Among the most significant changes in the 2024 rule are the protections for LGBTQI+ individuals. The previous version of Section 1557 rulemaking, finalized in 2020, had eliminated protections against discrimination based on gender identity, sex stereotyping, or sexual orientation – essentially preventing LGBTQI+ people from seeking relief from healthcare discrimination that was based on their gender identity or sexual orientation. But under the new rule, those forms of discrimination are prohibited, helping to improve access to medical care for LGBTQI+ individuals. Clarification of protections. The rulemaking related to Section 1557 implementation that was finalized in April 2024 updates the implementation of non-discrimination protections in healthcare, including a prohibition on discrimination based on race, color, national origin, sex (including sexual orientation and gender identity), age, or disability.[efn_note]“Section 1557 Final Rule: Frequently Asked Questions” U.S. Department of Health and Human Services. Accessed May 23, 2024[/efn_note] Extended protections to more people. Compared with the previous rule, issued in 2020, the new rule extends Section 1557’s non-discrimination protections to more people, and requires more entities and programs to comply with the requirements (meaning they are “covered entities”).[efn_note]“Section 1557 Final Rule: Frequently Asked Questions” U.S. Department of Health and Human Services. Accessed May 23, 2024[/efn_note] The rule clarifies that discrimination based on sexual orientation or gender identity is prohibited, as those are considered discrimination on the basis of sex (consistent with the 2020 U.S. Supreme Court ruling in Bostock v. Clayton County.)[efn_note]“Bostock v. Clayton County” Supreme Court of the United States. Ruling issued June 15, 2020[/efn_note] It also prohibits discrimination based on conditions related to pregnancy, including the termination of a pregnancy.[efn_note]“The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA” KFF.org. May 15, 2024 and ”Nondiscrimination in Health Programs and Activities” Federal Register. May 6, 2024[/efn_note] Reflects emerging technologies. The 2024 final rule extends Section 1557’s non-discrimination requirements to telehealth and patient care decision support tools (including algorithms, machine learning, and artificial intelligence used to aid in clinical and coverage decisions).[efn_note]“Nondiscrimination in Health Programs and Activities” Federal Register. May 6, 2024[/efn_note] Expands covered entities. Covered entities – entities that are subject to the nondiscrimination requirements – include any “health program or activity” that receives federal financial assistance, or is administered by HHS. This includes Medicare (including Medicare Part B, which was not previously required to comply), state Medicaid programs, most hospitals and medical providers, and many health insurance plans – including Marketplace plans and other products sold by the insurers that offer Marketplace plans.[efn_note]“The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA” KFF.org. May 15, 2024[/efn_note] The final rule is effective July 5, 2024 (60 days after publication in the Federal Register), but various provisions in the rule – including those that would require a change in a health plan’s benefits – have later effective dates.[efn_note]“Section 1557 Final Rule: Frequently Asked Questions” U.S. Department of Health and Human Services. Accessed May 23, 2024[/efn_note]