ACA Section 1557: the nondiscrimination rules for practices that take federal funds

Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in any health program or activity that receives federal financial assistance. Its regulation, 45 CFR Part 92, requires a covered practice to adopt four sets of written procedures, train relevant staff, and post two notices. Practices employing fifteen or more people must also designate a Section 1557 Coordinator and run a written grievance process.

For many independent practices, the reason this suddenly matters is a single change of interpretation. Until 2024, the U.S. Department of Health and Human Services (HHS) took the position that Medicare Part B payments were not federal financial assistance. The 2024 final rule reversed that position. A practice whose only federal program participation is billing Medicare Part B is now a recipient — and every compliance date in the rule has already passed.

Key takeaways

• Section 1557 is a civil rights statute (42 U.S.C. § 18116), not part of the Health Insurance Portability and Accountability Act (HIPAA). It is enforced by the same regulator — the HHS Office for Civil Rights (OCR) — and asks for entirely different documents.
• Coverage turns on receipt of federal financial assistance, not on practice size. Only two obligations — the Section 1557 Coordinator and written grievance procedures — carry a fifteen-employee threshold (45 CFR §§ 92.7, 92.8(c)).
• HHS finalized its interpretation that Medicare Part B funding meets the definition of federal financial assistance, with a one-year delayed applicability date of May 6, 2025 for entities whose federal program participation had been limited to Part B.
• Language access is a documented obligation, not a courtesy. The rule bars relying on a patient’s family member as the interpreter in ordinary circumstances and requires human review of machine translation for material that is critical to a patient’s rights (§ 92.201).
• A court vacated specified provisions of the 2024 rule to the extent they extend sex discrimination to gender identity. OCR has stated the remaining provisions stay in force, and the text still printed in the Code of Federal Regulations (CFR) does not flag which parts were voided.

Who does Section 1557 actually cover?

The statute reaches “any health program or activity, any part of which is receiving Federal financial assistance.”¹ Part 92 carries that forward: it applies to every health program or activity, any part of which receives federal financial assistance from HHS, directly or indirectly.²

Two features of that sentence do the work.

“Any part of which.” Federal money touching one corner of the practice pulls the whole entity in. Part 92 defines a health program or activity to include all of the operations of an entity principally engaged in providing health care — the definition names a physician’s practice explicitly.³ There is no way to wall off the cash-pay side of a practice that also bills Medicaid.

“Federal financial assistance.” The regulation defines this as any grant, loan, credit, subsidy, or contract other than a procurement contract, by which the federal government provides assistance in the form of funds, services of federal personnel, or property.³ Medicaid payments have long been treated as federal financial assistance. Medicare Part A has too. Medicare Part B is the change.

The Medicare Part B reversal

HHS’s longstanding position had been that Part B funding did not meet the definition, a reading it traced to its 2016 rulemaking. In the 2024 final rule, the Department reversed it:

The Department is finalizing its interpretation that Medicare Part B (“Part B”) funding meets the definition of “Federal financial assistance” for the purpose of title VI, title IX, section 504, the Age Act, and section 1557.⁴

The Department framed this as applying the existing definition rather than widening it, and noted that the change also reaches 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, and the Age Discrimination Act of 1975.⁴

Because that swept in entities with no other federal funding, HHS set a delayed applicability date. Practices whose federal program participation had been limited to Part B were required to be in compliance, and to file an Assurance of Compliance under 45 CFR § 92.5, no later than May 6, 2025.⁴

Who is outside it

• A practice that receives no federal financial assistance at all. A cash-only or commercially-insured-only practice that participates in no federal health program may not be a recipient. That is a funding question worth confirming rather than assuming, because participation can arrive through a grant, a supplemental program, or a payer contract nobody associates with federal money.
• Employment practices. Part 92 does not apply to an employer or plan sponsor of a group health plan with regard to its employment practices, including the provision of employee health benefits.² Workplace discrimination is governed by other statutes.
• Recognized religious freedom and conscience protections. Where applying a provision of Part 92 would violate federal protections for religious freedom and conscience, that application is not required, and the rule sets out a notification process for seeking an assurance of exemption.⁵

What Part 92 requires a covered practice to do

The operational core sits in Subpart A. These are documentation and process obligations — they exist whether or not anyone has ever complained.

Written policies and procedures (§ 92.8)

A covered entity must implement written policies and procedures designed to comply with the rule, each carrying an effective date and reasonably designed in light of the size, complexity, and type of health programs the entity operates.⁶ Four are required of every covered entity:

1. A nondiscrimination policy stating that the entity does not discriminate on the listed bases, that language assistance services and appropriate auxiliary aids and services are provided free of charge when necessary, and that reasonable modifications will be provided for individuals with disabilities.
2. Language access procedures describing how an employee identifies whether an individual has limited English proficiency, how staff obtain qualified interpreters and translators, the names of any qualified bilingual staff, and a list of translated materials with the languages and issuance dates.
3. Effective communication procedures describing how staff obtain qualified interpreters for individuals with disabilities and how to access auxiliary aids and services.
4. Reasonable modification procedures describing how the entity responds to requests for changes to a rule, policy, or practice, and how it determines whether a modification would fundamentally alter the program.

A fifth — written grievance procedures providing for prompt and equitable resolution — applies to covered entities employing fifteen or more persons, together with a three-year retention requirement for grievance records and a duty to keep the complainant’s identity confidential.⁶

The rule permits combining this content with existing policies under Title VI, Section 504, Title IX, and the Age Discrimination Act, provided Section 1557 is clearly addressed.⁶

A Section 1557 Coordinator (§ 92.7)

A covered entity that employs fifteen or more persons must designate and authorize at least one employee as its Section 1557 Coordinator, to coordinate compliance and investigate grievances. Designees may carry out some responsibilities, but the Coordinator retains ultimate oversight. The regulation enumerates six minimum duties, including processing grievances, coordinating recordkeeping, and coordinating the training required by § 92.9.⁷

Training (§ 92.9)

Relevant employees must be trained on the required policies and procedures, as necessary and appropriate for their functions. The rule defines “relevant employees” broadly: permanent and temporary staff whose roles involve interacting with patients and the public; anyone making decisions that directly or indirectly affect patient care, including executive leadership and legal counsel; and anyone whose work affects patients’ financial obligations, including billing and collections.⁸

Training must reach each relevant employee no later than thirty days after the entity implements its § 92.8 policies, and thereafter each new hire within a reasonable time and each affected employee after a material change to the policies. Completion must be documented contemporaneously and retained for at least three calendar years.⁸

Two notices, not one

This is where practices most often find an unmet obligation, because the two notices have different content and different placement rules.

The notice of nondiscrimination (§ 92.10) goes to participants, beneficiaries, enrollees, applicants, and members of the public. It must state the nondiscrimination commitment, describe the availability of reasonable modifications and auxiliary aids and services free of charge, describe the availability of free language assistance services, explain how to obtain them, give the Coordinator’s contact information and the grievance procedure where applicable, and explain how to file a discrimination complaint with OCR. It must be provided annually, on request, at a conspicuous location on the entity’s website, and in clear and prominent physical locations in no smaller than 20-point sans serif font.⁹

The notice of availability of language assistance services and auxiliary aids and services (§ 92.11) is shorter but travels further. It must appear in English and in at least the fifteen languages most commonly spoken by individuals with limited English proficiency in the states where the entity operates, and in alternate formats for individuals who need auxiliary aids.¹⁰

It follows the same annual, on-request, website, and physical-posting channels as the nondiscrimination notice — including the 20-point sans serif physical-posting floor — and must also accompany a specific list of communications when the entity uses them, including the notice of privacy practices required by 45 CFR § 164.520, application and intake forms, notices of denial or termination of benefits, consent forms and instructions for medical procedures, discharge papers, billing and collections materials and good faith estimates, complaint forms, and patient handbooks.¹⁰ The rule offers two compliance options that reduce the volume: an annual, documented opt-out offered to the individual, or documenting the individual’s primary language and serving them in it.¹⁰

Meaningful access for patients with limited English proficiency (§ 92.201)

A covered entity must take reasonable steps to provide meaningful access to each individual with limited English proficiency who is eligible to be served or likely to be directly affected by its programs, including companions.¹¹ Services must be free, accurate, timely, and protective of privacy and independent decision-making.

Several specific prohibitions here are the ones practices tend not to expect. An entity must not require an individual to provide or pay for their own interpreter; must not rely on an unqualified adult to interpret, except as a temporary emergency measure or where the patient specifically requests it in private with a qualified interpreter present and the request is documented; must not rely on a minor child except as a temporary emergency measure; and must not rely on staff who are not qualified interpreters, qualified translators, or qualified bilingual staff.¹¹

Machine translation is not banned, but where the underlying text is critical to an individual’s rights, benefits, or meaningful access, where accuracy is essential, or where the source material is complex or technical, the output must be reviewed by a qualified human translator.¹¹ The rule also sets technical quality standards for video and audio remote interpreting.¹¹

Disability obligations

Four provisions carry the disability side, and they reach further than the front door.

Provision	What it requires
§ 92.202	Communications with individuals with disabilities, including companions, must be as effective as communications with others; appropriate auxiliary aids and services free of charge, in accessible formats, in a timely manner.12
§ 92.203	Facilities constructed or altered on or after the dates in the rule must meet the 2010 ADA Standards for Accessible Design.13
§ 92.204	Health programs delivered through information and communication technology, including websites and mobile applications, must be accessible, subject to undue burden and fundamental alteration limits.14
§ 92.205	Reasonable modifications to policies, practices, or procedures where necessary to avoid disability discrimination, unless the modification would fundamentally alter the program.15

Patient care decision support tools (§ 92.210)

This provision is drawing attention because of how broadly it is drafted. A “patient care decision support tool” is defined as any automated or non-automated tool, mechanism, method, technology, or combination used to support clinical decision-making.³ A clinical calculator built into an electronic health record (EHR) counts; so does a paper scoring sheet.

The obligation has two parts. A covered entity has an ongoing duty to make reasonable efforts to identify uses of such tools that employ input variables or factors measuring race, color, national origin, sex, age, or disability; and for each tool identified, it must make reasonable efforts to mitigate the resulting risk of discrimination.¹⁶ Neither “reasonable efforts” is defined further, which makes the written record of what the practice looked at, and what it concluded, the substance of the obligation.

Telehealth delivery carries its own nondiscrimination provision at § 92.211.¹⁷

The compliance dates have already passed

The rule took effect July 5, 2024, with staggered dates for the procedural provisions.¹⁸

Requirement	Deadline in the rule	Calendar date
§ 92.7 Coordinator	Within 120 days of July 5, 2024	November 2, 2024
§ 92.10 Notice of nondiscrimination	Within 120 days	November 2, 2024
§ 92.9 Training	See the note below	May 1, 2025
§ 92.210(b), (c) Decision support tools	Within 300 days	May 1, 2025
§ 92.8 Policies and procedures	Within one year	July 5, 2025
§ 92.11 Language assistance notice	Within one year	July 5, 2025
Part B-only recipients: compliance and Assurance of Compliance	One-year delayed applicability	May 6, 2025

A note on the training date. The rule states the training deadline twice, and the two statements do not match. The table in § 92.1(b) sets it at “no later than one year of July 5, 2024,” while the operative provision at § 92.9(b)(1) requires training no later than thirty days after the entity implements its § 92.8 policies and “no later than 300 days following July 5, 2024.”¹⁸⁸ The specific provision is the stricter of the two, which makes May 1, 2025 the prudent date to measure against. This is an ambiguity in the regulation, not a settled reading — worth raising with counsel rather than resolving from a table.

A practice reading this for the first time is behind, and no provision of the rule cures a late start. What a late start does not mean is that the obligations lapsed. The gap is identifiable and dateable, which is what makes it a gap you can document and close rather than an unknown.

What a court vacated, and what survived

On October 22, 2025, the U.S. District Court for the Southern District of Mississippi entered final judgment in Tennessee v. Kennedy vacating specified parts of the 2024 rule “to the extent that they expand Title IX’s definition of sex discrimination to include gender-identity discrimination.”¹⁹ OCR and the Centers for Medicare & Medicaid Services (CMS) published notice of the decision in the Federal Register on June 2, 2026.¹⁹

The vacated provisions in Part 92 are § 92.101(a)(2)(iv), § 92.206(b)(1) through (4), § 92.207(b)(3) through (5), § 92.8(b)(1), § 92.10(a)(1)(i), and § 92.208, along with several CMS provisions in 42 CFR. The notice states that the vacated provisions are legally void to that extent, that OCR cannot and will not investigate or enforce them, and that the other provisions of the 2024 rule remain in force.¹⁹

Three points a careful reader should hold onto.

The vacatur is partial within the provisions it names. Sections 92.8(b)(1) and 92.10(a)(1)(i) are the written nondiscrimination policy and the content of the notice of nondiscrimination. They were vacated only to the extent they extend sex discrimination to gender identity — not in their entirety. The requirement to have a written nondiscrimination policy, and to issue a notice with the other enumerated content, was not disturbed.

The published CFR text does not tell you this. The current text of Part 92 in the Code of Federal Regulations still prints § 92.101(a)(2)(iv) and § 92.208 as though they were operative.²⁰ The Federal Register notice, not the CFR text, is where the enforcement posture is stated.

Nothing else in the rule was touched. The language access provisions, the disability provisions, the notice requirements, the training requirement, the decision support tool duties, and the Medicare Part B interpretation all survived and are the live obligations for a practice today.¹⁹

What is still in motion

Two items shape how long the current text is likely to stand.

A proposed rule is on the regulatory agenda but has not been published. HHS has entered an item in the Unified Agenda to amend its Section 1557 regulations “to conform more closely with statutory text, Executive Orders 14219, 14168, and 14192, court decisions, and reduce unnecessary burdens,” designated deregulatory and at the proposed rule stage with a projected Notice of Proposed Rulemaking (NPRM) date in February 2027.²¹ Agenda dates slip routinely, and no proposal has been issued. If a rule is eventually proposed, it would go through public comment before anything changed. Until then, the regulation in the CFR — less the vacated provisions — is what applies.

The language access obligation was not eliminated by executive order. Executive Order 14224, signed March 1, 2025, designated English as the official language of the United States and revoked Executive Order 13166, the 2000 order on improving access to services for persons with limited English proficiency. The same sentence adds that “nothing in this order, however, requires or directs any change in the services provided by any agency,” and the order states that agency heads are not required to stop producing documents or services in languages other than English.²² Sections 92.11 and 92.201 remain in the CFR, and the underlying obligation traces to Title VI and Section 1557 rather than to the revoked order. This is a live area worth watching, and a question for counsel before changing a language access practice.

How Section 1557 is enforced

Part 92 does not create its own penalty schedule. It borrows the enforcement mechanisms of the four underlying statutes — Title VI, Title IX, Section 504, and the Age Discrimination Act.²³ For recipients, that means the Title VI procedures at 45 CFR §§ 80.6 through 80.11 and 45 CFR Part 81.²⁴

Practically, the consequence structure differs from the civil money penalties familiar from HIPAA. It runs toward investigation, a finding of noncompliance, voluntary resolution, and — if that fails — the suspension or termination of federal financial assistance and other action authorized by law. The rule also makes explicit that failing to provide OCR with requested information in a timely, complete, and accurate manner can itself support a noncompliance finding.²⁴ Where discrimination is found, OCR may require remedial action, including with respect to people who are no longer patients or who would have become patients had the discrimination not occurred.²⁵

How this differs from HIPAA

The two are easy to conflate because OCR enforces both, and because both produce paperwork. They are not the same obligation and one does not discharge the other.

	HIPAA	Section 1557
Statute	42 U.S.C. § 1320d et seq.	42 U.S.C. § 18116.1
Regulation	45 CFR Parts 160, 162, 164	45 CFR Part 92.20
Trigger	Covered entity or business associate status	Receipt of federal financial assistance.2
Subject	Privacy and security of protected health information	Nondiscrimination in health programs and activities.1
Core artifacts	Risk analysis, safeguards, policies, breach records	Nondiscrimination policy, language access, effective communication, and reasonable modification procedures; training records; two notices.6

The one place they physically meet is § 92.11(c)(5)(ii): the notice of availability of language assistance services must accompany the notice of privacy practices required by 45 CFR § 164.520.¹⁰ A practice that updates its notice of privacy practices without attaching the language notice has an open gap in the Section 1557 file even if the HIPAA side is in order.

What to do next

None of this requires guessing. Five steps establish where a practice stands.

1. Settle the coverage question in writing. List every payer and program the practice participates in, and identify which of them are federal financial assistance. Medicare Part B alone is enough under the 2024 interpretation.⁴ Record the answer and the date, because a funding change moves it.
2. Count the workforce against the fifteen-person threshold. That number decides whether the Coordinator designation and written grievance procedures apply.⁷⁶
3. Inventory what already exists. Many practices have some of this scattered across an employee handbook, a Title VI assurance signed years ago, an interpreter vendor contract, and a website footer. Part 92 permits combining Section 1557 content with existing civil rights policies.⁶ Finding the fragments is cheaper than starting over.
4. Look at the two notices specifically. Check the physical posting against the 20-point sans serif requirement, the website placement, and the list of communications the language notice must accompany.⁹¹⁰ These are the most visible items and the easiest to verify.
5. Write down the decision support tool review. Identify which clinical tools in use take race, sex, age, national origin, or disability as an input, and record what the practice concluded about each. The duty is ongoing, so the record needs a date and a review cadence.¹⁶

The work from there is the same work every documented civil rights obligation requires: written procedures with effective dates, training that is delivered and evidenced, notices that are actually posted and actually accompany the right communications, and a dated record of the reviews behind them. It is specific, citation-heavy, and easy to get wrong from a blank page — which is a reason to start from the regulation itself rather than from a template of unknown provenance.

Sources

Footnotes

1. Section 1557 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18116 (prohibition of discrimination in health programs and activities receiving federal financial assistance). U.S. Government Publishing Office, United States Code: https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap157-subchapVI-sec18116.htm ↩ ↩² ↩³

2. 45 CFR § 92.2 (application; paragraph (b) excludes employer and plan sponsor employment practices, including the provision of employee health benefits). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.2 ↩ ↩² ↩³

3. 45 CFR § 92.4 (definitions, including federal financial assistance, covered entity, health program or activity, individual with limited English proficiency, machine translation, qualified interpreter and translator, and patient care decision support tool). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.4 ↩ ↩² ↩³

4. Nondiscrimination in Health Programs and Activities, final rule and interpretation, 89 Fed. Reg. 37522 (May 6, 2024). Section III (“Change in Interpretation—Medicare Part B Funding Meets the Definition of Federal Financial Assistance”) begins at 89 Fed. Reg. 37664. The formal notice of interpretation, the Federal Register effective date, the one-year delayed applicability date of May 6, 2025 for Part B-only recipients, and the Assurance of Compliance filing deadline appear under “Notice of Interpretation and Dates” at 89 Fed. Reg. 37666. U.S. Government Publishing Office: https://www.govinfo.gov/content/pkg/FR-2024-05-06/html/2024-08711.htm ↩ ↩² ↩³ ↩⁴

5. 45 CFR § 92.302 (notification of views regarding application of federal religious freedom and conscience laws; temporary exemption on submission of notification, determination, and appeal). See also § 92.3(c). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.302 ↩

6. 45 CFR § 92.8 (policies and procedures — nondiscrimination policy, grievance procedures for entities with fifteen or more employees with three-year record retention, language access procedures, effective communication procedures, reasonable modification procedures, and permission to combine with Title VI, Section 504, Title IX, and Age Act policies). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.8 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

7. 45 CFR § 92.7 (designation and responsibilities of a Section 1557 Coordinator; applies to a covered entity that employs fifteen or more persons). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.7 ↩ ↩²

8. 45 CFR § 92.9 (training; timing under paragraph (b)(1), the definition of relevant employees at paragraph (b)(4), and contemporaneous documentation retained at least three calendar years under paragraph (c)). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.9 ↩ ↩² ↩³

9. 45 CFR § 92.10 (notice of nondiscrimination; required content, annual and on-request delivery, website placement, and physical posting in no smaller than 20-point sans serif font). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.10 ↩ ↩²

10. 45 CFR § 92.11 (notice of availability of language assistance services and auxiliary aids and services; English plus at least the fifteen most commonly spoken languages of individuals with limited English proficiency in the relevant states, the enumerated communications it must accompany including the notice of privacy practices at 45 CFR § 164.520, and the two deemed-compliance options). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.11 ↩ ↩² ↩³ ↩⁴ ↩⁵

11. 45 CFR § 92.201 (meaningful access for individuals with limited English proficiency; free, accurate, and timely services, restrictions on relying on unqualified adults and minor children, human review of machine translation for critical material, and video and audio remote interpreting standards). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.201 ↩ ↩² ↩³ ↩⁴

12. 45 CFR § 92.202 (effective communication for individuals with disabilities, including companions; auxiliary aids and services free of charge, in accessible formats, in a timely manner). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.202 ↩

13. 45 CFR § 92.203 (accessibility for buildings and facilities; application of the 2010 ADA Standards for Accessible Design to construction or alteration commenced on or after the dates stated in the section). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.203 ↩

14. 45 CFR § 92.204 (accessibility of information and communication technology, including websites and mobile applications, subject to undue financial and administrative burden and fundamental alteration limits). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.204 ↩

15. 45 CFR § 92.205 (requirement to make reasonable modifications to policies, practices, or procedures, interpreted consistent with 28 CFR § 35.130(b)(7)). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.205 ↩

16. 45 CFR § 92.210 (nondiscrimination in the use of patient care decision support tools; ongoing duty to make reasonable efforts to identify tools using the listed input variables and to mitigate the resulting risk of discrimination). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.210 ↩ ↩²

17. 45 CFR § 92.211 (nondiscrimination in the delivery of health programs and activities through telehealth services). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.211 ↩

18. 45 CFR § 92.1 (purpose and effective date; Table 1 to paragraph (b) sets the staggered compliance dates measured from July 5, 2024). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.1 ↩ ↩²

19. Notice of Vacatur Regarding Certain Provisions of the 2024 Nondiscrimination in Health Programs and Activities Final Rule, 91 Fed. Reg. 32887 (June 2, 2026), reporting the final judgment in Tennessee v. Kennedy, No. 1:24-cv-161-LG-BWR (S.D. Miss. Oct. 22, 2025) and listing the vacated provisions. U.S. Government Publishing Office: https://www.govinfo.gov/content/pkg/FR-2026-06-02/html/2026-11015.htm ↩ ↩² ↩³ ↩⁴

20. 45 CFR Part 92, Nondiscrimination in Health Programs or Activities (current text, including the provisions later vacated in part by court order). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-92 ↩ ↩²

21. Unified Agenda of Federal Regulatory and Deregulatory Actions, HHS/OCR RIN 0945-AA32, “Modify Portions of Department of Health and Human Services Regulations Implementing Section 1557 of the Affordable Care Act” — proposed rule stage, EO 14192 designation deregulatory, projected NPRM February 2027. Office of Information and Regulatory Affairs: https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202510&RIN=0945-AA32 ↩

22. Executive Order 14224 of March 1, 2025, Designating English as the Official Language of the United States, section 3(b) (revoking Executive Order 13166 while stating that nothing in the order requires or directs any change in the services provided by any agency, and that agency heads are not required to stop producing documents or services in languages other than English). U.S. Government Publishing Office: https://www.govinfo.gov/content/pkg/FR-2025-03-06/html/2025-03694.htm ↩

23. 45 CFR § 92.301 (enforcement mechanisms; the mechanisms available under Title VI, Title IX, Section 504, and the Age Discrimination Act apply for purposes of Section 1557). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.301 ↩

24. 45 CFR § 92.303 (procedures for health programs and activities conducted by recipients and State Exchanges; Title VI procedures at 45 CFR §§ 80.6 through 80.11 and 45 CFR Part 81, and the consequences of failing to provide requested information). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.303 ↩ ↩²

25. 45 CFR § 92.6 (remedial action and voluntary action, including remedial action with respect to former participants and persons who would have participated absent the discrimination). Electronic Code of Federal Regulations: https://www.ecfr.gov/current/title-45/section-92.6 ↩