Section 1557 for the dental office on Medicaid or Medicare: the notices, language access, coordinator and training the 2024 rule requires, and what a court vacated

What it says#

Section 1557 of the Affordable Care Act, 42 U.S.C. 18116, provides that an individual shall not, on the grounds prohibited under Title VI, Title IX, the Age Discrimination Act or Section 504, "be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance." HHS's implementing rule at 45 CFR part 92 was published May 6, 2024 at 89 FR 37522 and took effect July 5, 2024. It is the third version: the first rule was published May 18, 2016 (81 FR 31375) and the second June 19, 2020 (85 FR 37160).

For a dental office the operative sections are the procedural ones in subpart A, each with a compliance date in Table 1 to 92.1(b). Section 92.7: "A covered entity that employs fifteen or more persons must designate and authorize at least one employee, a 'Section 1557 Coordinator,'" who receives and processes grievances, coordinates recordkeeping, language access, effective communication and reasonable modification procedures, and coordinates training; due within 120 days of July 5, 2024. OCR counts "full-time and part-time employees and independent contractors" toward the 15. Section 92.8 requires written policies and procedures: a nondiscrimination policy; at 15 or more employees, grievance procedures with records kept three years; language access procedures that say how an employee identifies a patient with limited English proficiency, how to obtain qualified interpreters and translators, the names of qualified bilingual staff and the list of translated materials; effective communication procedures; and reasonable modification procedures; due within one year. Section 92.9 requires training of "relevant employees," defined to include anyone "interacting with patients and members of the public," anyone making decisions that affect patients' care, "including the covered entity's executive leadership team and legal counsel," and anyone whose work affects "patients' financial obligations, including billing and collections"; the first round "no later than 30 days following a covered entity's implementation of the policies and procedures required by Sec. 92.8, and no later than 300 days following July 5, 2024," new hires within a reasonable period, completion documented and kept three years. (Table 1 gives 92.9 a one-year outside date; the section text and the preamble say 300 days.)

Section 92.10 is the notice of nondiscrimination. It must say the practice does not discriminate on the listed grounds; that it provides reasonable modifications and "appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, such as braille or large print, free of charge and in a timely manner"; that it provides language assistance "free of charge and in a timely manner"; how to obtain them; the coordinator's contact information and the grievance procedure, where applicable; "details on how to file a discrimination complaint with OCR"; and how to reach the website version. It goes out annually to patients, on request, "at a conspicuous location" on the website, and "in clear and prominent physical locations, in no smaller than 20-point sans serif font." Due within 120 days. Section 92.11 is the notice of availability of language assistance services and auxiliary aids: it states that they are free, and 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 in which a covered entity operates" and in alternate formats. It goes in the same four places and, when the practice uses them, in eleven kinds of documents, among them the notice of privacy practices, application and intake forms, denial notices and explanations of benefits, communications that require a response, consent forms and instructions for procedures, "communications related to the cost and payment of care ... including medical billing and collections materials, and good faith estimates," complaint forms and patient handbooks. A patient may opt out of receiving it in their language each year. Due within one year.

The substantive sections behind the notices are 92.201 and 92.202. A covered entity "must take reasonable steps to provide meaningful access to each individual with limited English proficiency"; the services must be "free of charge, be accurate and timely," delivered by a qualified interpreter or qualified translator, with machine translation reviewed by a qualified human translator when the text is critical; and the practice must not require the patient to bring or pay for an interpreter, rely on an adult who is not a qualified interpreter except in an emergency or on the patient's documented private request, or rely on a minor except in an emergency. Communication with patients with disabilities must be as effective as with others, under the standards at 28 CFR 35.160 through 35.164. Section 92.210, on patient care decision support tools, applied within 300 days.

The rule also changed who is covered. "The Department's longstanding position has been that Medicare Part B ('Part B') funding does not meet the definition of 'Federal financial assistance,'" the preamble says; the 2024 rule adopts the 2022 proposal "such that Part B funds will be considered Federal financial assistance when received by providers and suppliers."

On the litigation: on July 3, 2024, in Tennessee v. Becerra, the Southern District of Mississippi preliminarily enjoined HHS from enforcing the rule's provisions on gender-identity discrimination and stayed their effective date. On October 22, 2025, in Tennessee v. Kennedy, the same court entered final judgment vacating 45 CFR 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, and parallel CMS provisions, "to the extent that they expand Title IX's definition of sex discrimination to include gender-identity discrimination," holding that "universal vacatur is the appropriate remedy," and declaring that "HHS exceeded its statutory authority when (1) it interpreted Title IX, as incorporated into Section 1557, to prohibit discrimination on the basis of gender identity." HHS's June 2, 2026 Federal Register notice reports this: "Pursuant to the court's order, the vacated provisions are legally void. The other provisions of the Section 1557 Rule remain in force," and OCR "cannot and will not investigate or enforce" the vacated provisions to that extent. Separately, on May 14, 2025 HHS rescinded its 2021 Notification of Interpretation and Enforcement of Section 1557 and Title IX (86 FR 27984).

Who it applies to#

Any dental practice with federal financial assistance from HHS, which the rule defines to include "any grant, loan, credit, subsidy, contract (other than a procurement contract but including a contract of insurance), or any other arrangement" by which the federal government provides assistance. Medicaid and CHIP participation is the common case; since July 5, 2024, Medicare Part B payments count as well, and an HHS grant does. Once any part of the entity receives it, the rule reaches "all of the operations of any entity principally engaged in the provision or administration of" health services; the definition's own examples include a physician's practice, a pharmacy and a health clinic, and the preamble lists "medical, dental, and pharmaceutical care" among health-related services. A cash and PPO practice with no Medicaid, no Medicare and no grant is outside the rule; employers acting as plan sponsors are excluded by 92.2(b).

Size matters only for two pieces. The coordinator and the written grievance procedure attach at 15 or more employees, counting part-time staff and contractors, and OCR declined in the preamble to extend them to smaller practices "in an effort to reduce unnecessary or counterproductive administrative obligations on small providers." The notices, the policies, the training, free interpreters and effective communication apply to a two-chair office on Medicaid as much as to a group.

What changed#

Against the 2020 rule, the 2024 rule restored and expanded the paperwork: the preamble refers to concerns raised about "the removal of those requirements in the 2020 Rule," meaning the tagline requirements, and the 2024 notice of availability in 15 languages is the replacement. Training under 92.9 is new, and the coordinator requirement returns from the 2016 rule, where it sat at former 92.7. The Medicare Part B change moved practices that bill Medicare but not Medicaid into the rule for the first time.

Since the rule took effect, one thing has been removed and nothing added. The gender-identity provisions were enjoined two days before the effective date and vacated in October 2025; the notice of nondiscrimination must still say the practice does not discriminate on the basis of sex, but the gloss in 92.10(a)(1)(i) and 92.8(b)(1) that read sex to include gender identity is void. Federal Register searches on the check date by RIN 0945-AA17 and by the rule's title show no proposed or final rule revising part 92 after May 2024; the June 2, 2026 notice is the latest HHS document, and it says the rest of the rule remains in force.

Where the source is#

The 2024 final rule was read in the govinfo edition of the Federal Register for May 6, 2024 (FR Doc. 2024-08711, 89 FR 37522), including Table 1 to 92.1(b) and the regulatory text of sections 92.7 through 92.11, 92.201, 92.202 and 92.210; the Medicare Part B change is section III of its preamble. The litigation and enforcement status is from HHS's Notification of court decision at 91 FR 32887 (June 2, 2026, FR Doc. 2026-11015), and the 2021 interpretation's rescission from 90 FR 20393 (May 14, 2025). The codified text is on eCFR and the statute on uscode.house.gov. HHS's Section 1557 page at hhs.gov refused automated requests from this environment and archived copies of it returned an HHS "Page Not Found," so nothing on this page rests on it.