On September 8, 2015, HHS published a wide-ranging proposed rule to implement Section 1557 the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives financial assistance from or is administered by HHS or any entity created under Title I of the ACA, including qualified health plan issuers. Notably, the proposed rule would implement ACA civil rights protections against sex discrimination, including gender identity discrimination, in these health programs. It also would establish requirements related to effective communication for individuals with disabilities, enhanced language assistance for people with limited English proficiency, and legal remedies for discrimination. HHS requests comments on whether the rule should include a specific exemption for religious organizations, although it notes that nothing in the rule would affect the application of existing protections for religious beliefs and practices. The proposed rule includes a detailed regulatory impact analysis, in which HHS estimates that the rule would result in $383 million in training costs over a two-year period, another $122 million in increased annual enforcement costs. $48 million in costs associated with revisions to policies and procedures, and $5 million for various printing costs, for a total of $558 million. HHS will accept comments on the proposed rule through November 9, 2015.