ADA requirements for physician offices
by Sara Bergmanson, Digital Marketing and Brand Strategist,
Tanya Babitch, Assistant Vice President of Risk Management, and
Robin Desrocher, Director, Risk Management
Title III of the Americans with Disabilities Act (ADA) declares medical offices and hospitals as “public accommodations” that must comply with ADA regulations. It is important for people with disabilities to receive medical services equal to those services received by a person without a disability.
The breadth of the ADA’s definitions and resulting responsibilities can be daunting. Physicians often ask what constitutes “best practice” for providing reasonable accommodations for disabled patients. Sometimes even more unknown are the conditions that qualify as a disability under the law.
This article answers six common questions about the ADA. For more detailed information, please see our two-part article in the Reporter Quarter 2 and Quarter 3 2016. See also the CME course, “Treating and Accommodating Patients Under the Americans with Disabilities Act.”
What am I required to do under the ADA to accommodate patients who are hearing impaired?
Appropriate auxiliary aids and services may include qualified interpreters, assistive listening devices, note takers, and written materials. The ADA does not require modifications that would fundamentally alter the nature of the services provided or result in an "undue burden" on the provider.
What constitutes an "undue burden" is determined on a case-by-case basis. At least one court has found in favor of the plaintiff over the provision of an interpreter for a hearing-impaired patient in a primary care physician's office.
See more in this ADA Business Brief. Also see our article on page 9 in the Reporter Q3 2016 about accommodating hearing impaired patients.
What does the ADA require for mobility-impaired patients?
A public accommodation is required to remove architectural barriers in existing facilities where such removal is "readily achievable," which is defined as "easily accomplished and able to be carried out without much difficulty or expense." Examples of actions to remove barriers include installing ramps, widening doors, installing grab bars in bathroom stalls, installing a raised toilet seat, removing deep pile carpeting, and creating designated, accessible parking spaces.
Please refer to the ADA website and resource, "Access To Medical Care For Individuals with Mobility Disabilities," for more information.
What about those patients who do not speak English? Am I required to provide and absorb the cost of an interpreter?
These patients are not considered disabled under the ADA. However, according to the Office for Civil Rights, an entity receiving federal reimbursement (such as Medicaid or Medicare) is responsible for ensuring that effective oral and written communication occurs with program beneficiaries who are limited English proficient (LEP).
The entity can take several steps to meet its obligations to LEP patients. Providing interpreters, at no cost to the client, is one method. Please visit the Federal LEP website for more information.
Who has responsibility for ADA compliance in leased buildings, the landlord or the tenant?
The ADA places legal responsibility to remove barriers or provide auxiliary aids on both the landlord and the tenant. Typically, the tenant is responsible for the space they use and control such as an exam room or reception area. The landlord is typically responsible for common space such as a parking lot or building entrance used by more than one tenant.
What is my responsibility as an employer under the ADA?
Employers with 15 or more employees must comply with the ADA in their employment practices. The ADA protects individuals with disabilities from discrimination related to employment practices. Individuals with disabilities who meet "the skill, experience, education, and other job-related requirements of a position held or desired, and who, with or without reasonable accommodation, can perform the essential functions of a job" are protected.
To be covered by the ADA, an individual must have a mental or physical impairment that (even with corrective or mitigating measures, such as corrective lenses) substantially limits one or more major life activities. In addition, the ADA prohibits discrimination against persons who are perceived to have a disability.
As an employer, it is essential to train staff members on ADA requirements and what makes up “reasonable accommodation” for patients. It is good practice to create written policies and procedures that include topics such as scheduling appointments (with attention to patients needs such as accessible examination tables); service animals; providing interpreters; and making the office space as accessible as possible. Training resources can be found on the ADA National Network website.
TMLT policyholders also have access to information on employment and human resources issues through EPLI Pro. EPLI Pro offers webinars, workforce training, and guidance on creating staff handbooks and policies and procedures. (Please log in to myPortal, our members-only portal, to access ELPI Pro.)
Does my website or patient portal need to be ADA accessible?
Yes. ADA requirements apply to all goods, services, privileges, or activities offered by a business, including those offered on the web. Currently, there are no detailed standards enforced by the Department of Justice, and businesses are allowed to choose how they will ensure the accessibility of their online services.
For guidance, please see the Web Content Accessibility Guidelines and the Section 508 Standards, which the federal government uses for its own websites. See also ADA guidance on web accessibility.
How can I get more help understanding and interpreting ADA rules?
The Department of Justice operates a toll-free ADA Information Line to provide information and materials to the public about the requirements of the ADA. ADA Specialists assist callers in understanding how the ADA applies to their situation, are available on Monday, Tuesday, Wednesday, and Friday. Calls are confidential.
To get answers to technical questions, obtain general ADA information, order free ADA materials, or ask about filing a complaint, call 800-514-0301 (voice) or 800-514-0383 (TTY).