Anti-Discrimination

10.5.2 – Anti-Discrimination (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) An MAO may not deny, limit, or condition enrollment to individuals eligible to enroll in an MA plan offered by the organization on the basis of any factor that is related to health status, including, but not limited to the following: • Claims experience; • Receipt of health care; • Medical history and medical condition including physical and mental illness; • Genetic information; • Evidence of insurability, including conditions arising out of acts of domestic violence; or • Disability. Additionally, an MAO must: • Comply with the provisions of section 1557 of the Affordable Care Act, title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, section 504 of the Rehabilitation Act of 1973, title II of the Americans with Disabilities Act (ADA) of 1990, and the Genetic Information Nondiscrimination Act of 2008; and • Have procedures in place for each of its MA plans to ensure that enrollees are not discriminated against in the delivery of health care services, consistent with the benefits covered in their policy, based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Discrimination based on “source of payment” means, for example, that MA providers cannot refuse to serve enrollees because they receive assistance with Medicare cost-sharing from a State Medicaid program. However, there are three situations in which enrollment in an MA plan may be denied based on the presence or absence of a medical condition: • To a person who does not fulfill the eligibility criteria for enrollment in a Special Needs Plan (SNP), under the circumstances mentioned in chapter 16b of the MMCM, “Special Needs Plans,” at:https://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/mc86c16b.pdf; • To a person with end-stage renal disease (ESRD), under the circumstances mentioned in chapter 2 of the MMCM, “Enrollment and Disenrollment,” at: http://www.cms.gov/Medicare/Eligibility-and- Enrollment/MedicareMangCareEligEnrol/index.html?redirect=/MedicareMangCareEl igEnrol/; and • To a person receiving hospice benefits prior to completing an enrollment request for an MSA plan. Refer to chapter 2 of the MMCM, “Enrollment and Disenrollment” at: http://www.cms.gov/Medicare/Eligibility-and- Enrollment/MedicareMangCareEligEnrol/index.html?redirect=/MedicareMangCareEl igEnrol/ Additional information about Federal law and regulations related to discrimination may be found at the following sites: Age HHS OCR Page on Age Discrimination • http://www.hhs.gov/ocr/civilrights/understanding/age/index.html Race, color, national origin HHS OCR Page on Discrimination Based on Race, Color, and National Origin • http://www.hhs.gov/ocr/civilrights/understanding/race/index.html Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons • http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/hhslepguidancepdf.pdf The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care • http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15 Medical history/history of mental illness, claims experience, evidence of insurability, genetic information HHS Health Information Privacy Page • http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/genetic/ DOL HIPPA Nondiscrimination Requirements • http://www.dol.gov/ebsa/faqs/faq_hipaa_ND.html Disability HHS OCR Page on Disability Rights • http://www.hhs.gov/ocr/civilrights/understanding/disability/ Medicare Page on Resources for People with Disabilities • http://www.medicare.gov/people-like-me/disability/disability.html DOJ Civil Rights Division Page on the Americans with Disabilities Act • http://www.ada.gov/ Medicare Provider Applicants HHS OCR Page on Medicare Provider Applicants • http://www.hhs.gov/ocr/civilrights/clearance/index.html