The Patient Protection and Affordable Care Act, also known to us as Obamacare, came into effect in 2010. It’s a lengthy bill with nine titles covering a lot of ground.
The rights of people with disabilities are addressed under Title I: Quality, Affordable Health Care for All Americans, in Section 1557.1 What does this law mean for your health organization and how can it help you deliver a superior level of service to your clients and patients with disabilities?
The Affordable Care Act (ACA) was passed to ensure that more people have access to health care. And while that can mean eliminating financial barriers through initiatives like tax credits for families, it can also mean eliminating other, non-financial types of barriers, such as systemic or technology barriers.
Section 1557 prohibits discrimination against a number of disadvantaged groups, including people who have disabilities. This is critical, because people with disabilities are at a double disadvantage.
The World Health Organization is one of several agencies demonstrating that these individuals generally have a greater need for healthcare than people without disabilities, and yet are less likely to access health services due to barriers.
As an example, a CDC survey of adults with health insurance found that those who had disabilities were almost three times more likely to put off or go without medical care – even though they had coverage!
Thus even when people with disabilities can afford healthcare, a frustrating mix of physical, technological, logistical, systemic and attitudinal barriers can continue to block their path to better health.
With the increasing role of technology and other digital services in healthcare – from mobile platforms to telecare to health portals – people with disabilities can be put at an even greater disadvantage if their needs are not considered.
If, on the other hand, these technologies are made accessible to them, it can fundamentally contribute to their health and well-being.
Does your organization deliver a positive digital experience to clients with disabilities?
Does Section 1557 Apply to You?
Who is legally bound to comply with the Affordable Care Act? The law applies to any health program that’s either administered or funded by the U. S. Department of Health and Human Services (HHS), as well as health insurance marketplaces (health exchanges) and the insurance plans that are offered through them.
If, for instance, your organization receives federal tax credits, grants, subsidies or Medicaid, it’s considered an ACA covered entity.
It’s important to note that every component of an organization must comply with Section 1557, not just medical departments. If a federally funded hospital has any of the following:
- an online billing system
- a web form to request appointments
- a find-a-doctor search tool
- patient-care videos or financial assistance information in digital format
It’s just as important to remove accessibility barriers from these technologies as it is in its cardiac clinic. Rather than thinking of barrier removal as a burden, consider what a difference it can make to usability and customer satisfaction of patients with disabilities.
The final rule of Section 1557 became effective on July 18, 2016. Organizations were required to be in full compliance by October 16.
Is your organization not considered an ACA Section 1557 covered entity? Regardless, this doesn’t cancel out any obligations you may have under other disability rights legislation2 such as the Americans with Disabilities Act (ADA) and the Rehabilitation Act.
How Does Section 1557 Protect People With Disabilities?
If you’re at all familiar with other legislation that prohibits discrimination against people with disabilities, there won’t be much in the final rule of the ACA’s Section 1557 that surprises you. The requirements are similar to the spirit of those under the ADA and the Rehab Act.
The ACA Section 1557 final rule calls for health agencies to use “effective communication”3 when providing medical care or any other kind of service to people with disabilities. It also stipulates that when health services, programs or activities are delivered electronically or otherwise make use of information technology, this technology must be accessible to people with disabilities.
What is meant by effective communication and accessible information technology?
Consider the purpose of the law, which is to make sure that people with disabilities have equal access to health care. If your online health information or medical forms are in an inaccessible PDF format, then people with a vision disability do not have fair and equal access to that service.
If the links on your online appointment system can only be clicked with a mouse, this may be a barrier for people with poor dexterity.
As with other legislation that ensures fair treatment to people with disabilities, Section 1557 does make it clear that health organizations don’t have to provide alternate formats or accessible communication if they successfully demonstrate that it would be an “undue financial or administrative burden.”
What we already know from past cases, however, is that it’s pretty unlikely accommodations like these could ever be deemed undue burdens. And if an organization does indeed prove that the accommodation in question poses a hardship, it is still expected to provide some other kind of accommodation to make sure people with disabilities have equal access to its services.
Part of it is simply meeting the notice requirements, having grievance procedures, and taglines that have to be displayed. Section 1557 sample notice forms are available from the HHS website.
The fact is, fixing your digital assets is achievable, if you have expert consultants with disability experience and a thorough understanding of accessibility guidelines. Remember, the ACA Section 1557 effective date was July 18, 2016. So if you’re not in compliance yet, now’s the time to make improvements.
Letting People with Disabilities Know About Their Rights
Under Section 1557, ACA covered entities are not only required to acknowledge the rights of people with disabilities by treating them equally, they’re also required to let people know about their right to be treated equally! Thus they must post a notice of non-discrimination that explains this right. To make it easier, a Section 1557 model notice is made available by the HHS. Organizations can use or adapt this sample notice as they wish, or write their own, as long as it complies with Section 1557.
Besides a sample notice, the HHS also makes available sample taglines to meet the ACA Section 1557 tagline requirement. That’s the requirement to let people with limited English-language skills know that there are free language services available. Section 1557 covered entities must do this by posting a tagline about language services, and they must translate the tagline into the 15 most common non-English languages in their state. Having sample taglines already translated and available to covered entities makes it easier to satisfy this requirement of the law.
When You Make Accommodations Under Section 1557, HIPAA Still Applies
Keep in mind that however you accommodate your patients, clients or members of the public who have disabilities, you are still required to comply with the Health Insurance Portability and Accountability Act (HIPAA).4
You must not compromise someone’s privacy by, for instance, sending digital health information that is not properly safeguarded, or requiring them to bring a sighted person to read for them, when the printed information and forms may contain confidential details. That could be a violation of HIPAA. It’s another reason to ensure you are guided by expertise as you make these disability accommodations.
The HHS’s Office for Civil Rights has issued a reminder that there are many technological solutions available that can do the job effectively, while still keeping a person’s health information private.
The Million-Dollar Question – Will Section 1557 Be Repealed?
With the change in federal leadership, naturally there’s some uncertainty around Obamacare, including what will be repealed and when that might happen. Will the regulations outlined in Section 1557 continue to be relevant?
In a January letter5 signed by four federal physician associations, the incoming administration is urged to continue to protect people with disabilities and other groups from discrimination as it considers changes.
More recently, the new president promised – without going into details – that a replacement6 for the Patient Protection and Affordable Care Act is almost complete and on the way.
Whether people with disabilities are specifically mentioned in the plan, and whether the wording will mirror Section 1557 in the Federal Register, remains to be seen. Either way, the requirements under the ADA and the Rehab Act will continue to apply.
As a health organization, when you take accessibility guidelines seriously and take practical steps to comply with them, you’re enhancing your clients’ experience – and you’re enhancing their health.
An Innovative Web Accessibility Solution
eSSENTIAL Accessibility has developed a full-stack accessibility solution to help organizations follow the Web Content Accessibility Guidelines (WCAG) and achieve and maintain compliance with Section 1557. This includes integrating web accessibility compliance services with assistive technology to deliver a transformative experience for people with disabilities. Learn more about eSSENTIAL Accessibility’s innovative solution.
- Section 1557 of the Patient Protection and Affordable Care Act. U.S. Department of Health & Human Services.
- A Guide to Disability Rights Laws, July 2009. Web Accessibility U.S. Department of Justice, Civil Rights Division, Disability Rights Section.
- Section 1557: Ensuring Effective Communication with and Accessibility for Individuals with Disabilities. U.S. Department of Health & Human Services.
- Summary of the HIPAA Privacy Rule. U.S. Department of Health & Human Services.
- AAP AAFP ACOG ACP 115th Congress Health Reform Priorities Letter. American Academy of Pediatrics.
- Robert Costa and Amy Goldstein. Trump vows ‘insurance for everybody’ in Obamacare replacement plan. The Washington Post, January 15, 2017.