Section 1557: Understanding Document Accessibility Requirements

The 2024 final rule updating Section 1557 of the Affordable Care Act (ACA) has stirred up uncertainty in the healthcare world, especially around what it means to provide accessible documents and effective communication. With new terms, stricter expectations, and broader responsibilities, it’s easy to feel overwhelmed.

You don’t have to sort through it alone. Here’s what healthcare professionals and patients need to know about its document accessibility requirements.

What is Section 1557?

Enacted as part of the Affordable Care Act in 2010, Section 1557 prohibits discrimination in healthcare programs and activities that receive federal funding.

Section 1557 strengthens long-standing federal civil rights laws, including:

Title VI of the Civil Rights Act of 1964
Title IX of the Education Amendments of 1972
Section 504 of the Rehabilitation Act of 1973
The Age Discrimination Act of 1975

Section 1557 is unique in its scope. It combines these laws under one umbrella to ensure no one experiences discrimination in healthcare based on a wide range of characteristics, including disability.

Who must comply?

If your organization receives any funding from the U.S. Department of Health and Human Services (HHS), whether directly or indirectly, you’re likely covered. This includes:

Hospitals and clinics
Physician practices
Community health centers
Nursing facilities
Home health and hospice providers
Eye and dental care providers
Health insurance carriers and third-party administrators
State Medicaid and CHIP programs
Health Insurance Marketplaces and all plans sold through them

Even private employers may fall under Section 1557 if they receive federal funding for employee health benefits.

Key Document Accessibility Requirements

Section 1557 requires healthcare-related communications to be just as effective for people with disabilities as they are for those without. This is an extension and enforcement of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973.

Organizations must provide:

Accessible digital content readable by assistive technology, such as websites, emails, patient portals, and PDFs
Auxiliary aids and services, such as braille, large print, and audio formats
Effective communication methods that meet individuals’ needs
Reasonable modifications to policies and procedures to ensure full access to programs and services

For people who have a visual disability, these accommodations must be beneficial and timely. For example, someone who is blind may not read braille and instead rely on accessible PDF or audio formats. This highlights the importance of providing effective communication based on a person’s needs.

It’s important to note that these document accessibility requirements extend to a patient’s companion, like a parent or guardian, too.

What materials need to be accessible?

Essentially, any document or digital communication that’s made available to people with sight must also be available in an accessible format. This includes:

Insurance plans and marketing materials
Consent forms and patient rights information
Notices of nondiscrimination
Statements and notices of accessibility
Digital interfaces and forms

These aren’t just recommendations, they’re legal obligations for covered entities.

2024 Final Rule: What’s New?

In April 2024, HHS finalized updated regulations for Section 1557, reinforcing digital accessibility and the obligation to provide effective communication. Some key updates include:

Clarity around digital accessibility: Covered entities must ensure websites, mobile apps, patient portals, and digital forms comply with Web Content Accessibility Guidelines (WCAG) 2.1 AA standards, per Title II of the ADA.
Stronger language on communication: The final rule reiterates that effective communication must be appropriate and timely.
- This includes requiring an annual Notice of Nondiscrimination and Notice of Availability to be prominently displayed and publicly available, both digitally and physically, in 20pt or larger sans serif font.
- The Notice of Availability must accompany a wide range of other written and digital communications, which should also come in the patient’s preferred format.
Clearer obligations for third-party services: Organizations must ensure that contractors or vendors meet accessibility requirements.
Designated Section 1557 Coordinator: Covered entities must designate a coordinator to oversee compliance, including auxiliary aids and services. Their contact information must be easy for patients and staff to find.

These changes must be in effect no later than July 5, 2025.

Section 1557 Accessible Communications Timeline

March 2010: The Affordable Care Act is signed into law

May 2016: HHS releases original Section 1557 rule, requiring equally effective communication in healthcare for everyone

July 2016: Deadline for initial compliance

April 2024: HHS finalizes updated Section 1557 rule, strengthening effective communication requirements

January 2025: Deadline for Nondiscrimination on the Basis of Disability compliance

Section 1557 vs. ADA vs. 504: What’s the Difference?

Section 1557 doesn’t create new requirements for healthcare organizations. Instead, it brings existing civil rights laws into the healthcare sector and expands enforcement. This section complements the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act by clearly defining healthcare providers’ responsibilities, requiring public notice of accessible services, and providing a stronger framework for accountability.

Looking Ahead: 2025 and Beyond

While some Diversity, Equity, and Inclusion (DEI) initiatives are being challenged or scaled back across sectors, accessibility remains a legal and ethical priority. Organizations that fail to meet accessibility requirements face serious compliance and reputational risks.

How to Get Compliant and Stay That Way

If your organization is unsure how to meet the document accessibility requirements under Section 1557, you’re not alone. Many providers struggle with creating accessible versions of essential documents.

That’s where companies like Braille Works come in. With over 30 years of experience in accessible document production, Braille Works partners with health insurance and healthcare organizations to ensure their materials meet Section 1557 document requirements.

Final Thoughts

Accessibility isn’t just a legal box to check. It’s a commitment to dignity and equity in healthcare. Section 1557 of the Affordable Care Act puts that commitment into law, and the 2024 updates made it clearer than ever:

Accessible communication is a right, not a privilege.

Resources:

Jessica Sanders

Jessica Sanders has been in the document accessibility world for over a decade. Early in her career, she worked hands-on transcribing standard print into accessible formats like braille, large print, and audio and even helped Braille Works in their transition to Unified English Braille (UEB). After more than 5 years in transcription, Jessica decided it was time for a change and transitioned to Braille Works' marketing team. She now spends her time educating the world on the critical need for accessible documents.