Summary
Complying with ADA guidelines requires proactive policies, staff training, facility assessments, and reliable accommodation processes to reduce legal risk and support equitable patient care.
The goal of the Americans with Disabilities Act, or ADA, is to eliminate discrimination against persons with disabilities and provide enforceable standards and penalties to address such discrimination. Under the ADA, a disability includes “a physical or mental impairment that substantially limits one or more of the major life activities,” “a record of such an impairment,” or “being regarded as having such an impairment” (42 USC §12102). “Major life activities” include caring for oneself, seeing, hearing, speaking, eating, sleeping, breathing, learning, walking, standing, sitting, reaching, working, and the operation of a major bodily function (28 CFR §36.105).
Not everything that restricts a person’s major life activities is an impairment. Examples of this include obesity (unless there is a physiological disorder), hepatitis A (generally a limited illness), and side effects from certain drugs. The definition of what constitutes an impairment or disability is, however, subject to expansion based on federal and state legislative changes and rulings by appellate courts and administrative law judges (Federal Register, July 26, 1991, 56[144], 35694, 35699).
The Doctors Company frequently receives questions regarding ADA compliance. This article provides practical guidance to assist medical and dental practices in addressing common scenarios. ADA-related claims are generally not covered under professional liability policies; therefore, proactive compliance is essential.
Yes, but only for appropriate reasons. Dissolving the clinician-patient relationship due to the patient’s disability is prohibited. You are, however, allowed to end a patient relationship for reasons other than the patient’s disability. Examples include failure to pay the bill, repeated and/or chronic nonadherence to the practitioner-ordered treatment modalities, and disruptive behavior unrelated to the disability. The reason for the termination should be carefully documented in the medical record. See our article “Terminating Patient Relationships” and checklist “Quick Check: The Patient Dismissal Process.”
Possibly. ADA considerations require careful evaluation of the reason for terminating the practitioner–patient relationship. If the relationship is ended on the basis of the patient’s disability, such action could be considered discriminatory. However, if termination is based on legitimate, nondiscriminatory reasons—such as unsafe or unlawful behavior (e.g., prescription forgery)—the practitioner may proceed with proper termination procedures. In this scenario, referral to a pain management specialist may be appropriate to address the patient’s chronic pain needs. The practitioner should clearly document the rationale for withdrawal to support that the decision was based on clinical and safety concerns rather than disability status.
No. Practitioners are not required to provide care that exceeds their training, experience, or clinical expertise. Multiple sclerosis is a complex, potentially progressive neurologic condition that is typically managed by a neurologist.
While you must not abandon the patient, your responsibility is to ensure that the patient receives appropriate care—not to personally manage all aspects of a condition beyond your scope. Referral to a qualified specialist is appropriate and consistent with the standard of care. The practitioner should facilitate a safe transition of care and document the rationale for referral in the medical record.
No. Individuals with HIV are protected under the ADA. Because you would be providing disparate treatment compared to those individuals who are not infected, requiring a hospital admission and stay for minor surgery that can be completed in your office is prohibited. Universal precautions, designed to reduce the possibility of transmission of the HIV virus, are to be implemented and used for all patients.
Yes. To comply with the ADA, healthcare practices are expected to take reasonable steps to ensure clear, accurate, and timely communication with patients who are deaf or hard of hearing, including the use of appropriate communication devices and methods when needed. The patient’s preferred mode of communication (such as a qualified sign language interpreter) should guide the approach whenever practicable. Alternative methods may be used if they allow the same level of “effective communication” and do not compromise the accuracy of the clinical interaction, particularly when other resources are limited.
In practice, alternative methods are often insufficient for clinical discussions that involve diagnosis, consent, or treatment planning. In these situations, the use of a qualified interpreter is generally the safer and more reliable approach. See 28 CFR §36.303[a], 28 CFR §36.301[c], and 45 CFR Part 92–Nondiscrimination in Health Programs and Activities.
Additionally, pursuant to the Federal Rehabilitation Act of 1973, all auxiliary services and aids must be made available at no cost to the patient if they are needed for effective communication. To assist with providing these services, practices may access resources through the telephone company, local hospital network, the internet, and the patient’s health plan. To learn more, review the ADA National Network’s Effective Communication fact sheet.
Yes. Most solo practitioners are expected to provide interpreter services. Although this requirement does not fall under the ADA, the U.S. Department of Health and Human Services (HHS), through Title VI of the Civil Rights Act of 1964 and Section 1557 of The Affordable Care Act (ACA) (2016), has long required language access as part of its prohibition against national origin discrimination.
A limited exception has historically applied to practices that receive only Medicare Part B reimbursement; however, this exception is narrow and must be carefully evaluated in light of evolving requirements under Section 1557 of the Final Rule of the Affordable Care Act. Notably, the ACA Final Rule (effective July 5, 2024), together with prevailing patient safety standards, reinforces that providing interpreter services in healthcare is the expected—and safest—practice.
Key expectations include:
- Provision of free language assistance services
- Use of qualified interpreters
- Restrictions on the use of family members, friends, or untrained staff
- An expanded definition of “meaningful access” (with accurate, timely, and effective communication)
Beyond regulatory requirements, the use of interpreters is widely recognized as the prevailing standard of care. Qualified interpreter services are essential to support informed consent, ensure accurate diagnosis, and facilitate clear communication of medication instructions, treatment plans, and follow-up care. The bottom line is that patients must truly understand their diagnosis and treatment plan. Section 1557 is now increasingly interpreted to apply to Medicare providers and is the guide for medical practices to follow.
The following four factors remain relevant and are still reflected in longstanding federal guidance as a framework for assessing language access needs. Practices should continue to consider: (1) the number or proportion of individuals with limited English proficiency (LEP) served, (2) the frequency of LEP encounters, (3) the nature and importance of the services provided, and (4) available resources and cost. See HHS LEP Guidance (Federal Register, August 8, 2003).
This analysis, however, should be applied cautiously. Evolving requirements under Section 1557 of the Affordable Care Act (effective July 2024) place greater emphasis on ensuring meaningful access, regardless of practice size. While resources and cost remain a consideration, they do not eliminate the obligation to take reasonable steps to provide timely, effective language assistance.
From both a compliance and patient safety perspective, practices are expected to have reliable systems in place to provide qualified interpreter services when needed. It is also advisable to have consent forms—particularly for invasive procedures—professionally translated into relevant non-English languages by certified medical translators to support clear patient understanding. The use of artificial intelligence (AI) translation tools is discouraged for this purpose due to potential inaccuracies.
Yes, but it is permitted only in limited circumstances. Pursuant to the Section 1557 Final Rule of the Affordable Care Act, the requirement for ‘meaningful access’ establishes the use of qualified interpreters as the applicable standard of care. Family members and friends are not considered “qualified” as lay personnel are rarely familiar with medical terminology and may not provide an accurate translation, compromising patient safety. Additionally, the patient may feel uncomfortable with a family member having access to their confidential health information. If a family member must serve as an interpreter, that individual should be an adult whenever possible. Use of a minor may be considered only when an adult is unavailable and immediate interpretation is required due to a clinical emergency. See The Americans with Disabilities Act National Network.
In situations not involving an emergency situation, an accompanying adult who uses sign language may interpret if the patient requests it, the accompanying adult agrees, and relying on the accompanying adult is clinically appropriate. In this situation, clearly document in the medical record that the patient agrees to this alternative and that a qualified interpreter (at no cost) was refused.
Many hospitals maintain lists of qualified interpreters, and additional resources may include local cultural organizations, the Registry of Interpreters for the Deaf, and community deaf service centers.
Your website, as determined by the U.S. Department of Justice, is a place of public accommodation and must be accessible to people who have disabilities that affect their hearing, vision, or physical capabilities. It is important to assess your practice website proactively to ensure compliance with requirements for accessibility. In recent years, a surge in lawsuits has targeted healthcare websites with claims that they violate ADA accessibility requirements.
You can determine if your website complies with the Web Content Accessibility Guidelines (WCAG), 2.1 Level AA, by conducting a documented risk assessment for the website, portals, and documents. Some assessment tools include accessiBe: Check if your website is accessible and ADA compliant, Siteimprove, and Google’s Lighthouse Accessibility scoring. If adjustments to your website are necessary, available solutions include accessibility widgets and services (like EqualWeb), which help users make improvements such as enlarging text or improving contrast. For more information on the issue of website compliance, see Guidance on Web Accessibility and the ADA .
Service animals fall under the ADA; emotional support animals generally do not. The ADA defines a service animal as “a dog that has been individually trained to do work or perform tasks for an individual with a disability. The task(s) performed by the dog must be directly related to the person’s disability.” In contrast, emotional support, therapy, comfort, or companion animals provide emotional comfort through their presence but are not trained to perform specific tasks.
The ADA makes a distinction between emotional support animals and psychiatric service animals. Animals that are trained to support an individual with certain mental health conditions are considered “psychiatric service animals” and fall under the ADA. To learn more about service animals, emotional support animals, and psychiatric service animals, visit the ADA’s Frequently Asked Questions about Service Animals and the ADA. Additionally, many states have enacted legislation supplementing federal law. Practitioners are urged to consult applicable provisions in their jurisdiction to help ensure regulatory compliance.
Generally, as noted above, emotional support animals do not fall under the ADA, unless regarded as a psychiatric service animal. It is always recommended that any letters and/or supporting documents be based on clinical assessment and medical record documentation. These types of letters and supporting documents can be provided and signed only by a licensed physician or mental health clinician. The best approach is to always do what is best for the patient, and if the patient’s situation warrants the use of an emotional support animal based on clinical assessment, then supporting documents should be provided.
Patients cannot be denied service because they use a mobility device or require more time than patients with full mobility. Do not instruct patients with disabilities to bring a helper to the appointment to assist with transfers and the exam. Patient needs should be evaluated individually and treated equitably, with reasonable accommodations—not identically. Patients should be examined on an exam table, not in their mobility device. If a helper is accompanying the patient, engage directly with the patient, not through a third person when speaking. For more information, see the ADA’s Access to Medical Care for Individuals with Mobility Disabilities.
The ADA/HHS Medical Diagnostic Equipment (MDE) rules were updated in 2024 and became effective July 8, 2026, for medical and dental practices that receive funding from HHS. There are specific accessibility standards for exam tables and procedure chairs, weight scales, and imaging equipment, including mammography. See:
No. Under the ADA, medical practices are required to provide accessible facilities and reasonable accommodations, but it does not require staff to provide personal attendant services, such as physically transporting patients from their vehicles. Doing so could place the practice at risk for patient and employee injury. Medical practices are, however, obligated to provide accessible parking, entrances, and pathways to ensure equal access to care.
Additional Compliance Strategies
Every healthcare practice should be familiar with the ADA and its different applications in the office setting. This means that every member of the office should be trained in how to handle different types of phone calls and inquiries. Patients with disabilities generally know their rights, and so should every staff member in the office. Staff members should never have to guess how to interact with patients who have disabilities. We recommend the following strategies to prepare your practice:
- Develop and maintain a current written ADA compliance policy addressing accessibility and non-discrimination.
- Assign ADA compliance oversight to a designated individual responsible for managing the program. Ensure they receive ongoing training to maintain current and effective compliance with rules and legislation at the state and federal levels.
- Provide mandatory ADA training for all staff and new hires covering the practice’s legal obligations, disability awareness, service animal guidance, effective communication, safe patient handling and transfer techniques, and proper use of medical diagnostic equipment. Offer periodic refresher training as needed. Incorporate realistic learning methods such as role-playing and patient communication scripting for challenging situations. Assess staff understanding through quizzes, and ensure all training is documented in administrative records, as practices may be required to demonstrate completion of staff education during an investigation.
- Consider testing staff compliance with “secret callers.”
- Assess and address physical access barriers throughout your facility. See the ADA National Network’s tool Is Your Facility Accessible for All Patients? and the ADA Checklist for Existing Facilities.
- Review administrative paperwork (e.g., new patient paperwork) and the practice website, patient portal, and scheduling platforms for ADA compliance. Document compliance activities.
- Review patient documents—including questionnaires, educational materials, and other forms—for ease of understanding, particularly for patients with LEP. Make documents available in the most common patient languages using certified medical translators. (The use of AI-based translation tools is discouraged due to the potential for inaccuracies.)
- Procure accessible medical equipment, including adjustable exam tables, wheelchair accessible weight scales, and imaging equipment.
- Maintain comprehensive records for all compliance efforts.
If you have questions, please contact Patient Safety and Risk Management at (800) 421-2368 or by email or contact the ADA Information Line at (800) 514-0301.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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