ACA Section 1557 Final Rule — Nondiscrimination in Patient Care Decision Support Tools
United States · 42 U.S.C. § 18116; 45 C.F.R. § 92.210
A 2024 HHS rule says hospitals, insurers, and other covered health entities may not discriminate through clinical algorithms and AI decision-support tools, and must make reasonable efforts to find and fix bias in those tools. The requirement took effect May 1, 2025, but HHS has stayed quiet on enforcement, so its practical protection is uncertain while it stays on the books.
Technical detail
45 C.F.R. § 92.210 (89 Fed. Reg. 37522) prohibits discrimination via patient care decision support tools (including AI/clinical algorithms) and requires covered entities to make reasonable efforts to identify and mitigate discriminatory tool use; HHS OCR has issued non-enforcement signals regarding § 92.210(b)–(c).
Who is protected: Patients, against discrimination on the basis of race, color, national origin, sex, age, or disability via clinical algorithms and AI tools
Who must comply: Health programs and activities receiving federal financial assistance (hospitals, providers, many insurers)
Key facts
| Jurisdiction | United States |
|---|---|
| Level | Federal |
| Status | In effect |
| Protection strength | Limited protection |
| Effective date | 2025-05-01 |
| Enacted | 2024-05-06 |
| Citation | 42 U.S.C. § 18116; 45 C.F.R. § 92.210 |
| Enforced by | HHS Office for Civil Rights |
| Private right of action | Yes — individuals can sue |
| Penalties | Loss of federal funding, corrective action, compensatory damages in civil actions |
| Topics | healthcare AI · automated decision-making · consumer protection |
| Last verified | 2026-06-15 |
| Official source | Nondiscrimination in Health Programs and Activities (Final Rule), Federal Register ↗ |
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