We live in an increasingly digital world. So much of the day-to-day tasks we do are done on the internet on our computers and mobile phones. This is true in all aspects of life, including our health. We don't just count our steps with our phones; we also make doctor appointments, login to patient e-portals, access our medical records online, and even have virtual doctor visits. With this increased reliance on technology, it is important that all individuals have an equal opportunity to access their medical care. Some individuals with disabilities can face e-barriers, just as some other individuals may encounter physical ones. If a patient e-portal or hospital website is not accessible to an individual that cannot manipulate a mouse, then that individual is denied equal participation in those services. If a visually impaired person's screen reader cannot properly read the PDF of the medical forms he or she must complete, then that individual is not receiving communication in an effective manner.
Electronic information technology related to health care must be made accessible, but let's look at the why and how of it. There are several federal laws and regulations that come into play. The Americans with Disabilities Act (ADA) requires that individuals with disabilities be given an equal opportunity to participate in and to access the programs and services of both state and local government entities, as well as those of private businesses and nonprofits. Title II of the ADA covers state and local government and related entities while Title III of the ADA addresses public accommodations: essentially private businesses and nonprofits. Both Titles mandate that communication be equally effective with people with disabilities as communication with individuals without a disability. Section 504 of the Rehabilitation Act requires that any recipient of federal funds not discriminate against individuals with disabilities. Furthermore, recipients must furnish auxiliary aids to ensure equal communication for individuals with disabilities. Section 1557 of the Affordable Care Act (ACA) applies to any program receiving funding from the Department of Health and Human Services (HHS), any program HHS itself administers, and health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces. Section 1557 also requires that electronic and information technology is accessible to individuals with disabilities. And finally, the Center for Medicare and Medicaid Services (CMS) rules require the use of “electronic information and services which comply with modern accessibility standards such as section 508 guidelines, section 504 of the Rehabilitation Act, and W3C’s Web Content Accessibility Guidelines (WCAG) 2.0 AA and successor versions.”
But what are these "modern accessibility standards" to help measure the accessibility of websites and other forms of electronic communication? As the CMS rule suggests, WCAG 2.0 (Web Content Accessibility Guidelines) is one standard that is widely judged to be the best current practice. WCAG 2.0 is a framework established by the Web Accessibility Initiative (WAI) of the Worldwide Web Consortium (WC3). WCAG 2.0 is based on testable statements designed to create greater universal accessibility and usability. The Department of Justice -- the federal agency that enforces Title II and III of the ADA -- has used WCAG 2.0AA as a measuring stick in its enforcement activities under the ADA that involve websites and electronic information. WCAG has not been officially adopted by the Department as of this date, but it continues to apply this standard when designing settlement agreements. Section 504 does not have its own explicit standard, but serves as a framework for the application of Section 508; an electronic communication technology standard that applies to federal agencies and which now largely mirrors WCAG 2.0AA. Finally, Section 1557 of the ACA's implementing regulation states that it would be difficult for a covered entity to comply with its requirements without using a standard such as WCAG 2.0 or Section 508.
So in the end, what does this all mean? It means that individuals with disabilities should expect to have access to their health care, including when it is electronic. For hospitals, doctors' offices, managed care organizations, insurance providers, and other health care professionals it means that thoughtful consideration, planning, and effort need to be given to ensuring that individuals with disabilities can access their electronic information, services, and products.
To learn more about this issue, you may wish to view the Northeast ADA July 26 webinar on Information Access to Medical Records2017-07-25 11:08:54
On July 25-27, 2017 representatives from the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program will visit Disability Rights New York, the Protection and Advocacy system for the state of New York, in Albany.
SAMHSA/CMHS invites you to send written comments about the PAIMI Program services and activities conducted by Disability Rights New York.
Please email your comments to PAIMI@samhsa.hhs.gov2017-07-15 11:28:31
Mark the 27th anniversary of the ADA by joining this audio conference as we listen to representatives of the EEOC and DOJ present an update on their litigation, technical assistance and enforcement efforts over the past year. Participants will have an opportunity to pose questions to the presenters regarding issues in their own workplace or community.
Date: July 18, 2017
Time: 2:00pm-3:30pm ET (check the time zone where you are located to identify appropriate start time for you)
Speakers: Representatives from U.S. Department of Justice (DOJ) and the Equal Employment Opportunity Commission (EEOC)
This session is captioned via webinar platform.
Participants may join via telephone and/or via webinar platform or mobile device.
Registration is available at: www.ada-audio.org
Questions regarding this session should be directed to firstname.lastname@example.org or by calling 877-232-1990 (V/TTY)
It’s that time of year that many of us take advantage of the summer weather and “head to the shore” for some R&R. This webinar will review the scoping and technical requirements for beach access routes from the ABA Outdoor Developed Areas Final Rule. While the 2010 ADA Standards for Accessible Design do not directly address access to beaches, there are still Program Accessibility obligations to consider (for beaches maintained by state/local government entities) that require that programs and activities offered by public entities must be accessible to people with disabilities. This webinar will review the ADA’s requirements that apply to beach access routes in national parks and other outdoor areas developed by the federal government, as they can be a useful tool for ADA covered entities that are looking for best practice guidance related to beach access routes.
By Jennifer Perry
Yes, it’s that time of year when parents and guardians are busy trying to finalize plans for summer activities for their children. For many families, that involves exploring summer camp options. If you are a parent or guardian of a child with a disability, remember that your child has rights under the ADA re: summer camp. If you operate a summer camp, remember that you have obligations under the ADA to accept and support campers with disabilities as well. The U.S. Department of Justice (DOJ) along with U.S. Attorney’s offices nationwide, issued a notice in May, 2015 to reinforce the importance of inclusion when it comes to summer camps (link here: https://www.justice.gov/file/campadaflyerpdf/download). This is a good time of year to consider your policies and procedures if you operate a summer camp, to ensure that you are meeting your federal obligations under the ADA. In part, the notice issued by DOJ in 2015 states the following:
“Children with learning, mental health, or physical disabilities have the same rights to attend summer camp as their non-disabled peers and cannot be denied admission due to their disability. The Americans with Disabilities Act (ADA) requires that summer camps (both private and those run by towns or municipalities) must provide reasonable modifications of their policies, practices, and procedures when necessary to enable campers with disabilities to participate fully in camp programs, unless the camp can demonstrate that the necessary modifications would fundamentally alter the nature of the services and activities offered by the camp.”
Here are a few things for summer camps to consider:
· Does your camp have a Nondiscrimination Policy under The Americans with Disabilities Act? If so, is it made available to the public and understood by your staff? Among other things, this policy should include language that your camp will not discriminate against any individual on the basis of disability, and that your camp will make reasonable modifications in policies, practices, or procedures when such modifications are necessary to afford equal access to your services and facilities to individuals with disabilities, unless the modifications would fundamentally alter the nature of your services.
· Do your enrollment/registration materials include a nondiscrimination statement and encourage parents/guardians to reach out to camp staff to discuss appropriate reasonable accommodations or modifications in advance of the start of camp season?
· Have you trained your camp staff on the requirements of the ADA? This training includes understanding how to administer daily medicines that may be required by campers with disabilities, such as insulin (via pump or shots) and emergency medications, such as glucagon and Diastat, just as camps do for the proper use of Epi-Pens.
· Camps must evaluate each child and their accommodation needs on an individualbasis. It is critical to gather all relevant facts and consider alternatives before issuing a denial of admission to a camp program.
· Most importantly, when determining if a child with a disability is able to participate in programs/activities, camps must not react to unfounded preconceptions or stereotypes about what children with disabilities can or cannot do, or how much assistance they may require. Instead, camps must make an individualized assessmentabout whether it can meet the particular needs of the child without fundamentally altering its program. Sometimes a simple discussion with parents can result in an effective reasonable accommodation that camps can implement.
If you have questions about the obligations of summer camps under the ADA, feel free to contact the Northeast ADA Center at 1.800.949.4232 or via email at email@example.com. Happy Summer!
Jennifer Perry has worked in the accessibility field for over fifteen years, with a focus primarily on design and construction issues. She provides accessibility training for architects, code officials and other stakeholders that are tailor made for jurisdictions and include state specific accessibility requirements. Jennifer also provides technical assistance to these individuals. Before joining the Northeast ADA Center in 2014, Jennifer worked for United Spinal Association as a Compliance Specialist, proving plan review, site assessments and training programs to assist design professionals and building owners with state and federal accessibility compliance concerns. Prior to her role as a Compliance Specialist, Jennifer worked in United Spinal's Government Relations Program, where she advocated for the rights of people with disabilities in both Advocacy and Legislative roles. Jennifer holds a B.A in Political Science and French from King's College in Wilkes-Barre, PA and is a registered International Code Council (ICC) Accessibility Specialist/Plans Examiner. She has served on several ICC Task Groups, including the Visitability and Government Relations Task Groups. She was a member of the Philadelphia Accessibility Advisory Board from 1998-2005, and currently serves as the Vice President of the Board of Directors for the Fair Housing Council of Suburban Philadelphia. Jennifer and her family live in Sea Girt, New Jersey.2017-05-23 11:31:43
From Wendy Strobel Gower, Project Director, Northeast ADA Center: My friend and colleague Jim DeJong was part of an email chain in which we were discussing the ADA Education and Reform Act. He told a story of the “making of” Title III of the ADA. I asked him to write this for us so that others could understand the backdrop for Title III of the ADA and the true impact of the proposed law. Jim is in an excellent position to serve as a historian on this issue as he served on the U.S Congressional Task Force on the Rights and Empowerment of Persons with Disabilities that worked on the ADA. The ADA Centers (which both Jim and I represent) cannot lobby. Our role is to provide education. We offer the information below in that spirit.
Historical concerns with H.R. 620, the ADA Education and Reform Act of 2017
The Americans with Disabilities Act is a critical piece of legislation that ensures that people with disabilities have equal access to jobs, to their communities and to state and local government. The disability community worked long and hard to see this anti-discrimination law and its predecessors passed. The law was drafted and revised many times. When it was passed, it represented a number of compromises with the parties impacted by the law.
The fact that many organizations, including those representing the business community had a voice in the law is part of what is frustrating about the ADA Education and Reform Act of 2017. Many who understand the history of the ADA, and the work that went into its final form are understandably frustrated by this reactionary legislation. The ADA Education and Reform Act, which has been introduced into the U.S. Congress, is unnecessary. It is an overreaction to the actions of a few while placing in peril the rights of accessibility to places of public accommodation for persons with disabilities and their families. The bill ignores the past consensus efforts of disability advocates, policy makers and the business community.
As the ADA was being drafted, the National Federation of Business (NFIB) and the US Chamber of Commerce representatives met with disability leaders and congressional staff to carefully construct the ADA to not harm American business while providing access and opportunity to places of public accommodation and businesses for millions of Americans with disabilities and their families. This collaborative work happened in 1989. The disability community never intended nor wished to close or harm our places of commerce and public accommodation, as we need vibrant businesses to conduct our daily life activities and to participate in the economy of our country. But we do believe that we should have access to local business and an opportunity to spend our money just as anyone else does. The ADA represents a compromise between the interest of the disability community and the business community. All parties agreed that the final law contained extremely reasonable regulations and language. Remember, when the ADA was passed, there were only a handful of dissenting votes in Congress.
During the discussions between business, congressional and disability leaders the three main points of concern expressed and addressed as Title III of the ADA was constructed were:
1) Existing physical structures and the potential difficulty in making such facilities wholly accessible
2) The economic standing of a particular business that may not be able to afford making any structural changes
3) The need for available assistance to businesses and entities in understanding the new requirements and regulations to assist successful implementation
The parties agreed that the language in Title III of the ADA sufficiently addressed these concerns. Title III of the ADA incorporates language that states existing businesses are only required to provide access when doing so is readily achievable, meaning it is technically feasible to alter the physical structure and that those alterations are affordable. A business was not and still is not required to make its facility 100% accessible in a single effort but was and is allowed time to implement the changes as they remodel or are able to afford to do so. It is a win-win solution for all. As the business becomes more accessible, customer access increases and the opportunity for profit increases as the disability community gains access to goods and services. If a business cannot meet the aforementioned thresholds of compliance it must offer its goods in an alternative manner such as curbside service or delivery----not a new concept and obviously an economic growth concept being utilized by more and more companies in America. Sweetening the incentive for compliance with the ADA, the IRS offers tax deductions and credits for compliance efforts.
In order to ensure that business didn’t have to go it alone in understanding the regulations laid out in Title III of the ADA, federal agencies were and are mandated to provide assistance to businesses, entities and individuals about the law and its regulations. In addition to this direct assistance from federal agencies, the law established a regional network of technical assistance centers to support implementation of the ADA. The ADA National Network provides technical assistance, training, and dissemination activities to businesses, both large and small, to assist their understanding and successful implementation of the ADA. In existence now for over 25 years, the regional ADA Centers, collectively known as the ADA National Network, have assisted millions of businesses, both small and large, in doing precisely what the ADA was intended to do: provide accessible businesses to citizens with disabilities and their families. To my knowledge, none of the frivolous lawsuits occurred at a business receiving services from the ADA National Network. We are not an enforcement agency, rather we exist for the sole purpose of education and training around the requirements of the law. The ADA Centers and our relationships with business is a win –win for America and our economy. Businesses have access to more customers and people with disabilities and their families have opportunity and participation in the commerce of our society.
The proposed ADA Education and Reform Act essentially punishes businesses and entities who have complied with the law while rewarding competing businesses who chose to ignore or dismiss a federal civil rights law. This does not create a “level playing field” as the law was intended to do (The level playing field statement was articulated by President George Bush Sr. when he signed the ADA into law nearly 27 year ago). The proposed law unfairly rewards businesses who either have violated the law for decades. These businesses have failed to take advantage of the assistance to them at no charge. They chose to gamble that no one would ever notice their violations.
It is important to note that the ADA is not the only set of regulations or codes that require access for people with disabilities. The International Building Code (IBC) is utilized in most of America (about 85% of states and communities) also lays out accessibility requirements for communities. Local officials should have been informing and enforcing this building code when issuing permits for construction and operational licensing.
Finally, we must address the situation of concerns about frivolous lawsuits or serial litigants. The vast majority of ADA attorneys and plaintiffs who file claims around access issues are seeking solutions to fix real issues of access. For the rare few who may file fraudulent claims or engage in unscrupulous practices, courts and state bar associations already have extensive power to deal with any frivolous litigants or their attorneys. We should use those existing legal mechanisms when needed, rather than denying the civil rights established by the ADA. Money damages are not allowed for private plaintiffs under Title III of the ADA, which applies to privately operate public accommodations, commercial facilities, and private entities offering certain examinations and courses.
H.R. 620, the ADA Education and Reform Act of 2017, is unnecessary and it is punitive to law abiding businesses. Further, it results in denying the civil rights of citizens with disabilities and their families. It is economically unwise for our economy when one considers the needs of the growing aging population of our country and the spending power of persons with disabilities families.
I write this summary as a person with a disability, a family member of a person with a disability, a father, a husband, a small businessman, the Executive Director of the Great Plains ADA Center and former member of the U.S Congressional Task Force on the Rights and Empowerment of Persons with Disabilities (the ADA combine) and for the millions of people unable to do so themselves, or lacking the history of this situation to do so.
I ask you to dismiss this bill so we may all concentrate on fixing access to all aspects of American society that need our undivided and unified attentions.
Respectfully and adamantly submitted by,
James de Jong P.I., E.D.
GREAT Plains ADA Center
University of Missouri-Columbia2017-04-27 11:32:53
To read these stories and more go to: http://www.northeastada.org/pages/news/index.cfm?NewsID=207&NType=Newsletter2017-04-19 11:34:27
By Ellice Switzer
As a result of the November elections, the Republican Party has taken control of the legislative and executive branches of the federal government, as well as most of the Governorships and state legislative bodies throughout the country. What this means in practical terms, is that the Republican Party platform is free from the policy action “gridlock” that stymied conservative political action over the last 8 years. As a community, people with disabilities, their families and other stakeholders need to be informed about Republican ideals of distributive justice, social welfare and government oversight; as changes to these policies will impact the lives of millions.
The Republican Party platform states that:
“Our society is at a crossroads. For several generations, an expansive federal regime has marginalized and supplanted the institutions holding our society together. No wonder, then, that so much seems to be coming apart now. The question is whether we are going to reinvigorate the private-sector institutions under citizen control or allow their continued erosion by the forces of centralized social planning...”[i]
This view is represented by policy actions that seek to shrink bureaucracies in favor of private sector activities, including government spending on social programs, and to devolve responsibility for social welfare to states and individual communities. By “centralized social planning” the Republican platform refers in part to what is commonly known as “the social safety net” and encompasses programs like Medicaid and Social Security which are designed to protect the welfare of vulnerable citizens. This worldview was distinctly evident in President Trump’s recommendations for discretionary spending, which called for an overall reduction in funding to the departments of Labor (-20%), Health & Human Services (-16%), and Education (-14%), all of which fund a variety of programs and services for people with disabilities.[ii]Although Trump’s recommendations did not address the larger social welfare entitlement programs (Medicaid, Medicare, and Social Security), recent efforts at overall healthcare reform indicate a willingness to implement changes and cuts to those programs as well.
Major changes to Medicaid spending could have a swift and direct impact, as 42% of all Medicaid dollars are used to pay for services and supports for people with disabilities. [iii] Those supports include residential programs, supported employment services, transportation, personal assistance services and day habilitation programs designed to increase independence and community inclusion. However, the connection between long term supports and services for people with disabilities and Medicaid has long been misunderstood by many legislators on both sides of the aisle. The failed republican healthcare bill included changes to Medicaid that would impose ‘per capita’ or per-enrollee caps on Medicaid spending, and other healthcare reform ideas have proposed turning Medicaid into a block grant program. In either scenario, these types of reforms shift the financial burden to states and likely result in a loss of supports and services and narrower eligibility criteria[iv].
Even though the Patient Protection and Affordable Care Act (ACA or “Obamacare”) passed as an amalgam of previous attempts at bipartisan healthcare reform throughout the administrations of multiple presidencies[v], the contentious nature of the debate surrounding this legislation is no surprise given the diffuse costs associated with the ACA, in comparison to the relatively concentrated benefits of the major aspects of the plan; i.e. insuring the uninsured, and those with more costly medical expenses. But for people with disabilities, many aspects of the ACA represent a lifeline to good health, community engagement, and economic security. In the newest revisions to the now defunct healthcare bill, Republicans propose to reverse the trend of concentrated benefits and diffuse costs by eliminating the requirements to charge the same price for insurance regardless of the health status of the insured. It threatens protections for people with pre-existing conditions by allowing states an opt-out provision, and would no longer require that insurers cover a minimum of essential health benefits. The new revisions would also allow the Community First Choice Option in the ACA to expire - a Medicaid provision which allows states to provide more home and community based options to beneficiaries.
Regardless of personal political ideologies, the shift in policy action within the executive and legislative branches will undoubtedly result in real-world impact on the everyday lives of Americans with disabilities. Now more than ever, it is important to pay attention to changes as they are proposed, in order to effectively prepare and plan for the future. A better informed electorate can help to direct the dialogue around healthcare reform, to ensure that people with disabilities are not left behind.
[i] The Republican National Committee (2017) Republican platform: great American families, education, healthcare, and criminal justice. Retrieved on April 5, 2017 from https://www.gop.com/platform/renewing-american-values/
[ii] Parlapiano, A. Aisch, G. (March 16, 2016) Who wins and loses in trump’s proposed budget. Nytimes.com. Retrieved on April 4, 2017 from https://www.nytimes.com/interactive/2017/03/15/us/politics/trump-budget-proposal.html
[iv] Rudowitz, R. (2017). 5 Key Questions: Medicaid Block Grants & Per Capita Caps. The Henry J. Kaiser Family Foundation. Kff.org. Retrieved on April 4, 2017 from http://kff.org/medicaid/issue-brief/5-key-questions-medicaid-block-grants-per-capita-caps/
[v] Quadagno, J. (2014). Right-Wing Conspiracy? Socialist Plot? The Origins of the Patient Protection and Affordable Care Act. Journal of Health Politics, Policy & Law, 39(1), 35-56. doi:10.1215/03616878-2395172
Ellice Switzer has nearly 20 years of university and nonprofit experience in the field of disability. She provides national level technical assistance and training on topics related to disability and employment, and US disability policy.2017-04-06 11:35:42
Now available - The Diversity Partners Project website contains no-cost online toolboxes for leadership and frontline staff, supported by on-demand technical assistance and training from our team of subject matter experts at Cornell University’s Yang-Tan Institute on Employment & Disability. The Diversity Partners Project is for employment service professionals who wish to improve overall excellence in serving job seekers with disabilities, and to leverage existing business relationships to benefit those job seekers. The website contains over 20 learning modules for frontline staff, as well as information and guidance for organizational leaders.
To learn more, or to register, visit www.buildingdiversitypartners.org.
The contents of this project were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. Copyright © 2017 Cornell University2017-03-30 11:36:47
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