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.
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.
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.
- Effective Communication
Health care providers must ensure that communications with patients with hearing, vision, and speech disabilities are effective. The aid or service provided depends on the method of communication used by the patient, how long and how complex it will be, and in what setting it will take place. The following links provide information and resources on effective communication.
ADA - Questions and Answers for Health Care Providers 2018 - National Association of the Deaf Federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing. This document addresses effective communication questions for health care professionals.
Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings - U.S. Department of Justice (DOJ) This document discusses how to ensure effective communication in hospitals or other healthcare settings for individuals who are deaf or hard of hearing. It Includes an overview of different interpreter types as well as situations where an interpreter may be necessary.
Guidance and Resources for Electronic Information Technology: Ensuring Equal Access To All Health Services And Benefits Provided Through Electronic Means - U.S. Department of Health and Human Services, Office for Civil Rights (HHS) This document discusses the obligations of technological aspects of health care to be designed in a way that provides accessibility to all users and comply with the requirements of the ADA.
Effective Communication - ADA National Network The ADA requires public entities (state and local governments) and private entities (businesses and nonprofit organizations that serve the public) to provide auxiliary aids and services to make sure that individuals with speech, hearing and vision disabilities can understand what is said or written and can communicate effectively. This document discusses the goal to ensure that communication with people with disabilities is as effective as communication with people without disabilities.
711 for Telecommunications Relay Service 2015 - Federal Communications Commission (FCC) Telecommunications Relay Services (TRS) permits persons with a hearing or speech disability to use the telephone system via a text telephone (TTY) or other device to call persons with or without such disabilities. An individual can call someone using TRS by using their TTY or dialing 711 on their telephone. They will automatically be connected to a TRS operator.
Video Relay Services 2017 - Federal Communication Commission (FCC) Video Relay Service (VRS) is a form of Telecommunications Relay Service that enables persons with hearing disabilities who use American Sign Language to communicate with voice telephone users through video equipment, rather than through typed text. Video equipment links the VRS user with a TRS operator – called a communications assistant, or CA – so that the VRS user and the CA can see and communicate with each other in signed conversation.
- 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.
Modernizing Health Care To Improve Physical Accessibility 2019 - Center for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) The resources in this inventory include guidance on how to increase physical accessibility of medical services, tools to assess your practice or facility’s accessibility for individuals with disabilities, and tips and training materials to support efforts to reduce barriers and improve quality of care.
- 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.
- Legal Documents, Lawsuits and Settlements
Below are links to ADA related legal documents that may be of interest to healthcare providers.
Access to Healthcare and the ADA - Legal Brief 2018 (pdf) - ADA National Network (rtf) and (doc) versions. This legal brief contains examples of case law and settlement agreements on the ADA and healthcare.
Barrier- Free Health Care Initiative - U.S. Deparment of Justice Civil Rights Division (DOJ) The Barrier-Free Health Care Initiative is a multi-phase initiative that includes effective communication for people who are deaf or have hearing loss, physical access to medical care for people with mobility disabilities, and equal access to treatment for people who have HIV/AIDS.
Your Healthcare Rights under the ADA and other Civil Rights Laws - Nevada Disability Advocacy and Law Center An overview on accommodations that medical facilities must provide to individuals with disabilities such as physical access accommodation designs to facilities and exam rooms, effective communication techniques and how to make modification requests.
Settlement Agreement: The United States Attorney’s Office for the Western District of Kentucky and Hardin County Emergency Medical Services This settlement agreement regards the provision of emergency medical services to qualified individuals with disabilities, including individuals using service animals, so that they may participate in or benefit from healthcare services.
Settlement Agreement: The United States of America and Bio-Medics This matter was initiated by a complaint filed by the American Council of the Blind against Bio-Medics. The complainant alleged that he was prohibited from donating his plasma at a Bio-Medics donation center because he was blind.
Settlement Agreement: United States of America and Dr. Bruce Berenson, M.D. P.A The complainant alleged that he was denied access to medical services because he was accompanied by his service animal. The medical office staff inappropriately questioned and objected to the presence of the complainant's service animal in the office's waiting area, and requested written documentation regarding its training and certification.
Settlement Agreement: United States of America and McLean Hospital The complainant requested admission to a residential therapeutic facility and required the use of a wheelchair. She was immediately denied admission because of her need for wheelchair accessibility.
Settlement Agreement: United Spinal Association et al. v. Beth Israel Medical Center et al. This settlement agreement contains a comprehensive remedial plan to improve access to health care for patients and hospital visitors with disabilities. See exhibits A-D at the bottom of the above link for required remedial action in the areas of barrier removal, patient complaints, effective communication and service animals.
- Addiction and Substance Abuse Treatment
Addiction is an impairment that substantially limits the major life activity of the brain and neurological functions. Drug and alcohol addiction is considered a disability under the ADA when that addiction limits a major life activity. The following links provide healthcare professionals with information and resources in the area of addiction.
The ADA, Addiction and Recovery - 2019 - ADA National Network This factsheet discusses addiction to drugs and alcohol and what is covered under the ADA.
Drug Addiction and Federal Disability Rights Laws 2018 - U.S. Department of Health and Human Services (HHS) Drug addiction, including an addiction to opioids, is a disability under Section 504 of the Rehabilitation Act, the Americans with Disabilities Act, and Section 1557 of the Affordable Care Act, when the drug addiction substantially limits a major life activity. This document discusses when a drug addiction is considered a disability under federal disability rights law.
Opioid Use - Non Discrimination and Opioid Use Disorder 2018 - U.S. Department of Health and Human Services (HHS) Discriminatory barriers in health and human services programs, including opioid use disorder treatment and recovery programs, can delay and prevent people with an opioid use disorder from getting the help and support they need. This document discusses the protections that may extend to individuals in recovery from an opioid use disorder if they are members of a protected group.
Substance Abuse Disorder Treatment for People with Physical and Cognitive Disabilities - Substance Abuse and Mental Health Services Administration (SAMHSA) This document discusses the best treatment practices for individuals with disabilities and Substance Abuse Disorder. It includes an overview on recognizing barriers to treatment, adapting treatments to accommodate each disability on an individual basis and post-treatment follow-up.
Substance Use Disorders in People with Physical and Sensory Disabilities - Substance Abuse and Mental Health Services Administration (SAMHSA) This brief includes informational resources such as statistics, screening techniques, types of services that can assist with substance use disorders (SUD) and disabilities and ways to interact and assist clients with SUD.
- Supplemental Resources
The following documents provide additional ADA related information to assist in providing healthcare to individuals with disabilities.
Access to Care for Patients with Disabilities 2018 - American Medical Association (AMA) Accessibility of health care clinics, hospitals and other facilities in which patients receive care by a health care professional is essential to ensuring people have the ability to obtain the care they need when they need it. This document discusses strategies to assure that accessibility.
Accessible Health Care 2017 - ADA National Network The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act require that health care providers provide individuals with disabilities full and equal access to their health care services and facilities. This document discusses those responsibilities for health care professionals.
Barrier-Free Health Care Initiative - U.S. Department of Justice (DOJ) This document discusses a series of lawsuits and settlements that relate to the DOJ’s Barrier-Free Health Care Initiative. Each brief is organized in chronological order and relates to physical access, effective communication and equal treatment for individuals with HIV/AIDS.
Getting the Care You Need - Centers for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) This guide for Individuals with Disabilities is a best practices resource that highlights the approaches some beneficiaries with disabilities have implemented to help providers and office staff better meet the needs of people with disabilities. The guide includes a brief overview of patients’ rights, tips on preparing for medical appointments, information on what to do if a beneficiary experiences difficulties accessing care, and an appointment checklist with tips on how individuals can work with their provider to get the care they need before, during, and after an appointment.
Guidelines for Disability Inclusion in Physical Activity, Nutrition and Obesity Programs and Policies: Implementation Manual - National Center on Health, Physical Activity and Disability (NCHPAD) The Center on Disability at the Public Health Institute (COD-PHI) is part of the National Center on Health, Physical Activity, and Disability (NCHPAD). COD-PHI has developed Guidelines for Disability Inclusion in Physical Activity, Nutrition, and Obesity Program Initiatives. Those guidelines were developed to assist in the updating of community health programs and policies to be inclusive of the needs of people with disabilities.
How Does Disability Affect Access to Health Care for Dual Eligible Beneficiaries? 2019 - Centers for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) This data highlight examines how a disability affects access to health care for Medicare and Medicare dual eligible beneficiaries.
Modernizing Health Care To Improve Physical Accessibility - Centers for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) The resources in this inventory include guidance on how to increase physical accessibility of medical services, tools to assess your practice or facility’s accessibility for individuals with disabilities, and tips and training materials to support efforts to reduce barriers and improve quality of care.
Navigating Health Care with a Disability: Our Stories, a Focus on People with Disabilities - Centers for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) Listening to the personal stories of people with disabilities is a powerful tool to improve our cultural competency when serving people with disabilities in health care.
Navigating Health Care with a Disability: Our Stories, A Focus on the Provider - Centers for Medicare and Medicaid Services Office of Minority Health (CMS/OMH) Learn how health care organizations and providers can improve accessibility and care for people with disabilities.
The Pendleton Project: Making Health Care Accessible to All - ADA National Network The efforts of the Oregon Office on Disability and Health to increase access to healthcare for people with disabilities through their Community Engagement Initiative is called the Pendleton Project. The project is outlined in this document.
Revisiting Disability-Related-Inquiries and Medical Examinations Under Title I of the ADA - ADA National Network This document reviews the relevant ADA statutory and regulatory language as well as the EEOC guidance on disability-related-inquiries and medical examinations in employment.
Wheelchair-Accessible Medical Diagnostic Equipment: Cutting Edge Technology, Cost-Effective for Health Care Providers, and Consumer-Friendly - Administration for Community Living This fact sheet describes what accessible medical diagnostic equipment is, how it can help address health care disparities, and how it can help promote compliance with providers' disability rights obligations.