Some Biden-era rules addressing “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance,” that significantly impact medical practices, are nearing compliance deadlines. Despite pending legal challenges, 2024 federal HHS rules interpreting Section 504 of the Rehabilitation Act seem headed for final implementation soon.

The stated purpose of the rules is to ensure disabled people have equitable access to federally funded resources and services. Most notably for medical practices, the rules apply to Medicaid providers, Medicare providers, hospitals, and health systems. The rules come with significant unfunded mandated investments, the costs of which practices will have to absorb themselves.

The rules are wide-reaching and include provisions addressing ethical decisions on services like transplant recipients and contraceptives, but some of the salient provisions of the rules applicable to medical practices are noted below.

Web, Mobile, and Kiosk Accessibility

The rule does not mandate that medical practices utilize electronic web, mobile, or kiosk options. If they do, the rule clarifies that websites and mobile applications must meet the Web Content Accessibility Guidelines (WCAG) 2.1 level AA standard.

Compliance deadlines depend on organization size. Organizations with 15 or more employees must comply by May 11, 2026; those with fewer than 15 have until May 10, 2027.

Excepting out of these standards requires a high bar to overcome. The organization must demonstrate that compliance with the standard would result in a fundamental alteration in the nature of the program or activity or in undue financial and administrative burdens. Further, an organization that fails to meet full compliance with WCAG 2.1 Level AA will be deemed to be in compliance if it can demonstrate that the noncompliance has such a minimal impact on access that it would not affect the ability of an individual with a disability to use the web content or mobile app in a manner that provides substantially equivalent timeliness, privacy, independence, and ease of use.

Certain content is exempted. Five types of web content or mobile applications do not have to meet WCAG 2.1 Level AA: archived web content; certain preexisting conventional electronic documents; certain content posted by a third party; individualized, password protected conventional electronic documents; and preexisting social media posts. The content will need to be made accessible to an individual, if requested. Read HHS’ statement here for more information regarding this exempted content.

As for kiosks, they are not required to follow WCAG 2.1 AA, but they are required to be accessible under a generalized nondiscrimination provision. According to HHS, organizations can comply by having procedures that would allow persons with disabilities who cannot use a kiosk with inaccessible features to access the service without using the kiosk, by, for example, allowing persons with disabilities to go directly to the personnel at a main desk to register for necessary services.

Medical practices should check with their electronic services vendors to verify that their services meet the required standards. Going forward, medical practices should ensure that such standards are included and warranted in future vendor contracts. Your practice, not the vendor, is liable for compliance. Protect your organization. 

Medical and Diagnostic Equipment

The rules require that equipment such as “examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals” be accessible. Some examples provided by HHS include examination chairs designed to recline and be used as examination tables, weight scales that allow wheelchair users to stay in their chairs while being weighed, and imaging equipment designed for wheelchair use.  

Health care providers and systems cannot deny disabled people services because they lack accessible equipment. If they can’t, they should provide the patient with a referral to another healthcare provider and then make every effort to come into compliance with the rules.

By July 8, 2026, organizations that use exam tables and weight scales must have at least one accessible exam table and one accessible weight scale’ however, equipment acquired since July 2024 should already be compliant.

Premises 

Organizations must make reasonable modifications to policies, practices, and procedures unless the recipient can demonstrate modification would fundamentally alter the nature of the program or activity. Much of this should already be in place in compliance with the Americans with Disabilities Act. Briefly, if an organization begins new construction or alterations on or after May 9, 2025, it must comply with the 2010 Standards for Accessible Design. If any new construction is begun on or after July 8, 2024, but before May 9, 2025, the organization has the option of following either the 2010 Standards for Accessible Design or the Uniform Federal Accessibility Standards.

Enforcement and Next Steps

The HHS Office for Civil Rights (OCR) has enforcement authority. Disability advocates are also urging recipients who believe they are discriminated against or denied access to contact state attorney generals and Medicaid agencies.

Medical practices should verify compliance and make sure staff is routinely trained during onboarding and ongoing sessions. Make sure vendor contracts are updated and that compliance standards are included in work orders. Organizations with 15 or more employees must designate an individual to coordinate efforts to comply with the rule and must adopt grievance procedures that provide for a prompt and equitable resolution of complaints, although this would be a good idea for practices of any size.

Compliance Resources

The TMA legal department has compiled a list of resources to help members comply with the rules. Also, we have Law Guide topics including Deaf Patients Interpreters Companions; Limited English Proficiency; Nondiscrimination Rules Section 1557; and Service Animals.