Medicare Compliance & Reimbursement

A recent settlement highlights provider’s failure to help patient.

If you don’t have policies in place to assist your deaf or hard-of-hearing patients, you should. A recent case reminds providers that the responsibility of offering interpretation services and aides to patients lies with them — and you could find yourself in hot water for ignoring the federal regs.

Why? For starters, patients who are deaf or face other barriers to communication need to be completely involved in their care, and it’s the responsibility of the provider to ensure they’re fully informed and consent to services and treatment. On top of that, it’s the law.

Reminder: The Americans with Disabilities Act (ADA), which was first implemented in 1990, continues to outline rights for people with disabilities and organizations’ responsibilities in accommodating their needs. The ADA has particular requirements for medical institutions and puts the costs of those accommodations on the providers and facilities instead of patients who require access and assistance.

Settlement Shows the Importance of Offering Interpre­tation Services

The HHS Office for Civil Rights (OCR) in conjunction with the Department of Justice (DOJ) recently resolved a federal civil rights case between a deaf patient and Dearborn Obstetrics and Gynecology, P.C. in Michigan. After repeated requests for an American Sign Language (ASL) interpreter, the patient opened a complaint with OCR. Dearborn OBGYN further violated the individual’s rights by canceling her appointments and surgery — and then dropping her as a patient — which she documented, an OCR brief indicates.

In this case, the lack of a form of “effective communication” violated both “Section 504 of the Rehabilitation Act of 1973 (Section 504) and Section 1557 of the Affordable Care Act of 2010 (Section 1557),” OCR notes.

“Federal civil rights laws are clear that health care providers must provide those who are deaf or hard of hearing with appropriate auxiliary aids and services, such as an ASL interpreter, when requested,” says OCR Director Melanie Fontes Rainer in a release on the case. “Providers are required to follow the law and provide care in a manner that is free from discrimination.”

She adds, “In this matter, the provider terminated her as a patient because she requested an accommodation — this is unacceptable and will not be tolerated. Ensuring that people with disabilities can access their care equally is critical and today we call on providers around the country to follow the law.”

Results: An OCR investigation of Dearborn OBGYN’s policies and practices revealed issues, and the provider voluntarily entered into a resolution agreement with the feds. The resolution agreement includes requirements to modify related policies and procedures and submit them to HHS and the DOJ for approval; post signage; maintain a log of interpreter requests; train staff; and submit compliance reports to HHS and DOJ every six months. HHS and DOJ will monitor the practice for 18 months.

Consider This Advice on Adding ASL Services

In addition to reviewing the federal requirements and updating your policies accordingly to ensure both administrative and clinical staff understand the law, you should remember that providing individualized care means accommodating individuals’ needs, which can vary greatly depending on the level of hearing loss and the type of communication preferred by the patient.

For example, “some individuals may require interpreters who are fluent in American Sign Language, a language with grammar and syntax that is different from the English language,” the National Association of the Deaf explains in its online resource guide for healthcare practitioners. “Others may require interpreters who use Signed English, a form of signing which uses the same word order as does English. Still others who do not know any sign language may require oral interpreters, who take special care to articulate words for deaf or hard of hearing individual, or cued speech interpreters, who give visual cues to assist in lip reading (also called speech reading).”