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Health Care and the ADA

The ADA requires delivery of services in a way that ensures that all people have an equal opportunity to achieve the full benefit of a program or service (Title II or Title III).  For healthcare providers, this means equitable access to care and services to people with disabilities must be provided.  This applies to modification in policies, practices, and procedures, effective communication,  and the physical accessibility of facilities.

Health Care and the Americans with Disabilities Act - 2019  This factsheet was produced by the Pacific ADA Center and provides a broad overview of the ADA for Health Care Providers. The ADA requires that health care entities provide full and equal access for people with disabilities. This can be done through reasonable modification of policies, practices and procedures, effective communication, and accessibile facilities.

Below are resources in the main areas of accessibility, as well as resources for employment, legal cases in this area, addiction and substance abuse, and other supplemental resources.

 

  • Modification of Policies, Practices and Procedures
    The ADA requires State and local government agencies, businesses, and non-profit organizations (covered entities) that provide goods or services to the public to make “reasonable modifications” in their policies, practices,or procedures when necessary to accommodate people with disabilities. Health care providers are required to make reasonable modifications to policies, practices, and procedures to provide equal access to healthcare facilities and services to people with disabilities. 

    "Reasonable Modification of Policies Practices and Procedures” is defined in the ADA Title II and Title III regulations. The first two links below provide the definition as defined in the ADA regulations. The following links (including service animals) define and give more detail on reasonable modification of policies, practices and procedures.

     

    Modification of Policies, Practices and Procedures, ADA Title II Regulations Section 35.130, (7)   (scroll to (7). Title II assures nondiscrimination on the basis of disability in state and local government services.

    Modification of Policies, Practices and Procedures, ADA Title III Regulations Section 36.302 (a) Title III assures nondiscrimination on the basis of disability in business and non profit services.

    Reaching Out To Customers With Disabilities - Lesson One: Policies, Practices and Procedures - U.S. Department of Justice The ADA requires businesses to make “reasonable modifications” in their usual ways of doing things when it is necessary to accommodate customers who have disabilities. This document outlines how the ADA applies to places of public accommodation.

     

    Service Animals
    The ADA requires State and local government agencies, businesses, and non-profit organizations (covered entities) that provide goods or services to the public to make “reasonable modifications” in their policies, practices, or procedures when necessary to accommodate people with disabilities. The service animal rules fall under this general principle. Accordingly, entities that have a “no pets” policy generally must modify the policy to allow service animals into their facilities. 

    There is no federally recognized registry, form, application, vest or picture ID  to designate that an animal is a service dog, an emotional support animal, or a therapy animal. People with animals often purchase certificates from the internet that say their animal is a service dog or an emotional support animal, but these certificates are not recognized by the ADA.

    The ADA defines a service dog as any dog that is individually trained to perform one or more specific physical tasks for a person with a disability. Although there is no defined list of “acceptable” tasks, the dog needs to be able to intervene or assist the person with a disability in some way.  A covered entity is entitled to ask two questions regarding (1) whether a dog is a service animal and (2) what task(s) the animal is trained to do. The answers to these two questions is what determines if the dog is a service animal or not.

    Please note: Emotional support animals are not covered under the ADA. They are covered in rental housing under the Fair Housing Act and on airlines under the Air Carrier Access Act. Emotional support animals are allowed in rental housing but are not allowed in public places where there is a no pet policy.

    The following links provide more information on service animals. See below these links for information regarding medical documentation requests for service animals and emotional support animals.

     

    Service Animals - Frequently asked Questions About Service Animals and the ADA 2015 - U.S. Department of Justice (DOJ)  Service animal rules fall under the reasonable modifications provisions of the ADA.  Accordingly, entities that have a “no pets” policy generally must modify their policy to allow service animals into their facilities. This document provides guidance on the ADA’s service animal provisions.

    Service Animals - ADA Requirements - U.S. Department of Justice  This publication provides guidance on the term “service animal” and the service animal provisions in the Department’s new regulations. (2011)

    Service Animals and Emotional Support Animals - ADA National Network   Individuals  with disabilities may use service animals and emotional support animals for a variety of reasons. This guide provides an overview of how major Federal civil rights laws govern the rights of a person requiring a service animal.

    Service Animals Fact Sheet - ADA National Network  The information in this factsheet  took effect on March 15, 2011.  It revised  the definition of service animal and added additional provisions.

    Service Animals - Guidlines for Environmental Infection Control in Health-Care Facilities - Centers for Disease Control and Prevention, U.S. Department of Health and Human Services This section of the above document provides information regarding service animals in health-care settings.

    Service Animals - Service Animals in Dental Health Care Settings - Centers for Disease Control and Prevention, U.S. Department of Health and Human Services  This document considers the question: "Should any special infection prevention measures be used when a patient is accompanied by a service animal?"

    Service Animals - Understanding How To Accommodate Service Animals In Health Care Facilities - 2013 - U.S. Department of Health and Human Services (HHS)   This fact sheet is intended to clarify legal obligations and etiquette when interacting with an individual using a service animal, with a particular emphasis on the health care setting during an emergency or disaster.

     

    Documentation
    As a healthcare provider you may be asked to provide medical documentation for a patient's service animal or emotional support animal. Please note the following:

    The ADA does not require medical documentation for a service animal. Under the Air Carrier Act some  airlines, however, may require medical documentation.

    A landlord or airline can request medical documentation indicating that an emotional support animal is necessary because of an individual's disability.

     

     

     

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  • Accessible Facilities

    Health care entities must ensure that their facilities are accessible to people with disabilities. Health care providers must have an accessible facility that is compliant with ADA Standards and have available accessible exam/ treatment/ procedure rooms. The following links provide information that help define guidelines for accessible facilities under the ADA.

     

    Access to Medical Care for Individuals With Mobility Disabilities 2010 - U.S. Department of Justice (DOJ)   Accessibility of doctors' offices, clinics, and other health care facilities is not only legally required, it is important medically so that minor problems can be detected and treated before turning into major and possibly life-threatening problems. This question and answer document addresses these issues.

    Accessible Medical Examination Tables and Chairs - ADA National Network  This publication is intended for health care professionals, hospital/clinic staff who are responsible for selecting or purchasing diagnostic medical equipment, medical equipment specialists, and all those who require knowledge of the technical specifications for accessible examination tables and chairs.

    Accessible Medical Diagnostic Equipment - ADA National Network   This factsheet aims to inform health care providers about the laws and technical criteria that apply to accessible medical diagnostic equipment (MDE), in order to improve accessibility of MDE.

    Accessible Parking - ADA National Network  State and local government agencies that offer programs, services, or activities need to make sure that people with disabilities can gain access and participate in these activities. Designating accessible parking is considered a top priority because it enables many people with disabilities to “get in the door.”  See the "Medical Facilities" section of this document for additional accessible parking requirements.

    ADA Checklist For Existing Facilities - New England ADA Center   Because the ADA is a civil rights law and not a building code, older facilities are not "grandfathered"  and are often required to be accessible to ensure that people with disabilities have an equal opportunity to participate. This document is based on the 2010 ADA Standards for Accessible Design and outlines accessibility requirements for existing facilities. Please note: Some states have additional  requirements beyond the ADA Standards to assure even greater accessibility. Check with the local building department for guidance.

    2010 ADA Standards for Accessible Design - U.S. Department of Justice (DOJ)  The ADA Standards set minimum requirements for facilities to be readily accessible to and usable by individuals with disabilities. Those facilities include newly designed and constructed or altered State and local government facilities, public accommodations, and commercial facilities. Please note: Some states have additional requirements beyond the ADA Standards to assure even greater accessibility. Check with the local building department for guidance.

    Increasing the Physical Accessibility of Health Care Facilities -  Centers for Medicare and Medicare Services (CMS)  This document includes suggestions on how to improve the physical access of healthcare facilities. It includes sections on the importance of understanding the needs of individuals with disabilities and incorporating those needs into design, monitoring and evaluation of the facilities.


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  • Employment and Documentation of Disabilities

    Employees often seek medical assistance from their healthcare provider when they have concerns that arise in or from the work environment. Employees may have a need for medical documentation when requesting a reasonable accommodation from their employer. They may need medical advise regarding the need to take a leave from work, or advise on how a medical diagnosis might affect their ability to work. The following documents may assist medical professionals in their work with individuals with disabilities and employment.

     

    Cancer in the Workplace - U.S. Equal Employment Opportunity Commission (EEOC)   This question-and-answer document addresses how the ADA applies to job applicants and employees who have or have had cancer.

    Depression, PTSD, and other Mental Health Conditions in the Workplace: Your Legal Rights - U.S. Equal Employment Opportunity Commission (EEOC)   If an employee has depression, post-traumatic stress disorder (PTSD), or another mental health condition, they are protected against discrimination and harassment at work because of their condition. The employee may also have additional rights under other laws such as the Family and Medical Leave Act (FMLA) and various medical insurance laws. The following questions and answers briefly explain these rights.

    Reasonable Accommodation and Requests for Medical Information (D) - U.S. Equal Employment Opportunity Commission (EEOC) The  EEOC is committed to providing reasonable accommodations to its employees and applicants for employment to ensure that individuals with disabilities enjoy equal access to all employment opportunities. Medical documentation is often required during the request process. Section D explains that process and the medical professional's role.

    Work-Leave, the ADA, and the FMLA - ADA National Network  An employer may (but does not have to) require the worker to certify the need for work-leave from a medical professional. Employers cannot require a worker to be completely healed before returning to work. Such policies have been found to violate the ADA because they do not allow workers to use their right to an accommodation. This document considers how effective work-leave policies are a key part of legal compliance as well as a benefit to the business.


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