On May 10, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced it had entered into a Voluntary Resolution Agreement with Florida-based FQHC, MCR Health Inc. (MCR), to resolve a disability discrimination complaint based on Section 504 of the Rehabilitation Act of 1973 and Section 1557 of the Patient Protection and Affordable Care Act.

The resolution resolved a complaint filed from an individual who is deaf and hard of hearing who alleged MCR failed to provide her with auxiliary aids and services when she requested an interpreter to be present for her while she attended her husband’s post-surgical medical appointment as his companion. MCR had previously provided the complainant interpreters while she was a patient, but denied her request when she was a companion/caregiver.

Both Section 504 of the Rehabilitation Act and Section 1557 of the Patient Protection and Affordable Care Act require that medical care providers provide individuals with disabilities:

• Full and equal access to their health care services and facilities; and
• Reasonable modifications to policies, practices and procedures when necessary to make health care services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services (i.e., alter the essential nature of the services).

Additionally, covered entities such as Health Centers/FQHCs must provide effective communication for companions who have communication disabilities. “Companion” means a family member, friend or associate of a patient who, along with the patient, is an appropriate person with whom the health care provider should communicate.

The agreement highlighted some required and best practices for Health Centers:

• Provide an initial assessment to all patients and companions who are deaf or hard of hearing to determine the appropriate auxiliary aids and services (HHS included a Model Communication Assessment Form as an attachment to the Agreement. See Voluntary Resolution Agreement Between the United States Department of Health and Human Services, Office for Civil Rights and MCR Health, Inc. | HHS.gov at Appendix A).
• Document the assessment and make a notation of the results in the patient’s record.
• Do not rely on an adult accompanying a patient or companion to interpreter facilitate communication, except in the following circumstances:
  • In an emergency involving an imminent threat to safety
  • If a patient or companion specifically requests the accompanying adult and interpret or facilitate communication. You must document the request in the patient’s chart and advise the patient or companion that interpreters or other auxiliary aids are available without charge.
• Minors may not be used to interpret or facilitate communication except in an emergency involving an imminent threat to safety.

In the OCR press release announcing the Voluntary Resolution Agreement, the OCR Director cautioned that, “We are seeing case after case involving health care providers who fail in their responsibility under federal civil rights laws to provide effective communication to patients and their caregivers. This action supports OCR’s efforts to promote community integration by removing barrier to receiving services in the community. OCR will continue to take robust enforcement action until we make it clear that health care providers must remove unnecessary barriers and provide equal treatment to those who are dead and hard of hearing.”

Voluntary Resolution Agreements such as MCR’s carry with them additional reporting, scrutiny and compliance obligations. MCR’s agreement is of a two-year duration.

For other resources pertaining to health centers’ compliance obligations under Section 504 of the Rehabilitation Act and Section 1557 of the Patient Protection and Affordable Care Act, including the obligation to provide effective communication through the use of auxiliary aids and services please see Civil Rights for Providers of Health Care and Human Services | HHS.gov. FTLF’s webinar “It’s All About Access: Anti-Discrimination Laws for Health Centers and an ACA Section 1557 Update” can be found here.