The AMA sent a letter broadly supporting the Biden administration’s proposed rule updates, which were last changed in 2005 and are aimed at ensuring that people with disabilities are not discriminated against.
“The AMA applauds the Administration’s efforts to ensure that qualified individuals are never discriminated against in health care because of their disability,” AMA Vice President and CEO James L. Madara, M.D., wrote in a letter (PDF) to Health and Human Services (HHS) Secretary Xavier Becerra.
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“The AMA firmly believes that discrimination has no place in the practice of medicine,” Dr. Madara’s letter adds. “Disability should not be used as a factor in ineligibility for any medical products, benefits, or services.”
In the letter, HHS said:[ing] Regarding the proposals for new non-discrimination standards for medical services and the gradual implementation of new medical equipment requirements, the report said, “It is a skilled job of balancing the protection of people with disabilities with the administrative burden of implementing these changes in medical practice, while taking into account physicians’ clinical discretion and expertise.”
While the letter noted that certain limited exceptions would help avoid undue financial or administrative burdens, especially for smaller organizations, it said it expects to take all steps necessary to ensure that people with disabilities receive the same benefits and services to the extent possible, and that the proposed flexibilities are “thoughtful and substantiated.”[ive] “It’s a delicate balance between allowing equitable access for individuals with disabilities while not imposing insurmountable burdens on practice.”
The need for flexibility in technology standards
The need for flexibility in technology standards
While the letter expresses strong support for requiring new accessibility standards for certain web-based content, social media content, and mobile phone applications to promote equitable access to health services and activities, the AMA expresses serious concerns about the proposed approach, particularly with regard to adopting advanced technical standards within the proposed deadlines.
“If not implemented carefully and with an appropriate level of support, implementing these requirements will pose challenges, especially for less-resourced practices serving disadvantaged patient communities,” Dr. Madara wrote, adding that “successful implementation will rest with third-party application or web content developers, not with the practices.”
To reduce the burden on healthcare providers, the AMA proposes an alternative strategy: promoting accessibility standards for web-based content and phone applications through existing health information technology certification standards for vendors, and working with the healthcare community to design a principles-based approach to fill the gaps that remain, so that healthcare providers are more accessible to people with disabilities while minimizing the burden on healthcare providers.
The letter also proposes making federal subsidies available or requiring health insurers to directly pay or reimburse health care providers for the additional costs of complying with the rule.
Cooperative enforcement approach needed
Cooperative enforcement approach needed
Throughout the letter, the AMA urges HHS to consider a collaborative approach to enforcement, including working with organizations and clinics to identify deficiencies and develop corrective action plans to improve patient access, rather than taking a punitive approach that could disproportionately impact small, rural, safety net, and other types of clinics that serve underserved communities.
Support for people with disabilities
Support for people with disabilities
The AMA has extensive policies to address inequities in the care of patients with disabilities, and as part of its strategic plan to advance health equity, the AMA is developing structures and processes to ensure that the experiences and ideas of people from historically marginalized groups, including people with disabilities, remain centered.
In accordance with the policy adopted at the Delegate Conference, the AMA will form an advisory group composed of physicians and medical students with disabilities to promote disability education and training opportunities and tools to advocate for themselves in the workplace. AMA members who would like to learn more can contact William Jordan, MD, MPH, director of health equity policy at the AMA Health Equity Center, by emailing us at [email protected].
See the AMA’s detailed policy on health care for people with disabilities.