Who Pays?

Who Pays?

The Americans with Disabilities Act requires providers, business owners and the government provide accommodations and ensure full communication access in legal, medical, educational, employment and public access settings. Healthcare settings, legal services, workplaces and public and private services must be made accessible to all people, regardless of disability. For those who are Deaf, Deaf-blind, or hard of hearing, often the best way to ensure full communication access is to have an interpreter.

Americans with Disabilities Act & Healthcare

Title III of the American with Disabilities Act (ADA) requires private physical and mental healthcare providers offer appropriate accommodations and ensure patients have full communication access. All private healthcare facilities and providers, regardless of business size, are required to meet this obligation.

Hospitals, nursing homes, psychiatric and psychological services, offices of private physicians, dentists, health maintenance organizations (HMOs) and health clinics are included among the healthcare providers covered by the ADA.

• How does a healthcare provider determine which auxiliary aid or service is best for a patient with a hearing loss?
A person with a hearing loss knows best which auxiliary aid or service will achieve effective communication with his or her healthcare provider. The auxiliary aid requirement is flexible, and the healthcare provider can choose among various alternatives as long as the result is effective communication for the individual with a hearing loss. The Justice Department expects that the healthcare provider will consult with the person and consider carefully his or her self-assessed communication needs before acquiring a particular aid or services. 56 Fed. Reg. at 35566-67

• Are there any limitations on the ADA’s auxiliary aids and services requirements?
Yes. The ADA does not require the provision of any auxiliary aid or service that would result in an undue burden or in a fundamental alteration in the nature of the goods or services provided by a healthcare provider. However, the healthcare provider is not relieved from the duty to furnish an alternative auxiliary aid or service, if provision of that aid or service would not result in a fundamental alteration or undue burden. Both of these limitations are derived from existing regulations and case law under section 504 of the Rehabilitation Act and are to be determined on a case-by-case basis. 28 C.F.R. 36.303(a) (http://www.ada.gov/reg3a.html#Anchor-97857), 28 C.F.R. 36.303(f) (http://www.ada.gov/reg3a.html#Anchor-97857)

• When would providing an auxiliary aid or service be an undue burden?
An undue burden is something that involves a significant difficulty or expense. Factors to consider include the cost of the aid or service, the overall financial resources of the healthcare provider, the number of the provider’s employees, legitimate necessary safety requirements, the effect on the resources and operation of the provider, and the difficulty of locating or providing the aid or services. 28 C.F.R. 36.104 (http://www.ada.gov/reg3a.html#Anchor-36104)

• Who is qualified to be an interpreter in a healthcare setting?
A qualified interpreter is an interpreter who is able to interpret effectively, accurately, and impartially both receptively and expressively, using any necessary specialized vocabulary. In the medical setting, this will mean that the interpreter may need to interpret complex medical terminology. 28 C.F.R. 36.104 (http://www.ada.gov/reg3a.html#Anchor-36104)

• Do all individuals with hearing loss use the same kind of interpreter?
No, there are various kinds of interpreters. The healthcare provider should ascertain the particular language needs of the deaf or hard of hearing patient before hiring an interpreter. Some individuals may require interpreters who are fluent in American Sign Language, a language that has a grammar and syntax that is different from the English language. Others may require interpreters who use Signed English, a form of signing which uses the same word order as does English. Still others who do not know any sign language may require oral interpreters who take special care to articulate words for individuals with hearing loss.

• Can healthcare providers receive any tax credits for the costs of providing auxiliary aids and services?
Yes. Businesses, including healthcare providers, may claim a tax credit. Examples of eligible access expenditures include the necessary and reasonable costs of providing interpreters, and other auxiliary aids; and acquiring or modifying equipment or devices. As amended in 1990, the Internal Revenue Code allows a deduction of up to $15,000 per year for expenses associated with the removal of qualified architectural and transportation barriers. The 1990 amendment also permits eligible small businesses to receive a tax credit for certain costs of compliance with the ADA. An eligible small business is one whose gross receipts do not exceed $1,000,000 or whose workforce does not consist of more than 30 full-time workers. Qualifying businesses may claim a credit of up to 50 percent of eligible access expenditures that exceed $250 but do not exceed $10,250.
Omnibus Budget Reconciliation Act of 1990, P.L. 101-505, 44 (http://www.ssa.gov/OP_Home/comp2/F101-508.html)

• ADA Information Line
ADA Information Line for documents, questions and referrals – http://www.usdoj.gov/crt/ada/adahom1.htm

• Employment
Equal Employment Opportunity Commission offers technical assistance on the ADA provisions applying to employment; also provides information on how to file ADA complaints – http://www.eeoc.gov President’s Committee on Employment of People with Disabilities answers employment questions and funds the Job Accommodation Network (JAN) – https://askjan.org/index.html

• Public Transportation
Department of Transportation offers technical assistance on ADA provisions applying to public transportation – http://www.fta.dot.gov

• Accessibility
Access Board, or Architectural and Transportation Barriers Compliance Board, offers technical assistance on the ADA Accessibility Guidelines – http://www.access-board.gov/

• Education
Department of Education funds ten regional centers to provide technical assistance on the ADA – https://adata.org/national-network