Population Care

Proposed rule could advance health equity for disabled patients

Andis Robeznieks , Senior News Writer

The AMA sent a letter largely supporting the Biden administration’s proposed rule updating regulations last changed in 2005 and meant to ensure that people with disabilities are not subject to discrimination.

“The AMA applauds the Administration’s commitment to ensuring that qualified individuals are never subject to discrimination in medical treatment on the basis of disability,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter (PDF) to Health and Human Services (HHS) Secretary Xavier Becerra. 

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“The AMA believes firmly that discrimination has no place in the practice of medicine,” Dr. Madara’s letter adds. “A disability should never be used as a disqualifying factor for any medical good, benefit, or service.”

The letter specifically credits HHS with “do[ing] a skilled job of balancing protections for individuals with disabilities while accounting for necessary clinical discretion and expertise of physicians, as well as the administrative burden of implementing these changes on practices” when it comes to proposed new non-discrimination standards for medical services and a proposed gradual implementation for new medical device equipment requirements.

The letter also calls out how certain limited exceptions would help to avert undue financial or administrative burden, particularly for smaller organizations, while still expecting practices to take all steps necessary to ensure individuals with disabilities receive the same benefits and services to the maximum extent possible, calling the proposed flexibilities “thoughtful and demonstrate[ive] of the delicate balance between ensuring equitable access for individuals with disabilities without imposing insurmountable burdens on practices.”

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 healthcare services and activities, the AMA raises serious concerns with the proposed approach to adopt highly technical standards, particularly within the proposed timeframe.

“If not implemented thoughtfully and with appropriate levels of support, implementation of these requirements will present a challenge, particularly for under-resourced practices serving disadvantaged patient communities,” Dr. Madara wrote, adding that “successful implementation… does not rest squarely on practices, but rather on a third-party application or web content developer.”

To mitigate the burden on practices, the AMA suggests an alternative strategy of promoting accessibility standards for web-based content and phone applications through existing health information technology certification standards for vendors, while working alongside the health care community to design a principles-based approach to cover any remaining gaps. This approach would provide greater access for individuals with disabilities while minimizing the burden on medical practices.

The letter also suggests that federal grants be made available or that health insurers be required to directly pay or reimburse practices for the added expenses of complying with the rule.

Throughout the letter, the AMA strongly urges HHS to consider a collaborative approach to enforcement, working with organizations and practices to identify deficiencies and develop corrective action plans to improve patient access, rather than taking a punitive approach that would likely disproportionately impact small, rural, safety net, and other types of practices serving underserved communities.

The AMA has a wide range of policy addressing inequities in care for patients with disabilities. As part of its strategic plan to advance health equity, the AMA is developing structures and processes to consistently center the experiences and ideas of people from historically marginalized groups, including those with disabilities.

Pursuant to policy adopted by the House of Delegates, the AMA is forming an advisory group composed of physicians and medical students with disabilities to promote educational and training opportunities around disabilities and tools to advocate for themselves in their own workplaces. AMA members interested in learning more should email William Jordan, MD, MPH, director of health equity policy at the AMA Center for Health Equity.

Explore the AMA’s detailed policy on medical care for people with disabilities.