Rfi Aca Section 1557

7/27/2019 Rfi Aca Section 1557

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46558 Federal Register / Vol. 78, No. 148/ Thursday, August 1, 2013/ Proposed Rules

12. Clarity of This Regulation

We are required by Executive Order12866 and 12988, the Plain Writing Actof 2010 (H.R. 946), and the PresidentialMemorandum of June 1, 1998, to writeall rulemaking in plain language. Thismeans each rule we publish must:

Be logically organized;Use the active voice to address

readers directly;Use clear language rather than

jargon;Be divided into short sections and

sentences; andUse lists and table wherever

possible.

List of Subjects in 43 CFR Part 2

Administrative practice andprocedure, Classified information,Courts, Freedom of information,Government employees, Privacy.

Dated: July 18, 2013.

Rhea Suh,

Assistant Secretary for Policy, Managementand Budget.

For the reasons stated in thepreamble, the Department of the Interiorproposes to amend 43 CFR part 2 asfollows:

PART 2FREEDOM OF INFORMATIONACT; RECORDS AND TESTIMONY

I 1. The authority citation for part 2continues to read as follows:

Authority: 5 U.S.C. 301, 552, 552a, 553;31 U.S.C. 3717; 43 U.S.C. 1460, 1461.I 2. Revise 2.254 to read as follows:

2.254 Exemptions.

(a) Criminal law enforcement recordsexempt under 5 U.S.C. 552a(j)(2).Pursuant to 5 U.S.C. 552a(j)(2) thefollowing systems of records have beenexempted from all of the provisions of5 U.S.C. 552a and the regulations in thesubpart except paragraphs (b), (c)(1) and(2), (e)(4)(A) through (F), (e)(6), (7), (9),(10), and (11), and (i) of 5 U.S.C. 552aand the portions of the regulations inthis subpart implementing theseparagraphs:

(1) Investigative Records, Interior/

Office of Inspector General2.(2) Incident Management, Analysisand Reporting System, DOI10.

(b) Law enforcement records exemptunder 5 U.S.C. 552a(k)(2). Pursuant to 5U.S.C. 552a(k)(2), the following systemsof records have been exempted fromparagraphs (c)(3), (d), (e)(1), (e)(4) (G),(H), and (I), and (f) of 5 U.S.C. 552a andthe provisions of the regulations in thissubpart implementing these paragraphs:

(1) Investigative Records, Interior/Office of Inspector General2.

(2) Permits System, Interior/FWS21.

(3) Civil Trespass Case Investigations,Interior/BLM19.

(4) Employee Conduct Investigations,Interior/BLM20.

(5) [Reserved](6) [Reserved](7) Employee Financial Irregularities,

Interior/NPS17.(8) Trespass Cases, Interior/

Reclamation-37.(9) Litigation, Appeal and Case Files

System, Interior/Office of the Solicitor-1 to the extent that it consists ofinvestigatory material compiled for lawenforcement purposes.

(10) Endangered Species LicensesSystem, Interior/FWS19.

(11) Timber Cutting and TrespassClaims Files, Interior/BIA24.

(12) Incident Management, Analysisand Reporting System, DOI10.

(c) Investigatory records exemptunder 5 U.S.C. 552a(k)(5), the followingsystems of records have been exempted

from subsections (c)(3), (d), (e)(1), (e)(4)(G), (H), and (I) and (f) of 5 U.S.C. 552aand the provisions of the regulations inthis subpart implementing thesesubsections:

(1) [Reserved](2) National Research Council Grants

Program, Interior/GS9(3) Committee Management Files,

Interior/Office of the Secretary68.

[FR Doc. 201318223 Filed 73113; 8:45 am]

BILLING CODE 4310RKP

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Office of the Secretary

45 CFR Subtitle A

RIN 0945ZA01

Request for Information RegardingNondiscrimination in Certain HealthPrograms or Activities

AGENCY: Office for Civil Rights (OCR),HHS.

ACTION: Request for Information.

SUMMARY:Section 1557 of the PatientProtection and Affordable Care Act of

2010 (Affordable Care Act) (42 U.S.C.18116) prohibits discrimination on the

basis of race, color, national origin, sex,age, or disability in certain healthprograms and activities. Section 1557(c)of the Affordable Care Act authorizesthe Secretary of the Department ofHealth and Human Services(Department) to promulgate regulationsto implement the nondiscriminationrequirements in Section 1557. Thisnotice is a request for information (RFI)

to inform the Departments rulemakingfor Section 1557. This RFI seeksinformation on a variety of issues to

better understand individualsexperiences with discrimination inhealth programs or activities andcovered entities experiences incomplying with Federal civil rightslaws.

DATES: Comments must be received atone of the addresses provided below, nolater than 5p.m. on September 30, 2013.

ADDRESSES: Written comments may besubmitted through any of the methodsspecified below. Please do not submitduplicate comments.

Federal eRulemaking Portal:Youmay submit electronic comments athttp://www.regulations.gov.Follow theinstructions for submitting electroniccomments. Attachments should be inMicrosoft Word, WordPerfect, or Excel;however, we prefer Microsoft Word.

Regular, Express, or Overnight Mail:You may mail written comments (oneoriginal and two copies) to the followingaddress only: U.S. Department of Healthand Human Services, Office for CivilRights, Attention: 1557 RFI (RIN 0945AA02), Hubert H. Humphrey Building,Room 509F, 200 Independence AvenueSW., Washington, DC 20201. Mailedcomments may be subject to deliverydelays due to security procedures.Please allow sufficient time for mailedcomments to be timely received in theevent of delivery delays.

Hand Delivery or Courier:If you

prefer, you may deliver (by hand orcourier) your written comments (oneoriginal and two copies) to the followingaddress only: Office for Civil Rights,Attention: 1557 RFI (RIN 0945AA02),Hubert H. Humphrey Building, Room509F, 200 Independence Avenue SW.,Washington, DC 20201. (Because accessto the interior of the Hubert H.Humphrey Building is not readilyavailable to persons without federalgovernment identification, commentersare encouraged to leave their commentsin the mail drop slots located in themain lobby of the building.)

Inspection of Public Comments:Allcomments received before the close ofthe comment period will be available forpublic inspection, including anypersonally identifiable or confidential

business information that is included ina comment. We will post all commentsreceived before the close of thecomment period at http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT:Carole Brown, 2026190805.

SUPPLEMENTARY INFORMATION:

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46559Federal Register / Vol. 78, No. 148/ Thursday, August 1, 2013/ Proposed Rules

I. Background

Section 1557 is consistent with andpromotes several of theAdministrations and Departments keyinitiatives that promote health andequal access to health care. In 2011, theDepartment adopted the Health andHuman Services Action Plan to ReduceRacial and Ethnic Health Disparities(HHS Disparities Action Plan). With theHHS Disparities Action Plan, theDepartment commits to continuouslyassessing the impact of all policies andprograms on health disparities andpromoting integrated approaches,evidence-based programs and bestpractices to reduce these disparities.The HHS Action Plan builds on thestrong foundation of the Affordable CareAct and is aligned with programs andinitiatives such as Healthy People 2020,the First Ladys Lets Move initiativeand the Presidents National HIV/AIDSStrategy. In addition, Exchanges or

Health Insurance Marketplacesestablished under the Affordable CareAct must also comply with allapplicable Federal laws prohibitingdiscrimination.

Section 1557 provides that anindividual shall not be excluded fromparticipation in, be denied the benefitsof, or be subjected to discrimination onthe grounds prohibited under Title VI ofthe Civil Rights Act of 1964 (Title VI),42 U.S.C. 2000d et seq. (race, color,national origin), Title IX of theEducation Amendments of 1972 (TitleIX), 20 U.S.C. 1681 et seq. (sex), the Age

Discrimination Act of 1975 (Age Act),42 U.S.C. 6101 et seq. (age), or Section504 of the Rehabilitation Act of 1973(Section 504), 29 U.S.C. 794 (disability),under any health program or activity,any part of which is receiving Federalfinancial assistance, or under anyprogram or activity that is administered

by an Executive Agency or any entityestablished under Title I of theAffordable Care Act or its amendments.Section 1557 states that theenforcement mechanisms provided forand available under Title VI, Title IX,Section 504, or the Age Act shall apply

for purposes of violations of Section1557. The Department is responsible fordeveloping regulations to implementSection 1557.

In developing a regulation toimplement Section 1557, theDepartment recognizes that Section1557 builds on a landscape of existingcivil rights laws. For example, theprohibitions against discrimination onthe grounds of race, color, nationalorigin, age, and disability in Title VI, theAge Act, and Section 504, respectively,apply to all programs and activities

covered by those statutes, includingthose related to health; however, theprohibition of sex discrimination inTitle IX applies only to educationprograms and activities of coveredentities. Section 1557 is the first Federalcivil rights statute that prohibits sexdiscrimination in health programs andactivities of covered entities. Section

1557 also applies to entities createdunder Title I of the Affordable Care Act,such as the Health InsuranceMarketplaces.

Additionally, Section 1557 is the firstbroad based Federal civil rights statuteincorporating the grounds prohibited byfour distinct civil rights statutes.Although Title VI, Title IX, the Age Act,and Section 504 have similarities intheir purpose, structure, requirements,and enforcement mechanisms, they alsohave notable differences.

Moreover, almost 50 years havepassed since Title VI was enacted and

roughly 40 years have passed since TitleIX, Section 504, and the Age Act wereenacted. Since the enactment of thesecivil rights laws, the demographics ofthe United States have increasinglydiversified, major advances in electronicand information technology haveoccurred, and the health care landscapehas changed, particularly with theenactment of the Affordable Care Act.

Recognizing the significant issuesimplicated by the development of aregulation to implement Section 1557,the Department is requestinginformation through this notice fromstakeholders on a range of issues to

better inform our rulemaking. TheDepartment welcomes comments fromall interested stakeholders, includingindividuals potentially protected fromdiscrimination under Section 1557,organizations serving or representingthe interests of such individuals, thelegal community, State, Tribal, and localhealth agencies, health care providers,health insurers, and other healthprograms.

II. Solicitation of Comments

The Department is requestinginformation regarding the following

issues. In responding, please indicate inyour response the correspondingquestion number and provide the basisor reasoning for your answers with asmuch specificity and detail as possible,as well as any supportingdocumentation, including research oranalyses, to ensure we have the mosthelpful information for our rulemaking.

Understanding the Current Landscape

1. The Department is interested inexperiences with, and examples of,discrimination in health programs and

activities. Please describe experiencesthat you have had, or examples of whichyou are aware, with respect to thefollowing types of discrimination inhealth programs and activities: (a) Race,color, or national origin discrimination;(b) Sex discrimination (includingdiscrimination on the basis of genderidentity, sex stereotyping, or

pregnancy); (c) Disabilitydiscrimination; (d) Age discrimination;or (e) discrimination on one or more

bases, where those bases intersect.2. There are different types of health

programs and activities. These includehealth insurance coverage, medical carein a physicians office or hospital, orhome health care, for example. What areexamples of the types of programs andactivities that should be consideredhealth programs or activities underSection 1557 and why?

3. What are the impacts ofdiscrimination? What studies or other

evidence documents the costs ofdiscrimination and/or the benefits ofequal access to health programs andactivities for various populations? Forexample, what information is availableregarding possible consequences ofunequal access to health programs andservices, such as delays in diagnosis ortreatment, or receipt of an incorrectdiagnosis or treatment? We areparticularly interested in informationrelevant to areas in which Section 1557confers new jurisdiction.

Ensuring Access to Health Programsand Activities

4. In the interest of ensuring access tohealth programs and activities forindividuals with limited Englishproficiency (LEP):

(a) What are examples ofrecommended or best practice standardsfor the following topics: (1) Translationservices, including thresholds for thetranslation of documents into non-English languages and thedetermination of the service arearelevant for the application of thethresholds; (2) oral interpretationservices, including in-person andtelephonic communications, as well asinterpretation services provided viatelemedicine or telehealthcommunications; and (3) competence(including certification and skill levels)of oral interpretation and writtentranslation providers and bilingual staff?

(b) What are examples of effective andcost-efficient practices for providinglanguage assistance services, includingtranslation, oral interpretation, andtaglines? What cost-benefit data areavailable on providing languageassistance services?



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46560 Federal Register / Vol. 78, No. 148/ Thursday, August 1, 2013/ Proposed Rules

(c) What are the experiences ofindividuals seeking access to, orparticipating in, health programs andactivities who have LEP, especiallypersons who speak less common non-English languages, including languagesspoken or understood by AmericanIndians or Alaska Natives?

(d) What are the experiences of

covered entities in providing languageassistance services with respect to: (1)Costs of services, (2) cost management,

budgeting and planning, (3) currentstate of language assistance servicestechnology, (4) providing services forindividuals who speak less commonnon-English languages, and (5) barrierscovered entities may face based on theirtypes or sizes?

(e) What experiences have you haddeveloping a language access plan?What are the benefits or burdens ofdeveloping such a plan?

(f) What documents used in healthprograms and activities are particularlyimportant to provide in the primarylanguage of an individual with LEP andwhy? What factors should we considerin determining whether a documentshould be translated? Are there commonhealth care forms or health-relateddocuments that lend themselves toshared translations?

5. Title IX, which is referenced inSection 1557, prohibits sexdiscrimination in federally assistededucation programs and activities, withcertain exceptions. Section 1557prohibits sex discrimination in healthprograms and activities of covered

entities. What unique issues, burdens,or barriers for individuals or coveredentities should we consider and addressin developing a regulation that appliesa prohibition of sex discrimination inthe context of health programs andactivities? What exceptions, if any,should apply in the context of sexdiscrimination in health programs andactivities? What are the implicationsand considerations for individuals andcovered entities with respect to healthprograms and activities that serveindividuals of only one sex? What otherissues should be considered in this

area?6. The Department has been engagedin an unprecedented effort to expandaccess to information technology toimprove health care and healthcoverage. As we consider Section 1557srequirement for nondiscrimination inhealth programs and activities, what arethe benefits and barriers encountered bypeople with disabilities in accessingelectronic and information technologyin health programs and activities? Whatare examples of innovative or effectiveand efficient methods of making

electronic and information technologyaccessible? What specific standards, ifany, should the Department considerapplying as it considers access toelectronic and information technologyin these programs? What, if any, burdenor barriers would be encountered bycovered entities in implementingaccessible electronic and information

technology in areas such as web-basedhealth coverage applications, electronichealth records, pharmacy kiosks, andothers? If specific accessibilitystandards were to be applied, shouldthere be a phased-in implementationschedule, and if so, please describe it.

Compliance and EnforcementApproaches

7. Section 1557 incorporates theenforcement mechanisms of Title VI,Title IX, Section 504 and the Age Act.These civil rights laws may be enforcedin different ways. Title VI, Title IX, and

Section 504 have one set of establishedadministrative procedures forinvestigation of entities that receiveFederal financial assistance from theDepartment. The Age Act has a separateadministrative procedure that is similar,

but requires mediation before aninvestigation. There is also a separateadministrative procedure under Section504 that applies to programs conducted

by the Department. Under all theselaws, parties also may file privatelitigation in Federal court, subject tosome restrictions.

(a) How effective have these different

processes been in addressingdiscrimination? What are ways in whichwe could strengthen these enforcementprocesses?

(b) The regulations that implementSection 504, Title IX, and the Age Actalso require that covered entitiesconduct a self-evaluation of theircompliance with the regulation. Whatexperience, if any, do you have withself-evaluations? What are the benefitsand burdens of conducting them?

(c) What lessons or experiences maybe gleaned from complaint andgrievance procedures already in place atmany hospitals, clinics, and othercovered entities?

8. Are there any other issuesimportant to the implementation ofSection 1557 that we should consider?Please be as specific as possible.

III. Response to Comments

Because of the large number of publiccomments we normally receive onFederal Register documents, we are notable to acknowledge or respond to themindividually. We will consider allcomments we receive by the date and

time specified in the DATES section ofthis preamble.

Dated: June 5, 2013.

Leon Rodriguez,

Director, Office for Civil Rights.

[FR Doc. 201318707 Filed 73113; 8:45 am]

BILLING CODE 415301P

DEPARTMENT OF TRANSPORTATION

Pipeline and Hazardous MaterialsSafety Administration

49 CFR Part 192

[Docket ID PHMSA20130161]

Pipeline Safety: Class LocationRequirements

AGENCY: Pipeline and HazardousMaterials Safety Administration(PHMSA), DOT.

ACTION: Notice of proposed rulemaking.

SUMMARY: PHMSA is seeking publiccomment on whether applying theintegrity management program (IMP)requirements, or elements of IMP, toareas beyond current high consequenceareas (HCAs) would mitigate the needfor class location requirements for gastransmission pipelines.

Section 5 of the Pipeline Safety,Regulatory Certainty, and Job CreationAct of 2011 requires the Secretary ofTransportation to evaluate and issue areport on whether IMP requirementsshould be expanded beyond HCAs and

whether such expansion would mitigatethe need for class location requirements.DATES: The public comment period forthis notice ends September 30, 2013.

ADDRESSES: You may submit commentsidentified by the Docket ID PHMSA20130161 by any of the followingmethods:

E-Gov Web site:http://www.regulations.gov.This site allowsthe public to enter comments on anyFederal Register notice issued by anyagency. Follow the instructions forsubmitting comments.

Fax:12024932251.

Mail:Docket Management System,U.S. Department of Transportation(DOT), 1200 New Jersey Avenue SE,Room W12140, Washington, DC 20590.

Hand Delivery:DOT DocketManagement System, Room W12140,on the ground floor of the WestBuilding, 1200 New Jersey Avenue SE.,Washington, DC between 9:00 a.m. and5:00 p.m., Monday through Friday,except Federal holidays.

Instructions:Identify the Docket ID atthe beginning of your comments. If yousubmit your comments by mail, submit

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Rfi Aca Section 1557