The ADA and Health Care Providers
SUMMARY: This article introduces basic Americans with Disabilities Act (ADA) requirements for health care providers. It talks about providing access to the actual building and its features, the use of service animals, changes that may need to be made, and more.
In order to best assist people with disabilities and avoid discriminating against them, health care providers must follow special rules, based on the Americans with Disabilities Act (ADA). Many of these rules are common-sense provisions that allow people with disabilities to access appropriate care in a reasonable way, understand their care, and communicate effectively about their care.
Which Health Care Providers?
Health care providers—whether a doctor’s office, a clinic, a hospital, a group practice, an urgent care provider, a general physician, a dentist, or some other type of health professional—are usually covered by the ADA.
Title II of the ADA applies to state and local governments and various related organizations (public entities). This means that a county hospital, a city-operated clinic, or other similar organization must adhere to the obligations of Title II.
Title III of the ADA applies to public accommodations. A public accommodation is generally a business or nonprofit organization that provides goods or services (such as medical care) to the public. This includes places like private medical practices, private hospitals, and private physical rehabilitation facilities.
Facilities that receive federal funding may also need to consider disability-related requirements based on the Rehabilitation Act.
The ADA and Religious Organizations
Although Title III exempts “religious organizations or entities controlled by religious organizations, including places of worship,” other disability-related legislation may apply. Here are a few examples:
- If a health care provider has 15 or more employees, it must comply with Title I of the ADA.
- The health care provider may receive federal financial assistance, such as Medicare or Medicaid. If so, it must follow Section 504 of the Rehabilitation Act.
- Local and state non-discrimination laws may apply.
Physical accessibility makes it possible for patients to enter a building and use its features. It means that a person using a wheelchair, walker, or other mobility aid can enter the building and access all the areas of the building that other patients can access. Curb cuts, ramps, elevators, accessible bathrooms, Braille on signs, and much more play a role in physical accessibility.
A health care provider that is a public entity under Title II or a public accommodation under Title III must comply with the relevant physical access requirements under each title of the ADA. That means that any new construction or alterations must comply with the 2010 ADA Standards for Accessible Design.
Existing facilities are expected to progress over time toward full compliance with these standards. In addition to the requirements to provide such things as accessible parking (section 208), an accessible path of travel, and access to primary function areas, each health care facility must meet certain specific standards based on the type of facility and the patient population it serves. For examples, sections 223 and 805 cover certain considerations for medical facilities where the period of stay is longer than 24 hours.
Under the regulations for Title II and III of the ADA from the Department of Justice, a service animal is a dog (with the sole exception of a miniature horse) that is trained to perform a specific task for a person with a disability.
When a service animal needs to enter a medical facility with its handler, it must be permitted to accompany their handler wherever the public is normally allowed to go. This includes spaces such as patient rooms, cafeterias, waiting areas, and examination rooms. However, a service animal may be prohibited from strictly sterile environments, such as a burn unit or operating room.
The service animal must be under the control of its handler at all times. It should be harnessed, leashed, or tethered—unless the handler’s disability prevents the use of these tools, or if they would interfere with the task of the service animal.
There is no special license or certification required for a service animal. When it is not clear what task a service animal performs, a health care provider may ask two questions:
- Is the animal a service animal needed because of a disability?
- What task or work has the animal been trained to perform?
Beyond these two questions, a provider may not ask about an individual’s disability or request additional verification. A person with a disability should not be asked to remove their service animal unless it is out of control and the handler does not correct it, or if the service animal is not housebroken.
A concern for allergies is not a reason to exclude a service animal from a facility. The health care provider may need to create a strategy for accommodating the handler, their service animal, and those who may have allergies.
Reasonable Modification to a Policy, Practice, or Procedure
As a public entity under Title II or a public accommodation under Title III, a health care provider must reasonably modify its policies, practices, and procedures to avoid discriminating against an individual with a disability. This may mean adapting the way something is done to best accommodate the individual. Policies, practices, and procedures must be carefully thought out to include individuals with disabilities, though the health care provider does not have to make a modification that would fundamentally alter its programs, activities, goods, services, or facilities.
Even though there may be cost to a health care provider to comply with the ADA, a health care provider covered by Title II or III may not pass the cost to an individual with a disability or group of individuals with a disability. Any surcharge for reasonable modifications, auxiliary aids or services, or removal of physical barriers is not allowed.
Nondiscrimination in Programs, Services, and Activities
A key aspect of Title II is that individuals with disabilities must be provided an equally effective opportunity to participate in or benefit from a public entity’s aids, benefits, and services. An individual may not be denied participation or excluded from a program based on their disability.
Under Title III, an individual with a disability may not be denied full and equal enjoyment of the “goods, services, facilities, privileges, advantages, or accommodations” of a public accommodation. An individual with a disability must be given equal opportunities to participate, benefit, and receive the benefits of a public accommodation in the most integrated setting appropriate.
In short, in order to comply with the ADA, health care providers must apply the concept of equal opportunity to their operation.
Health care providers must ensure that communication with a person with a disability is equally effective as that provided to individuals who do not have a disability. To put this into real-world terms, providers must use auxiliary aids and services to communicate effectively. Examples of auxiliary aids are alternative formats for documents, such as Braille and large print. Examples of auxiliary services are qualified readers and sign language interpreters.
Providers should consult with the individual to determine what is an appropriate aid or service:
- For a public entity, primary consideration must be given to the individual’s choice.
- For public accommodations, the preference of the individual must be taken into account, but the public accommodation may provide an alternative aid or service as long as it is equally effective.
A health care provider must factor in the length and complexity of communication in assessing what is the appropriate aid or service. If a patient who is Deaf is stopping by to drop off a form, then a sign language interpreter would not be necessary; communication can take place with written notes. However, if the same patient is consulting with a physician, then a sign language interpreter would be appropriate. And, it would be inappropriate to require the patient to have a family member or friend interpret, given the nature of the communication. A qualified interpreter must be provided.
While a provider does not have to offer an auxiliary aid or service that would cause a fundamental alteration to its programs, services, or goods, or create an undue burden, all the resources available to the provider must be weighed in its decision. Refusing to offer an aid or service simply because there is a cost is prohibited.
Helping Health Care Organizations Meet Their Goals
An important goal for most health care providers is to improve the lives of patients. Title II and Title III of the ADA provide a valuable starting point for helping providers take care of patients who have disabilities appropriately. Title II and Title III also help everyone understand what’s required of health care providers to ensure that all people have equal access to appropriate health care.