Section 1557 nondiscrimination compliance is the set of policies, notices, language access and accessibility procedures, training and grievance handling a health program needs to meet section 1557 of the Affordable Care Act and its rule at 45 CFR Part 92. It applies to health programs and activities that receive federal financial assistance from HHS. Integral Healthcare Solutions (IHS) assesses your program against Part 92 as it stands after the 2025 partial vacatur and drafts the documents for your compliance officer and counsel to approve.
Last reviewed: October 2026.
What is Section 1557?
45 CFR Part 92, "Nondiscrimination in Health Programs or Activities," states its purpose: "to implement section 1557 of the Patient Protection and Affordable Care Act (ACA) (42 U.S.C. 18116), which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities" (45 CFR 92.1(a)).
The current text comes from the HHS final rule "Nondiscrimination in Health Programs and Activities," 89 FR 37522, published May 6, 2024 (Federal Register document 2024-08711). The eCFR, current as of September 30, 2026, shows July 5, 2024 as the most recent amendment to Part 92 (eCFR).
Part of that rule has since been vacated. HHS announced on June 1, 2026: "On October 22, 2025, the U.S. District Court for the Southern District of Mississippi, in the case of Tennessee v. Kennedy, issued a final judgment vacating portions of the 2024 Rule. The court's order voids the Rule's provisions to the extent that they expanded the definition of sex discrimination under Title IX of the Education Amendments of 1972 to include gender identity" (HHS press release). HHS added that "OCR will continue to enforce the Rule's protections against discrimination based on race, color, national origin, age, disability, and aspects of sex discrimination not impacted by the court's order."
IHS's reading, October 2026: the eCFR text we reviewed had not been changed to reflect the court's order; for example, 92.101(a)(2) still lists gender identity. HHS's statement and the eCFR text therefore differ. The Federal Register notice of vacatur (Federal Register document 2026-11015, scheduled for publication June 2, 2026) lists them, each only to the extent it expands Title IX's definition of sex discrimination to include gender identity: 45 CFR 92.101(a)(2)(iv), 92.206(b)(1)-(4), 92.207(b)(3)-(5), 92.8(b)(1), 92.10(a)(1)(i) and 92.208, and 42 CFR 438.3(d)(4), 438.206(c)(2), 440.262, 460.98(b)(3) and 460.112(a). The notice says the other provisions of the rule remain in force. How your program treats the vacated provisions is for your counsel to decide.
Who needs it and what triggers it
Part 92 applies to "Every health program or activity, any part of which receives Federal financial assistance, directly or indirectly, from the Department" (45 CFR 92.2(a)(1)). It does not apply "to any employer or other plan sponsor of a group health plan ... with regard to its employment practices, including the provision of employee health benefits" (92.2(b)). Whether your organization is covered is a legal question for your counsel.
Several obligations had compliance dates in 45 CFR 92.1(b); for 92.8 policies and procedures and 92.11 notices the rule says "within one year of July 5, 2024." Those dates have passed, so the requirements are due now, subject to the vacatur above. Reasons to start include a new HHS funding source, a new line of service, a language access or accessibility complaint, or a review that finds the 2024 rule was never mapped to the organization's documents. These are IHS's reading.
How IHS helps
- Gap assessment. IHS sends questionnaires covering coordinator designation, policies, notices, language access, effective communication, accessibility, patient care decision support tools, training and grievances, and compares the answers with Part 92.
- Document and evidence mapping. Each Part 92 requirement is mapped to the document or record that shows it.
- Drafting. IHS drafts the policy set, notices, grievance procedure, language access and effective communication procedures, a training outline and a decision support tool inventory template, for your compliance officer and counsel to approve.
- Mock review. IHS tests the adopted documents against sample encounters and records.
What your organization supplies: current nondiscrimination policies and notices, language access and interpreter arrangements, your website and app accessibility information, a list of clinical decision support tools in use, training records and grievance logs.
The limit: your organization decides applicability, how to treat the vacated provisions and any exemption or religious freedom question, with its counsel. Your organization files anything that goes to HHS. IHS gives no legal advice and does not predict how OCR will enforce.
Related IHS pages: Compliance Services and Compliance Program Development.
What to have ready
Each item ties to 45 CFR Part 92, eCFR current as of September 30, 2026.
- Your headcount. A covered entity with fifteen or more employees "must designate and authorize at least one employee, a 'Section 1557 Coordinator'" (92.7(a)).
- The name and written duties of your Section 1557 Coordinator, if designated (92.7(a)).
- Your written nondiscrimination policies and procedures, with their effective date. They "must include an effective date and be reasonably designed, taking into account the size, complexity, and the type of health programs or activities" (92.8(a)).
- Training records for relevant employees on those policies (92.9(a)).
- Your notice of availability of language assistance and the languages it is in. The notice "must be provided in English and at least the 15 languages most commonly spoken by individuals with limited English proficiency of the relevant State or States" (92.11(b)).
- Your interpreter and translation arrangements, since a covered entity "must take reasonable steps to provide meaningful access to each individual with limited English proficiency" (92.201(a)).
- Accessibility information for your website and mobile apps, which 92.204(b) ties to section 504 "as interpreted consistent with title II of the ADA" (92.204(b)).
- A list of patient care decision support tools in use. A covered entity has "an ongoing duty to make reasonable efforts to identify uses of patient care decision support tools" that use race, color, national origin, sex, age or disability as inputs (92.210(b)).
- Your grievance log and procedure for nondiscrimination complaints.
To go through the list with IHS, book the introductory call below.
How it compares
| Approach | What the sources say |
|---|---|
| Relying on existing Title VI, section 504, Title IX and Age Act compliance | 45 CFR 92.3(a) says neither section 1557 nor Part 92 shall be construed to apply a lesser standard than those laws (92.3(a)). How far your existing program already covers Part 92 is a question for your counsel; IHS's crosswalk shows where the documents overlap. |
| Counsel review alone | Gives the legal position on coverage and the vacatur. IHS drafts the operating documents and does not give a legal position. |
| IHS gap assessment and drafting | The crosswalk, drafted documents and mock review. No legal opinion. |
What it costs
No fee appears in the Part 92 text we reviewed; this is a regulatory obligation, not an accreditation. HHS does not publish a fee schedule for this work on the pages we reviewed; costs depend on scope, such as the number of locations, languages and services. IHS scopes each engagement after a free introductory call.
What this is not
- This page is not legal advice. IHS is a consulting firm, not a law firm, and does not interpret the court's order for you.
- IHS does not predict how the HHS Office for Civil Rights will enforce.
- IHS does not contact, file with or respond to HHS or OCR for your organization. IHS drafts; your organization submits.
Frequently asked questions
Does Section 1557 apply to us?
45 CFR 92.2(a)(1) applies Part 92 to every health program or activity, any part of which receives federal financial assistance, directly or indirectly, from HHS. Section 92.2(b) excludes an employer or group health plan sponsor with regard to its employment practices, including employee health benefits. Whether your organization is covered is a legal determination for your counsel.
Which parts of the 2024 rule are affected by the Tennessee v. Kennedy vacatur?
HHS stated on June 1, 2026 that the court's October 22, 2025 judgment voids the rule's provisions to the extent they expanded the definition of sex discrimination to include gender identity. HHS said it will continue to enforce protections based on race, color, national origin, age, disability and aspects of sex discrimination not affected by the order. The Federal Register notice of vacatur (Federal Register document 2026-11015, scheduled for publication June 2, 2026) lists the vacated provisions, each only to the extent it expands Title IX's definition of sex discrimination to include gender identity: 45 CFR 92.101(a)(2)(iv), 92.206(b)(1)-(4), 92.207(b)(3)-(5), 92.8(b)(1), 92.10(a)(1)(i) and 92.208, and 42 CFR 438.3(d)(4), 438.206(c)(2), 440.262, 460.98(b)(3) and 460.112(a). The notice says the other provisions of the rule remain in force. As of October 2026, IHS reads the eCFR text as not yet reflecting the order; your counsel decides how your program treats the vacated provisions.
What written policies and procedures does 45 CFR 92.8 require?
Section 92.8(a) requires written policies and procedures designed to comply with Part 92. They must include an effective date and be reasonably designed for the size, complexity and type of your health programs. Section 92.8(b)(1) is among the provisions vacated to the extent it expands sex discrimination to include gender identity (Federal Register document 2026-11015). IHS drafts the policy set against the full section.
Do we need a Section 1557 Coordinator?
Yes, if your organization is a covered entity that employs fifteen or more persons. Section 92.7(a) requires a covered entity of that size to designate and authorize at least one employee as Section 1557 Coordinator to coordinate compliance with section 1557 and Part 92.
What languages do we need for the notice of language assistance?
Section 92.11(b) requires the notice in English and in at least the 15 languages most commonly spoken by individuals with limited English proficiency in the relevant state or states where you operate. IHS drafts the notice and the procedure for keeping the language list current.
What does language access require beyond the notice?
Section 92.201(a) requires reasonable steps to provide meaningful access to each individual with limited English proficiency eligible to be served or likely to be directly affected, including companions. IHS drafts the language access procedure for your team to adopt.
Are our website and mobile app covered?
Section 92.204(b) addresses the accessibility of websites and mobile applications and ties it to section 504 as interpreted consistent with title II of the ADA. IHS includes your web and app accessibility information in the gap assessment; technical remediation is done by your own team or vendor.
What is a patient care decision support tool, and what must we do?
Section 92.210(b) gives covered entities an ongoing duty to make reasonable efforts to identify uses of patient care decision support tools that use race, color, national origin, sex, age or disability as input variables. IHS drafts an inventory template so your clinical and IT leads can record each tool and its inputs.
Who has to be trained?
Section 92.9(a) requires training of relevant employees on the civil rights policies and procedures required by 92.8, as necessary and appropriate for their functions. IHS drafts the training outline; your organization delivers it and keeps the records.