tools. University of the Pacific has health history forms translated into multiple languages. In fact, I was trying to count all the different languages while we were on this podcast today, and I ran out of time, but they have health history forms that can be accessed, and we'll be sure and include the link to University of the Pacific Dental School, where they have multiple language health history forms and translation for the forms for those who needed that. I will again put that link into the show notes.
SPEAKER_02That is fantastic. And Olivia, thank you for bringing up the point about the insurance companies, because I know when the 1557 rule first became effective, Delta Dental Plan in many states and some other companies did make those services available. So hopefully that will be still available and accessible. But I think, as you said, Olivia, having the policy and training the team so that they understand what are their obligations under this rule, because not knowing and not doing anything can certainly find a practice on the receiving end of a discrimination complaint or perhaps even a lawsuit for not meeting these patient needs. And really looking at what are some, as Linda talked about, some very subtle kinds of things that we may not even realize are discriminatory. I think of a number of practices that I've seen over the years that accepted Medicaid. And when they would appoint Medicaid patients, they would double and triple book them. And it was a gamble because sometimes the patients didn't show for their appointments. But if they all did, then it makes me wonder what kind of compromises were made to treatment, possibly because we were rushed, because we put all these patients in the schedule, and that maybe could be some form of a discrimination. But there's probably other things as well that we need to be very careful about. So, in wrapping up this discussion today, do any of the divas have anything else that they would like to share? Any other tips, any past experiences? Linda?
SPEAKER_00Mary, at the beginning of the podcast, you were discussing the different types of insurances that offices may participate in that helps that wraps them into this section 1557. And I'm seeing more of our clients that work with veterans. And as they do, which is a great population to take care of, of course, they're accepting funds directly from the VA. In some cases, they're accepting funds through a third-party insurance company where the money's still coming from the government. And so they don't realize that those two are related. They're thinking, well, we're not working with the government directly. I'm not getting a check from centers for Medicare and Medicaid, but you are getting a check indirectly from the US government. So we want to make sure that they really tease that out very thoroughly and keep their heads out of the sand and keep themselves out of trouble.
SPEAKER_02Absolutely. Linda, thank you for bringing that up. So just a quick summary if it's if it's a VA program, if it's a Medicare Advantage program, even though it may be paid through third-party payer like Delta or Blue Cross Blue Shield, a healthy kids or champs program that is funded by Medicaid, or it's Medicaid, because we know that there are many practices that do accept Medicaid, and including Indian Health Services. So any of those entities must be compliant and provide these services under the 1557 section of the Affordable Care Act. So that wraps up this episode for today. Remember that resources will be included on your podcast app. And while you are on your podcast app and you're finished listening to this episode, please scroll down and give us a review or give us some feedback on the app, give us a rating. And we hope to see you again in a future episode. We bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. If you have questions about this episode, submit them by email to support at the compliancedevas.com. Thanks for listening.