Steven Baruch - Health Care Compliance Association

More documents

Recommendations

Info

December 2010 4 Mobility disabilities: A technical assistance manual for health care providers Editor’s note: David H. Ganz is Of Counsel to the Sills Cummis & Gross Employment and Labor Practice Group. David may be contacted by telephone in Newark, New Jersey at 973/ 643- 4852 or by e-mail at dganz@sillscummis.com. Gary W. Herschman is Chair of the Sills Cummis & Gross Health and Hospital Law Practice Group. Gary may be contacted by telephone at 973/ 643-5783 or by e-mail at gherschman@ sillscummis.com. On July 22, 2010, the Civil Rights Division of the US Department of Justice and the Office for Civil Rights of the US Department of Health and Human Services issued Access to Medical Care for Individuals with Mobility Disabilities, a technical assistance manual designed to help persons with mobility disabilities (such as those who use wheelchairs, scooters, walkers, or crutches) obtain accessible medical care. The manual will also assist medical providers in understanding how the Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973 (Section 504) apply to them. This article provides an overview of the new publication, which is comprised of four parts. Overview and general requirements The ADA is a federal law that prohibits discrimination against individuals with disabilities in everyday activities, including access to medical services. Section 504 is By David H. Ganz and Gary W. Herschman another federal statute that prohibits discrimination against individuals with disabilities in programs or activities that receive federal financial assistance. Public hospitals, as well as clinics and medical offices operated by state and local governments, are covered by Title II of the ADA. Private hospitals and medical offices are covered by Title III of the ADA as places of public accommodation. Section 504 covers any of these facilities that receive federal financial assistance, which can include Medicare and Medicaid reimbursement. Titles II and III of the ADA and Section 504 require that medical care providers provide individuals with disabilities (1) full and equal access to their health care services and facilities; and (2) reasonable modifications to policies, practices, and procedures when necessary to make health care services fully available to such individuals, except where to do so would fundamentally alter the nature of the services. The ADA sets out requirements for new construction of, and alterations to, buildings and facilities, including health care facilities. These requirements may be found in the federal regulations. 1 In addition, all buildings (including those constructed before the ADA became effective) are subject to accessibility requirements. For example, under Title II, a public entity must ensure that its program as a whole is accessible—a requirement which Health Care Compliance Association • 888-580-8373 • www.hcca-info.org may entail removing architectural barriers. Under Title III, existing facilities are required to remove architectural barriers where such removal is readily achievable. If barrier removal is not readily achievable, the entity must make its services available through alternative methods, if those methods are readily achievable. Frequently asked questions The technical assistance manual answers eleven commonly asked questions relating to the provision of medical services to individuals with mobility disabilities. The topics covered by these questions are varied, but many of the answers share a common theme—that patients with mobility disabilities should be treated like all other patients. For example, one of the questions asks whether a provider can refuse to treat a patient because the provider does not have accessible medical equipment. Another asks whether it is permissible to refuse to treat a patient with a disability because more time will be spent on his or her exam, and a third asks whether a patient with a disability can be made to wait until a particular room becomes available. A fourth question asks whether a nurse with a bad back must nonetheless lift a patient with a disability onto an exam table. Given that individuals with mobility impairments are to be treated like other non-disabled patients, the answers are not altogether surprising. The technical assistance manual provides that generally no service can be denied simply because a patient has a disability. Nor may a patient be refused treatment simply because the exam may take more of the provider’s time—time which an insurance carrier may not reimburse—or be forced to wait longer than other patients, so that a particular exam table becomes available. Accessibility needs can be determined in advance so that equipment is ready for a particular person’s appointment. As
for the nurse with the bad back, the guidance provides that while staff should be protected from injury, that concern does not justify the failure to provide equal medical services to disabled patients. Staff injuries can be avoided by providing accessible equipment (e.g., adjustable exam tables, patient lifts) and training on proper patient handling techniques. Several questions address assistants; namely, whether a patient with a disability must bring an assistant to the exam, and if he or she does, whether the assistant must remain in the room while the patient is being examined and his or her condition is being discussed. The manual provides that a patient with a disability can, if he or she chooses, bring a friend or family member to the exam, but the patient is not required to do so. If the patient comes to the exam alone, then the provider must provide reasonable assistance (e.g., help with dressing and undressing, getting on and off equipment) so that medical care can be delivered. When the patient brings an assistant, the provider should address the patient. Whether the assistant remains in the room for the exam and ensuing discussion is the patient’s choice. Other questions concern exam tables. For example, can a doctor examine a patient who uses a wheelchair in that wheelchair because he or she cannot independently get onto an exam table The answer is generally no, because an examination in a wheelchair is less thorough than an exam on a table. The technical guidance manual makes clear that it is important that the patient with a disability receives medical services equal to those received by the patient without a disability. The manual also addresses the question of whether an office or clinic with multiple exam rooms must have an accessible exam table in every room. The answer is probably not, as the number of accessible exam tables will depend on several factors, including the size of the practice and the patient population. Two questions deal with the financial cost of making exam rooms and other parts of the office accessible to the patient with a disability: (1) Whose responsibility is it and (2) Are there tax benefits for making accessibility changes The manual provides that both tenants and landlords are responsible for complying with the ADA, and the lease may speak to who in particular must make an accessibility change. As for tax breaks, both tax credits and deductions are available to private businesses to offset expenses incurred to comply with the ADA. A final question asks what a provider should do if the staff does not know how to help a disabled patient. Training is the answer – training on how to operate accessible equipment, on how to assist with transfers and positions of disabled individuals, and on how not to discriminate. The manual identifies several resources where such training can be found. Accessible exam rooms For the patient with a mobility disability to receive appropriate medical care, it is critical that they are able to enter the exam room, move around, and use the accessible equipment provided. Features that make an exam room accessible to the disabled patient include: n an accessible route to and through the room; n an entry door with adequate clearance width, maneuvering clearance, and accessible hardware; n appropriate models and placement of accessible examination equipment; and n adequate floor space inside the room. An accessible doorway must have a minimum clear opening width of 32 inches when the door is opened to 90 degrees. Door hardware must not require tight grasping, tight pinching, or twisting of the wrist in order to use it. The hallway outside the door should be kept clear of obstacles, such as boxes or chairs. Once inside the exam room, a patient who uses a wheelchair or other mobility device must be able to approach the exam table and other areas of the room. There must be sufficient clear floor space next to an exam table so that a patient with a disability can approach the side of the table for transfer onto it. The minimum amount of space required is 30 inches by 48 inches. While clear floor space is needed along at least one side of an adjustable-height examination table, providing clear floor space on both sides allows one table to serve both right and left side transfers (for those individuals who can only transfer from the right or left side). Where more than one accessible room is available, a reverse furniture layout in the additional room allows for transfers from either side of the exam table. Accessible exam rooms should also have enough turning space for an individual in a wheelchair to make a 180-degree turn, using a clear space of 60 inches in diameter or a 60 inch by 60 inch T-shaped space. Chairs and other objects should be moved to provide sufficient clear floor space for maneuvering and turning. Where portable patient lifts or stretchers are used (as opposed to ceilingmounted lifts), additional clear floor space will be needed to maneuver the lift or stretcher. Accessible medical equipment To ensure that a person with a mobility disability receives medical services equal to those received by a person without a disability, accessible medical equipment is important. If a patient must be lying down to be thoroughly examined, then a person with a disability must also be examined lying Continued on page 7 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org 5 December 2010
Page 1 and 2: Volume Twelve Number Twelve Decembe
Page 3: Publisher: Health Care Compliance A
Page 7 and 8: Mobility disabilities: A technical
Page 9 and 10: RACs are coming to Medicare Advanta
Page 11 and 12: an attestation statement for the pu
Page 13 and 14: Social Networking John Falcetano Ed
Page 15 and 16: SB: I am the first full-time, dedic
Page 17 and 18: If you have any questions that you
Page 19 and 20: I called Joe Murphy, and before I t
Page 21 and 22: Once these steps are completed, the
Page 23 and 24: of 2010 (PPACA) and the Health Care
Page 25 and 26: 100% Why is Compliance not a part o
Page 27 and 28: Routine meetings should be set up s
Page 29 and 30: COMPLIANCE 101 Stark and academic m
Page 31 and 32: total compensation of the referring
Page 33 and 34: teaching hospitals, medical schools
Page 35 and 36: providers who participate in the Me
Page 37 and 38: Health Care Compliance Association
Page 39 and 40: ecognized now by the federal govern
Page 41 and 42: Federal medical record requests: Se
Page 43 and 44: medication and services previously
Page 45 and 46: individual accountability provision
Page 47 and 48: created inappropriate financial inc
Page 49 and 50: New HCCA Members n Coquette O’Rou
Page 51 and 52: • Internal Audit • Litigation S

Steven Baruch - Health Care Compliance Association

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?