C-TAC recently submitted comments in support of a proposed CMS rule to reinstate nondiscrimination provisions in health care for federal, state, tribal, and commercial programs receiving federal funding. Many of these had been previously deleted by the Trump Administration.
C-TAC noted that there are health equity issues with the serious illness population as, per a 2021 Commonwealth report, communities of color are more likely to die from treatable conditions and are also at higher risk for many chronic health conditions. The lack of access to health insurance and primary care mean many are diagnosed only at a late or end-stage of illness when disease-modifying treatment is typically no longer effective. Those from historically disadvantaged communities who also have serious illness also experience poorer care and access.
We pointed out that, therefore, those living with serious illness represent a vulnerable population and they require all the legal and regulatory support possible. Beyond racial and ethnic disparities, we shared that individuals that identify as LGBTQ and their caregivers often experience challenges in accessing high-quality palliative and advanced illness care, including hurdles related to provider communication, perceptions of safety and acceptance, and assessing and respecting patients’ definitions of family and spirituality. Additionally, people from culturally and linguistically diverse backgrounds and their caregivers are often confronted with difficult language barriers and unfamiliar customs that frustrate their ability to access palliative care and benefit most fully from its interventions.
We particularly support the following aspects of this proposed rule:
- It reinstates and strengthens the application of nondiscrimination protections to health insurance issuers that receive federal financial assistance.
- Codifies protections against discrimination on the basis of sex including discrimination on the basis of sexual orientation and gender identity.
- Requires recipients of federal financial assistance, the Department’s health programs and activities, and State Exchanges to implement anti-discrimination policies and procedures to give staff clear guidance on the provision of language assistance services for limited English proficient individuals, and effective communication and reasonable modifications to policies and procedures for people with disabilities. Covered entities will also be required to train relevant staff on these policies and procedures.
- Requires covered entities to provide notice of the availability of language assistance services and auxiliary aids and services.
- States that a covered entity must not discriminate against any individual on the basis of race, color, national origin, sex, age, or disability through the use of clinical algorithms in its decision- making.
- Provides a clear process for raising conscience and religious freedom objections.
- Clarifies that nondiscrimination requirements apply to health programs and activities provided through telehealth services.
- Reinstates protections on the basis of gender identity and sexual orientation in CMS regulations.
