From ADA to CLAS: A Healthcare Provider’s Legal Accessibility Checklist

This healthcare accessibility legal guide looks at what accessibility in healthcare is. One of the best ways to stay compliant is to ensure you’ve covered different needs. That includes digital, language, and disability access. 

Language access in hospitals is a focus. However, all kinds of medical facilities need to ensure they’re compliant. Any space where you interact with patients, whether physical or digital, needs to meet requirements. 

The recent increase in legal pressure and the focus on ethics make compliance more important than ever before. Learn about the legal frameworks, including a link to a detailed guide on Section 1557 and how to stay compliant.  

What Healthcare Accessibility Really Means

Healthcare accessibility ensures every individual receives the appropriate services. Plus, they get the best possible outcomes. It’s not just a matter of best practice but a legal obligation that facilities need to meet. Care needs to have barriers removed.  Accommodations need to be made to ensure equitable access for all.  

In this healthcare accessibility legal guide, you’ll find out about the barriers and legal requirements for the following categories.

• Physical access
• Language access
• Sensory barriers (e.g., deaf or hard of hearing)
• Digital access

Legal Frameworks You Need to Know

To ensure your facility is compliant, it’s vital to know the laws that apply and the standards and requirements that you need to meet. We’ve listed the crucial frameworks in this healthcare accessibility legal guide.

ADA 

For ADA compliance in healthcare, we need to look to Title II and Title III of the Americans with Disabilities Act. Title II addresses nondiscrimination based on disability in state and local government services. Public accommodations cannot discriminate against individuals with disabilities under Title III. That includes private hospitals and medical offices. 

They both set out that healthcare providers must ensure full and equal access to their services and facilities. That includes reasonable modifications to practices, procedures, and policies wherever necessary.

Section 504 of the Rehabilitation Act

This civil rights law protects individuals with disabilities from discrimination. It applies to any employer or organization that receives financial assistance from a Federal agency or department. That includes the Department of Health and Human Services (DHHS).

It prohibits denying qualified individuals access to services. It ensures access to opportunities to participate in programs or other benefits, especially as a result of physical barriers. 

ACA Section 1557

There are other healthcare civil rights laws that address accessibility. The Affordable Care Act is one, in particular, Section 1557. You can get a comprehensive overview of compliance in our dedicated Section 1557 of the ACA article. 

It protects people against discrimination on the grounds of age, sex, disability, race, color, and national origin. It applies to healthcare programs and activities funded by Federal departments.

CLAS Standards

CLAS refers to the National Standards for Culturally and Linguistically Appropriate Services. They’re in place to eliminate healthcare disparities. 

When implementing the 15 CLAS standards, healthcare facilities ensure they provide equitable, understandable, respectful, and effective quality care. It specifically identifies being responsive to diverse cultural health beliefs, practices, languages, communication needs, and health literacy.

Local and State Laws

Your facility may also need to take steps to comply with local or state laws that reinforce federal mandates. For example, Connecticut has a Website Accessibility Policy. You can check digital accessibility laws in different states through this government website. 

Language Access Compliance

National origins and language preferences are protected under several laws. Language access, then, is a crucial aspect of compliance. Facilities can make their services accessible by using language services for healthcare providers.

Protections for LEP Patients

LEP stands for Limited English Proficiency. These patients are covered by legal protections. They require providers to ensure that LEP patients can participate in their healthcare. When complying, your aim is to identify and overcome language barriers in the healthcare industry.

Patients have a right to language assistance services. That includes an interpreter or document translation. Types of services where this applies include:

• Seeking care in an emergency room
• Picking up a prescription from a pharmacy
• Visiting a dentist or a doctor
• Applying for a health insurance plan
• Visiting family members in healthcare facilities, such as a nursing home

Meeting Vital Document and Interpreter Requirements

Providing access to LEP patients means using interpreter and translation services. Some State Executive Orders, such as Order 26 in New York, require public services to develop language access plans. 

As part of the plans, facilities are required to translate all vital documents into the top six languages in New York State. They also have to provide interpretation services in those languages.

Similar orders apply to pharmacies. There’s also a New York City Emergency Room Interpreter Law. It states that an interpreter for non-English speakers must be provided immediately in all NYC hospital ERs. Working with professional services is crucial to meeting requirements for translation and interpretation.

Examples of OCR Enforcement

Our healthcare accessibility legal guide looks at real examples of enforcement from the Office of Civil Rights (OCR). The OCR has completed Compliance Reviews and Complaint Investigations in hospitals, state departments of human services, social services, health systems, medical centers, and a pharmacy benefit management company.

Here are some of the outcomes:

• Agreement to expand language assistance services.
  
  
• Commitment to improve the quality of services for people who are deaf, hard of hearing, or with LEP.
  
  
• Ensured a language assistance coordinator was appointed. Training was provided to employees, and a contract with an interpreter agency was in place.
  
  
• Agreement to train staff to improve oral and written communication assessment needs of LEP patients. Included the primary language on medical cards. Updated signage with the five most commonly used languages. Added signage indicating interpreter services are available free of charge. Had a contract with video and telephone interpreter services.
  
  
• Corrective action ensured that over 900 forms and vital documents were translated. Periodic reviews of language services were in place.

The OCR enforces several healthcare accessibility laws regarding civil rights. Read our in-depth Section 1557 guide here.

Disability Access Obligations

We move on now in our healthcare accessibility legal guide to compliance with disability access obligations. We’ve explored the key areas to focus on and the requirements.

ASL Interpreting and Auxiliary Aids

Both the ADA and Section 1557 of the ACA mandate that healthcare providers need to ensure effective communication with patients who are hard of hearing, deaf, or have other communication disabilities. That means facilities are obliged to provide auxiliary aids and services. 

It’s essential to remember that medical translation and interpreting don’t only apply to overcoming language barriers. It also includes ASL interpreters, large print information, braille texts, or a qualified reader or notetaker. Other aids can include:

• Real-time captioning
• A speech-to-speech transliterator
• A computer screen-reading program
• Audio recordings of printed information 

Physical Access Requirements

The ADA also outlines specific requirements for access to medical care for individuals with mobility disabilities. They focus on physical access and disability accommodations medical facilities need to implement. Physical access is wide-ranging. It begins outside the building. It also covers the waiting room, toilets, and any consulting and patient care spaces.

When meeting physical access requirements, consider:

• Parking, including designated spaces that allow easy access for those with mobility disabilities
  
  
• Signage
  
  
• Accessible routes with ramps, lifts, and doors, corridors, and rooms with enough room for wheelchair and mobility aid users
  
  
• Accessible equipment, including adjustable-height exam tables, rails, positioning and support aids, stretchers, and patient lifts
  
  
• Assistance with equipment, dressing, undressing, or other parts of medical care

Website Accessibility under ADA

Physical spaces aren’t the only consideration. Websites and health platforms need to be accessible to people with disabilities. Here are the key considerations:

• Captions on videos
• Labels for screen readers
• Clear instructions and error indicators if information is incorrect or missing
• Mouse and keyboard navigation
• Alt text on images
• Not relying solely on color for information
• Clear color contrast

Integration vs. Segregation of Services

When implementing measures to ensure accessible healthcare, it’s essential to take an inclusive and integrative approach. The ADA prohibits discrimination and specifies segregation and unequal treatment. 

An integrated approach means everyone uses the same facilities, but there are aids and measures in place to enable full access and participation. While not every room will necessarily have an adjustable exam table, it’s important to assess the need accurately. Patients with disabilities should not have to wait longer than other patients to receive care. 

Digital Accessibility and Telehealth

As many elements of healthcare are now accessed online, this healthcare accessibility legal guide also looks at digital access. That includes telehealth, platform, and website accessibility.

What WCAG 2.1 Compliance Means

Healthcare providers can look to the Web Content Accessibility Guidelines. They provide information on accessible and compliant websites. WCAG 2.1 is an extension of the 2.0 guidelines, which include the following success criteria:

• Text alternatives 
• Captions, audio description, alternatives, and sign language 
• Content is adaptable and can be presented in different ways
• Information is distinguishable, e.g., text size, color, contrast, spacing, and audio control
• Keyboard accessible, with controls
• Not designed in a way that is known to cause seizures
• Navigable, e.g., section headings and page titles
• Understandable, e.g., uses appropriate language and explains abbreviations

How Telehealth Platforms Must Accommodate Deaf, Blind, and LEP Patients

The increasing use of telehealth means compliance in those areas needs just as much attention. Consider these points:

• Ensure the platform supports screen reader software.
• Ensure ASL or other interpreters can join from separate locations.
• Provide instructions in languages other than English.
• Allow additional time for patients with disabilities to become familiar with the platform.
• Provide qualified interpreters for appointments.
• Use real-time captioning.
• Use audio descriptions.

Implementing Multilingual Digital Materials

Healthcare information is often communicated digitally. For LEP patients, they need to have the same opportunities and access. Here’s how you can ensure compliance.

• Include a statement in other languages in emails and social media posts with information on how to obtain the details in a language they can understand.
  
  
• Create versions of your website in the most-used languages in your state or area.
  
  
• Let website users know that translated materials and language services are available free of charge.

Common Legal Risks in Non-Compliant Systems

This list of common legal risks can help compliance teams review their policies and procedures.

• To ensure interpretation compliance in healthcare, work with professional and qualified interpreters and not untrained bilingual staff.
  
  
• Regularly review patient portals to see if anything is outdated and test them for accessibility using WCAG and the digital guidance above.
  
  
• Focus on signage and notifying patients of their rights, especially access to free language services.
  
  
• See more OCR cases for examples.

Proactive Steps to Stay Compliant

One of the best ways to stay compliant is to be proactive in the following ways.

• Conduct accessibility audits.
• Create disability and language access plans.
• Train staff and ensure vendor accountability.
• Commission accurate medical document translation and amend signage.

Language Network offers expert support for healthcare accessibility reviews; let’s talk.

Legal Accessibility = Patient Safety and Institutional Protection

When you address accessibility and meet legal requirements, you’re also paving the way for the best outcomes for your patients. Not only does that reduce risk, but it enhances your reputation. Use this healthcare accessibility legal guide to review your accessibility systems now. Reach out to Language Network for more guidance and support services.