Section 1557 Notice of Nondiscrimination for NEMT: The Notice, the Language Notice, and the Policy

A rider calls in Vietnamese, a deaf rider books through relay, a rider with low vision asks for your rider rules in large print. Under HHS’s Section 1557 rule, how you answer each one is a civil rights question, and the rule asks you to put your answer in writing before anyone calls. This template holds the three written pieces a covered NEMT company needs: the notice of nondiscrimination, the notice of free language help, and the policies behind them, sized for a company with a few vans and one dispatch line.

How to use this template

1. Check whether the rule covers you. Read who has to follow Section 1557 below. If any of your rides are paid with Medicaid, CHIP, or Medicare Advantage money, directly or through a broker or plan, plan on it.
2. Count your employees. At 15 or more, fill in Part 8: you need a Section 1557 Coordinator and a written grievance procedure. Under 15, Part 8 is optional.
3. Fill in Parts 1 to 5 with your phone numbers, your interpreter service, and the staff who help. Give every policy an effective date, as 45 CFR 92.8(a) requires.
4. Get Part 2 translated. Find the 15 languages most spoken by people with limited English in each state you serve, using the steps under which 15 languages, and have a qualified translator do each line.
5. Post and send the notices everywhere Part 6 lists: your website, the places riders see you, and once a year to each rider.
6. Train everyone who deals with riders or billing within 30 days of adopting the policies, and each new hire soon after they start. Record it in Part 7.
7. Review the template once a year, and whenever a phone number, your interpreter vendor, or your bilingual staff change.

The day-to-day interpreter rules, such as never relying on a rider’s child, are in language access for NEMT phone calls. Record each rider’s language and any aids they need on the rider profile form. Vehicle, service animal, and fare rules for riders with disabilities are in the ADA guide for NEMT. This template does not repeat them.

The template

Part 1: Notice of nondiscrimination (post it and hand it out)

Print posted copies in a sans serif font, such as Arial, at 20 points or larger.

[Company name] follows federal civil rights laws.

We do not discriminate against anyone, or treat anyone worse, because of race, color, national origin (including limited English and the language a person speaks), sex, age, or disability.

Free help for people with disabilities. When you need it to use our service, we provide, free of charge and in a timely manner:

• Changes to our rules or usual way of doing things (reasonable modifications)
• Qualified sign language interpreters
• Written information in other formats, such as large print, braille, audio, or accessible electronic files

Free help in your language. When you need it to use our service, we provide, free of charge and in a timely manner:

• Qualified interpreters, by phone or in person
• Information written in other languages

To ask for any of this, call ____________ (TTY ____________, or dial 711 for relay), email ____________, or tell your driver or dispatcher.

If you think we discriminated against you or did not give you this help, you can file a grievance with our Section 1557 Coordinator: ____________ (name and title), ____________ (phone), ____________ (email), ____________ (address). Our grievance procedure is available at ____________. (Leave this paragraph out if you employ fewer than 15 people and have no grievance procedure.)

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, in writing: online at ocrportal.hhs.gov, by email to OCRComplaint@hhs.gov, or by mail to Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201. For help, call 1-800-368-1019 (TDD 1-800-537-7697).

This notice is also on our website at ____________.

Effective date: ____________

Part 2: Notice of free language help and disability aids

The English line:

Free language help and aids are available. [Company name] provides interpreters, translated information, and aids for people with disabilities free of charge. Call ____________ (TTY ____________ or 711).

Translations (one line per language, each by a qualified translator):

No.	Language	Translated line, with the phone number	Translated by, and date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

State or states counted: ____________. Census table and year used: ____________. Large print and accessible electronic versions kept at: ____________.

Part 3: Nondiscrimination policy

Effective date: ____________

[Company name] does not discriminate in its rides, booking, dispatch, or billing on the basis of race, color, national origin (including limited English and primary language), sex, age, or disability. We provide language help and appropriate aids and services for people with disabilities free of charge when they are needed. We make reasonable modifications to our policies, practices, and procedures for riders with disabilities. Questions about this policy go to ____________ (our Section 1557 Coordinator, if we have one, or the owner), at ____________.

Approved by (owner), signature and date: ____________

Part 4: Language help procedures

Item	Our procedure
Section 1557 Coordinator (if we have one), phone and email
How staff find out a rider needs language help	Ask “What language do you prefer?” at booking, and write the answer in the rider’s profile
Phone interpreter service: company, phone number, account number, PIN
Translation service for written materials: company and how to order
Video or in-person interpreter: company and how to book
Qualified bilingual staff: name and language
What drivers do when a rider needs an interpreter during a ride	Call dispatch, who conferences in the phone interpreter
What we never do	Ask a rider to bring or pay for an interpreter, rely on a child or a companion to interpret except briefly in an emergency, or use staff who are not qualified

Translated materials we have:

Title	Language	Date issued	Where riders get it (paper or link)

Part 5: Help for riders with disabilities

Item	Our procedure
Relay and TTY calls: number and who answers them
Sign language interpreter service: company, phone, account
Qualified interpreter staff: name
Large print, braille, audio, or electronic files: who makes them and how fast
How a rider asks for a change to a rule or practice	Call dispatch or tell the driver, and dispatch writes it down the same day
Who decides, and how fast
How we decide a change would fundamentally alter our service, and the alternative we offer instead

Change request log:

Date	Rider	Change asked for	Decision, and any alternative offered	Decided by

Part 6: Where the notices go

Where	Nondiscrimination notice	Language notice	Done (date)
Website, in a conspicuous spot	Yes	Yes
Office or lobby where riders come in	Yes	Yes
Inside each vehicle, if riders never visit an office	Yes	Yes
To each rider, once a year	Yes	Yes
To anyone who asks	Yes	Yes
With the nondiscrimination notice itself		Yes
HIPAA notice of privacy practices, if you have one		Yes
Rider intake and profile forms		Yes
Complaint forms		Yes
Bills, payment notices, and collection letters sent to riders		Yes
Letters that suspend or end a rider’s service		Yes
Letters or texts that ask the rider to respond		Yes
Rider handbook or welcome packet		Yes

Instead of sending the language notice every year, you may record a rider’s primary language and any aids they need, then communicate with that rider in that language and with those aids, or send the language notice in that language with each document listed above (45 CFR 92.11(d)(2)).

Part 7: Training record

Train every employee who talks with riders or the public, handles billing and collections, or makes decisions that affect riders, including the owner and managers. Keep this record at least 3 years.

Date	Employee	Job	What was covered (Parts 1 to 6, interpreters, relay calls, change requests)	Trainer	Employee signature

Part 8: Coordinator and grievance procedure (15 or more employees)

Item	Entry
Section 1557 Coordinator: name, title, phone, email
Designees and what each handles
Where the grievance procedure is posted

Grievance procedure:

1. Anyone may file a grievance about discrimination or a missing interpreter, aid, or change, in writing or out loud, with the Coordinator or any employee, who passes it to the Coordinator the same day.
2. The Coordinator confirms receipt within ______ business days and offers language help or aids for the process.
3. The Coordinator investigates promptly and fairly, talking with the person who filed, the driver or staff involved, and any witnesses, and checking trip records.
4. The Coordinator sends a written decision, with the reasons and any fix, within ______ days of receipt.
5. The person who filed may ask the owner to review the decision within ______ days.
6. We keep the identity of the person who filed confidential, except as the law or the investigation requires, and no one is punished for filing or helping.

Grievance record (keep at least 3 years from the date it is resolved):

Field	Entry
The grievance, as filed
Name and contact details of the person filing, if given
What they say happened, and the basis (race, color, national origin, sex, age, or disability)
Date filed
Date resolved
Resolution
Other information that matters

Who has to follow Section 1557

The rule applies to every health program or activity that receives federal financial assistance from HHS, directly or indirectly (45 CFR 92.2). Any organization or person that gets that assistance counts as a recipient, except the ultimate beneficiary, such as the rider (45 CFR 92.4). Three points bring a NEMT company inside it:

• Rides to care are a health-related service. In the 2024 final rule, HHS listed transportation to and from health services, when needed for access to them, among health-related services, citing the Medicaid rule that states must ensure rides to providers (89 FR 37540, May 6, 2024).
• Medicaid money is federal financial assistance. The rule names all the operations of a state Medicaid program as a health program (45 CFR 92.4). HHS’s Section 504 rule of May 9, 2024 adds that managed care plans paid with Medicaid funds are covered too, and that a recipient’s civil rights duties pass down to the subcontractors it hires to run the program (89 FR 40073 to 40074).
• Getting paid through a broker or plan counts. HHS explained that a recipient may pass federal money to a subrecipient to carry out all or part of a health program, and that subrecipients are covered too. For contractors, HHS called it a fact-specific question that turns on the contract: one paid with federal money to carry out a covered entity’s program is a subrecipient (89 FR 37527).

Brokers already treat their providers as covered by the civil rights laws that come with this money. Federal rules require every Medicaid managed care contract, including a NEMT-only plan’s contract, to comply with Section 1557 and the other civil rights laws (42 CFR 438.3(f) and 438.9). MTM Health’s Rhode Island handbook (updated July 1, 2026) says every contracted transportation provider is subject to Title VI and HHS’s rule at 45 CFR part 80. MTM Health’s standard agreement (January 1, 2023, as Pennsylvania posts it) has providers comply with the ADA and Section 504.

A company that carries only private pay riders, with no HHS money anywhere in the chain, is outside Section 1557. The ADA still applies to its rides. If you take Medicaid trips, give every rider the same notices. When rides to care are your main business, you are likely principally engaged in health-related services, and the rule’s definition of a health program then takes in all your operations, private pay rides included (45 CFR 92.4).

What the rule requires, and at what size

All of these duties have applied since July 5, 2025 at the latest (45 CFR 92.1(b)). Training follows your policies: train staff no later than 30 days after you put the policies in place, and each new employee within a reasonable time after they join (92.9(b)).

Duty	Who needs it	Rule
Notice of nondiscrimination	Every covered entity	45 CFR 92.10
Notice of free language help and aids, in 15 languages	Every covered entity	92.11
Written nondiscrimination policy	Every covered entity	92.8(b)
Written language, communication, and change request procedures	Every covered entity	92.8(d) to (f)
Training, with records kept 3 years	Every covered entity	92.9
Section 1557 Coordinator	15 or more employees	92.7
Written grievance procedure, with records kept 3 years	15 or more employees	92.8(c)

The notice of nondiscrimination must state the six protected bases, that reasonable modifications, aids, and language help are free and timely, and how to ask for them. It also gives the Coordinator’s contact and the grievance procedure when you have them, how to file with HHS’s Office for Civil Rights, and your website address (45 CFR 92.10(a)(1)). It goes to riders once a year and on request, at a conspicuous spot on your website, and in clear and prominent physical locations in 20-point sans serif type or larger (92.10(a)(2)).

The language notice says that language help and aids are free. It goes out in English and at least 15 other languages, in alternate formats for people who need them, and to the same places as the nondiscrimination notice (45 CFR 92.11). It also rides along with the documents in Part 6. HHS said in the rule’s preamble that you may fold it into the nondiscrimination notice (89 FR 37567).

The written policies each need an effective date and must fit your size and the kind of service you run (92.8(a)). You may combine them with Title VI and Section 504 policies if Section 1557 is clearly addressed (92.8(g)). The notice can also do double duty: one combined notice may satisfy the notice duties under Title VI, Section 504, Title IX, and the Age Discrimination Act if it carries every 92.10 element (92.10(b)). Section 504’s own rule asks recipients with 15 or more employees for a coordinator and grievance procedures too (45 CFR 84.7), so one person and one procedure can serve both.

Training reaches permanent and temporary employees who deal with riders and the public, make decisions that affect their care, or handle billing and collections, including the owner and managers. Document each person’s training when it happens and keep it at least 3 years (92.9).

Which 15 languages go on the language notice

A person with limited English proficiency is someone whose primary language is not English and who has a limited ability to read, write, speak, or understand English (45 CFR 92.4). A rider can speak English well and still need written forms in their own language.

1. Open the Census Bureau’s table B16001, Language Spoken at Home by Ability to Speak English, and pick your state. The 2020 to 2024 five-year estimates are the latest as of October 2026.
2. Read the “Speak English less than very well” count for each language group.
3. Rank the groups by that count and take the top 15. If you run rides in more than one state, HHS’s preamble describes adding the states together and taking the top 15 of the total (89 FR 37568).
4. A few rows group several languages, such as “Amharic, Somali, or other Afro-Asiatic languages.” Use the language your riders in that group speak.

Fifteen is the minimum. You still owe meaningful access to a rider whose language is not on your list (89 FR 37568), and a state may require more languages.

Where the rule stands in October 2026

• The text has not changed since July 5, 2024. The eCFR shows no version of part 92 after that date, and no HHS rule amending the notice, policy, training, or language access sections appeared in the Federal Register through September 2026.
• Court rulings on one topic, the meaning of sex. On August 30, 2024, the U.S. District Court for the Eastern District of Texas, in Texas v. Becerra, stayed nationwide the rule’s definition of sex discrimination as including sex characteristics, pregnancy or related conditions, sexual orientation, gender identity, and sex stereotypes, as HHS described it in an April 24, 2026 notice. On October 22, 2025, the U.S. District Court for the Southern District of Mississippi, in Tennessee v. Kennedy, vacated provisions of the rule to the extent they extend sex discrimination to gender identity, including the wording about sex in the notice (92.10(a)(1)(i)) and the policy (92.8(b)(1)). HHS’s notice of June 2, 2026 says its Office for Civil Rights will not enforce those parts, and that the other provisions remain in force. The template lists sex as a protected basis with no added definition.
• The English executive order. Executive Order 14224, signed March 1, 2025, made English the official language and revoked Executive Order 13166, which had told federal agencies to improve access for people with limited English and to write guidance for the groups they fund. It says nothing in it requires any change in agency services, and it did not amend the Section 1557 rule. The Justice Department rescinded its own 2002 guidance on March 21, 2025. Its notice reminds recipients and subrecipients that denying language help can, in some circumstances, be evidence of national origin or disability discrimination.
• State law can add more. State and local laws that give more protection against discrimination on these bases still apply (45 CFR 92.3(d)). Check your state guide and your broker contract.

How a discrimination complaint reaches you

A rider can complain to you, to the broker, or straight to HHS’s Office for Civil Rights. OCR takes written complaints online, by mail, by fax, or by email, and they must be filed within 180 days of when the person knew of the act, unless OCR extends the time for good cause (OCR complaint page, last reviewed May 21, 2025, and 45 CFR 80.7(b)). OCR resolves what it can informally. If a recipient will not comply, the remedies include suspending or ending federal financial assistance, the money behind a NEMT company’s Medicaid rides, or a referral to the Justice Department (45 CFR 80.8).

No one may threaten or punish a person for complaining or for helping an investigation (45 CFR 80.7(e)). Log each discrimination or language complaint in your NEMT complaint log with type D, keep the detail sheet in a locked file, and send the broker your answer by its deadline.