ADA Accessibilty

All providers who receive federal funds from the U.S. Department of Health and Human Services (HHS) for the provision of Medicaid/CHIP services are obligated to make language services available to those with Limited English Proficiency (LEP) under Title VI of the Civil Rights Act and Section 504 of the Rehab Act of 1973 (source: www.medicaid.gov ). State laws may also require a doctor to provide translation services. If the doctor does not participate in Medicaid and does not practice in a state with laws that address the subject, the doctor would not be required by law to provide translation services. However, most providers would like to be able to care for all patients, and there is a range of possible approaches that would allow you to provide such care.

Remember that where required by law (i.e., state law or federal law applicable to Medicaid providers), a doctor is required to provide an effective means of communication with the patient. As is the case with providing care to hearing impaired patients, there is no bright line rule that defines what constitutes an effective means of communication.

For a foreign language speaker, using written means of communication is helpful only if the text has been translated in advance and the optometrist can understand the answers to questions. Effective communication between the patient and the doctor or staff may require a method of real-time communication, in which case commercially-available conference telephone and video language interpretation services are a possible solution. There may also be low cost interpreters available through local social services agencies. A doctor is not required to pay for an interpreter brought by the patient; however, if there is an unresolvable disagreement between the patient and the doctor as to what it takes to facilitate effective communication between the patient and the doctor, the safest approach may be to agree to the patient’s request, in particular for Medicaid providers or doctors who live in states with laws requiring the provision of translation services.

It is not permissible to require a patient to bring his or her own interpreter, whether a family member or professional interpreter; however, in many cases a patient may prefer to have a family member interpret. If the patient requests it, this an acceptable solution.

HIPAA rules do not require a doctor to obtain authorization from the patient in order to share patient information with a professional translator, or a member of the patient’s family present when the care is delivered. While a translator hired by a doctor’s practice as an independent contractor is not a workforce member, a doctor is permitted to disclose patient information to the translator so long as a business associate contract is in place in compliance with 45 C.F.R. 164.504(e). See Title 45 C.F.R. 164.506(c) for more information.

The U.S. Department of Justice and Department of Health and Human Services take the position that bathrooms in doctor’s offices must be ADA accessible. However, exact requirements depend on the characteristics of the building, such as the date it was build or last renovated. The ADA Standards for Accessible Design available on the ADA website ( www.ada.gov) provide more detailed information.

For a definitive answer based on your building’s characteristics, it would be best to consult an architect or an attorney who specializes in ADA law. Doctors who lease space should ensure that the issue of ADA accessibility is addressed in their lease and ideally make the Landlord responsible for providing accessible facilities either in the leased space or building common areas.