Do You Know Your Legal Obligations to Disabled Patients?

Ms. Gelburd

Ms. Gelburd notes that before the ACA, if a person wanted an in-person sign language interpreter, all that was required was that a practice consider the individual’s request. There was a lower bar for turning down the request. Now, unless a practice can demonstrate that another equally effective means of fulfilling that request is available or that supplying the requested type of aid would result in an undue burden, the person’s request must be honored.

“What is ‘equally effective’ is an issue the practice’s attorney would have to sort out,” says Ms. Gelburd. “Attorneys are critical here, because they are the ones [who] can tell you what courts have determined this means—especially since the standards under the definitions can change from one jurisdiction to the next.”

Undue Burden on Practices

The other important concept to understand what comprises an “undue burden” on the practice. If you can show the changes in the physical structure of the practice would cause an undue burden, then you can dispute the request and say you can’t accommodate it.

This is another time to talk to your attorney. They can help you work through the law and define what is or, perhaps more importantly, is not an undue burden. This can be a very high bar, especially because you cannot charge the patient extra for providing these services. A $500-an-hour, in-person, sign language interpreter usually comes out of the practice’s pocket.

“It can be very expensive to hire auxiliary services, and [the costs] can exceed the amount of reimbursement,” says Ms. Gelburd. “Basically, it costs money to see these patients, but you still can’t legally refuse to see them or charge them extra. This gets more significant if you make the arrangements and the patient is a no-show.”

One recommendation is to talk to your attorney and get policies and procedures in place long before a situation arises. You may very well never have a hearing- or sight-impaired patient come in. If you do, your practice will be prepared.

“You don’t want to be in a position where you don’t know how to accommodate requests and you don’t know what the rules are,” Ms. Gelburd says. “You don’t want to be struggling to figure out these complex rules in real time.”

Physical Accommodations

Both the tenant and the owner are required to meet ADA standards for architectural concerns, such as handicapped parking and accessibility to waiting rooms and bathrooms.

The need for wide doors for entry to, and egress from, the building and the practice offices are well understood and, to a large extent, have been incorporated into building codes. But it is probably still a good idea to check, especially if your practice is in an older structure.

The interior design of your practice’s offices should be considered.

“Take a look at access to your facility,” says Ann Marslett, practice administrator for Rheumatology Associates of Baltimore. “For example, how easy is it for folks using walkers and wheelchairs to get around? Are the hallways wide enough, and are the exam rooms able to fit both a person in a wheelchair and someone accompanying them?”