HHS Finalizes Changes to Federal Conscience Protections for Health Care Workers
- January 12, 2024
The Department of Health and Human Services Office for Civil Rights (OCR) issued this week a final rule (89 Fed. Reg. 2078) that partially rescinds or modifies certain provisions of a 2019 final rule that broadened protections for health care entities and individuals who refuse to provide or pay for medical services because of their religious or moral beliefs.
The final rule, which was published in the January 11 Federal Register, restores the longstanding process for enforcing federal conscience laws and strengthens protections against conscience and religious discrimination, the agency said.
According to the agency, the changes are aimed at striking a better balance between strengthening conscience and religious nondiscrimination protections for health care workers while also ensuring access to care for patients.
The 2019 final rule, which has never taken effect, explicitly extended conscience protections to services such as abortion, sterilization, and assisted suicide, as well as advance directives. The rule also required those receiving federal funds to provide assurances and certifications of compliance, maintain records, and meet reporting and non-retaliation requirements. Under the 2019 final rule, HHS could terminate federal funding for covered entities for non-compliance.
The conscience rule drew several legal challenges from states and local governments, which characterized the rule as an unlawful attempt to allow health care providers to openly discriminate and refuse to provide necessary health care to patients. Federal courts in California, New York, and Washington struck down the final rule, holding HHS lacked authority to promulgate significant portions and that it conflicted with other federal statutes.
OCR said it received over 48,000 comments on the proposed rule, which was issued in February 2023. The agency specifically asked for comments on retaining or modifying certain provisions of the 2019 final rule and on whether it would hinder access to sexual and reproductive health care and other preventive services.
“After carefully considering these comments, the Final Rule clarifies what federal conscience laws OCR enforces, details how OCR will enforce federal conscience laws, and encourages covered entities, such as grantees and providers, to voluntarily post a notice of rights to ensure compliance and educate the public about conscience statutes and rights,” the agency said.
The final rule is effective March 11.