By Sara Bergmanson, Tanya Babitch and Robin Desrocher

ADA Requirements for Physician Offices

By Sara Bergmanson, Tanya Babitch and Robin Desrocher

The Americans with Disabilities Act (ADA) was signed into federal law in 1990 with the intention of providing equal protection for people with disabilities, specifically regarding employment, housing, federal funding, and access to services, such as health care.

For many, the breadth of the ADA’s definitions and resulting responsibilities can be daunting. Sometimes even more unknown are the conditions that qualify as a disability under the law.

Title III of the ADA declares medical offices and hospitals as “public accommodations” that must comply with ADA regulations. But what constitutes “best practices” for providing reasonable accommodations for disabled patients?

This article answers six common questions about the ADA

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 caseby-case basis. At least one court has found in favor of the plaintiff over the provision of an interpreter for a hearingimpaired patient in a primary care physician's office.

See more in the “ADA Business BRIEF: Communicating with people who are dead or hard of hearing in hospital settings” at https://www.ada.gov/hospcombr.htm.

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.

For more information, please refer to the ADA website, www.ada.gov/ada_intro.htm, and resource, "Access To Medical Care For Individuals with Mobility Disabilities,” at www.ada.gov/medcare_mobility_ta/medcare_ta.htm.

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 at www.lep.gov.

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 re-

quirements 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 at https://adata.org/ada-training.

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 following resources, used by the federal government for its own websites: • Web Content Accessibility Guidelines at https://www.w3.org/WAI/standards-guidelines/wcag/ • Section 508 Standards at https://www.access-board.gov/ict/ • See also the ADA guidance on web accessibility at https://beta.ada.gov/resources/web-guidance/.

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).

Sara Bergmanson is a Digital Marketing and Brand Strategist at TMLT. She can be reached at sara-bergmanson@tmlt.org

Tanya Babitch is an Assistant Vice President of Risk Management at TMLT. She can be reached at sara-bergmanson@tmlt.org

Robin Desrocher, BSN, RN, Director and Risk Manager at TMLT. He can be reached at robin-desrocher@tmlt.org