If you read Deaf blogs or Deaf organizations’ websites for information about requesting and receiving live sign language interpreters for medical appointments, you probably won’t find recent news about a law revision giving patients who are Deaf many rights.
Revisions to part of the Affordable Care Act bring more rights–including:
- the right to choose which accommodations work best for you,
- how health care providers need to post notices with information about how to get an interpreter or other accommodations, and
- requirements for interpreters your health care provider uses to communicate with you.
The National Association of the Deaf’s website has a “Position Statement on Health Care Access for Deaf Patients” that doesn’t include the most recent information about laws that now give patients who are Deaf the right to choose: the best communication method for them, whether they need a live or remote interpreter, and more.
Deaf Organizations Provided Input for the Law Changes
We’ve examined the most recent law revisions for you. We asked the National Association of the Deaf’s Policy Counsel of the Law and Advocacy Center, Zainab Alkebsi, Esq., why the latest law revisions aren’t on the organization’s website. She said that the National Association of the Deaf, or NAD, gave formal comments to Health and Human Services regarding the revisions to a part of the Affordable Care Act that now gives patients who are Deaf, Hard of Hearing, and Deaf-Blind, the right to choose.
Changes Section 1557 Brings
The part of the law that provides the changes is Section 1557.
Here are changes Section 1557 addresses, when your medical provider:
- denies you an interpreter,
- tells you to bring your own interpreter,
- asks you to use family members or friends as interpreters for your appointment,
- or when you are told an interpreter can’t be provided because they are a small practice.
All of the above excuses are now removed by Section 1557 of the Affordable Care Act, which Health and Human Services has revised.
The changes are so broad, this is probably one of the reasons Alkebsi said the NAD is transitioning their website to a new one.
The Biggest Change the Law Brings for the Deaf Community
The language for Section 1557 is complicated. One of the most important revisions for the Deaf community says healthcare providers should give individuals a choice about how they will communicate.
Section 1557 says medical providers should “give primary consideration to the choice of an aid or service requested by the individual with a disability.”
In a time when many health care providers are considering providing remote sign language interpreters, often without asking patients who are Deaf what is most appropriate for them, Health and Human Services reaffirms federal laws to defend the individual’s right of choice to determine what accommodations will help them understand their health care providers best.
Section 1557 revisions are based on Health and Human Services interpretation of the Americans with Disabilities Acts’ Titles II and III.
Title III says that public service providers need to provide accommodations for people with disabilities.
The department’s interpretation of Title II has brought the most changes, because anyone who receives government funding such as Medicare or Medicaid or other financial resources, which includes almost every medical practice and hospital, must follow the law. And the department determined that the law calls for the health care providers to give “primary consideration,” or first choice, to the person with a disability.
Removal of Economic Burden as Reason for Not Providing an Interpreter
Before, smaller health care practices, such as a clinic or dentist’s office, were allowed to give an excuse for not providing interpreters if the costs of the interpreter was a “burden” to the practice.
With the Section 1557 revisions, claiming a financial burden for providing barrier free healthcare with sign language interpreters is removed.
Why Using Family, Friends, or Inexperienced Interpreters May Not be Appropriate
Each individual has a choice about their needs. It’s sometimes difficult to know what’s best, though.
Health and Human Services determined that interpreters should be familiar with medical vocabulary, or “terminology,” as well as how healthcare providers communicate, or “phraseology.”
According to the revisions, “…we added the words ‘terminology’ and ‘phraseology’ in both definitions to align the final rule’s description of the requisite knowledge, skills, and abilities an interpreter must possess with those recognized within the field.”
Federal law has already determined that having people under the age of 18 should not interpret for anyone. Why? It can be psychologically damaging to children to interpret for others and feel responsible for their health. If things go poorly, the child may feel responsible for injuries or death. Besides this, some material covered during health care appointments may be too advanced or mature for children.
When selecting whether a friend or family member should interpret for your medical appointment, consider if they will:
- understand medical vocabulary,
- keep your medical appointment confidential, and
- avoid getting emotional.
Required: Notices about How to Request an Interpreter or File a Complaint
Section 1557 also requires providers to have notices with information about how to request an interpreter or other accommodations, as well as information about who to contact if you have a grievance, or complaint.
If your health care provider doesn’t have this notice, they can find examples of what language to use on their notices on the Section 1557 web page, under the Appendix Section.
Those Receiving Government Money Can’t Discriminate
Health and Human Services cited many disability laws, including Section 504 of the Rehabilitation Act, which doesn’t allow for any government contractor–that is, anyone receiving money from the federal government–to discriminate against patients, even if the cost of interpreters is more than the money they make from patients.
Tax Assistance for Health Care Providers
While this could seem unfair to health care providers, if they make less than $1 million a year and have a staff of 30 people or less, they qualify for a tax deduction. This allows them to get their money back.
The IRS saw this coming, because their 2014 Fact Sheet said, “Follow the person’s cues to determine the most effective accommodation.”
Even the IRS recommended asking the person who is Deaf, Hard of Hearing, or Deaf-Blind, which accommodation they needed, and not assuming it or basing the decision on the health care provider’s choice.
Health care providers should discuss interpreter costs with their financial professional to determine which tax credits and/or deductions they can take for these expenses.
More Ways for Providers to Save Money
Certified and/or qualified interpreters protect providers from liabilities that may arise from patients who are Deaf, Hard of Hearing, or Deaf-Blind that don’t understand them and whose conditions worsen as a result. Cases like this may result in lawsuits, some of which the U.S. Department of Justice joins.
Lawsuits can be more expensive than personal damages alone, because health care providers may be required to:
- provide staff training,
- document their processes,
- undergo government supervision, and
- potentially have to assign or hire staff to manage accommodations requests.
You can learn more about these court cases and read the decisions here.
Lawsuits are Rarely the Answer: Education and Advocacy Are
When we at The Capsule Group and Sign Shares, Inc. communicate with the Deaf community as advocates, they often ask about us how to file a lawsuit. While going to court is an option, it’s a choice that involves a lot of time and effort.
Only serious incidences usually end up going to court, such as when not understanding a health care provider resulted in serious health problems or worse.
First, educate your health care professional about your needs. You can also send them to the Section 1557 website at http://1.usa.gov/24j8z7j to learn about the changes and your right to choose an interpreter or the services you need to communicate with them.
Violations of Section 1557 can already be reported to Health and Human Services. These violations are Civil Rights Complaints and can be completed online.
Educating yourself and others about the changes in the law is one of the quickest ways to make sure everyone knows about them understands them.
If you know of anyone needing this information, please share this article or link with them.