The Office for Civil Rights has issued guidance on nondiscrimination regarding telehealth services and patients with disabilities and limited English proficiency. We will outline the guidance as well as the HIPAA requirements that come into play.
What is Required?
Federal civil rights laws require providers to furnish appropriate auxiliary aids and services, such as an American Sign Language (ASL) interpreter, to those who are deaf or hard of hearing upon request. Providers must also ensure meaningful access to services by limited English proficient (LEP) patients, such as professional interpretation services.
If it is determined that some type of professional interpretation service is required, it is the responsibility of the provider to cover the expenses. Likewise, if telehealth services are provided, they must be accessible to individuals with disabilities unless doing do would result in undue financial and administrative burdens or fundamental alteration of the health program. However, practices are expected to explore the most cost-effective means of providing services before limiting them due to resource concerns. Please see the Resources section at the end of this article for links to more information on this subject and for assistance in locating medical interpreters, translation services, etc.
Telehealth Considerations
Before the appointment – Include a way for patients to note any special needs when making the appointment or on an intake form in advance of their virtual visit. Contact the patient before their appointment to work around possible technology challenges and ensure they feel comfortable with the platform. Consider whether some patients may need longer appointment times.
Online tools – Make sure your website and online tools are accessible such as by ensuring they are compatible with screen reader software, etc.
Your telehealth platform – Consider ways to make your telehealth platform and services more accessible for patients with disabilities or limited English proficiency:
- Choose a telehealth platform that offers accessible features, such as:
- The ability to include an interpreter or support person on the same call with the patient and provider (whether present with the patient or from a third location)
- Live captions
- High-contrast display
- Automatic transcription
- Ensure staff are trained on how to utilize accessibility features.
- Provide closed captioning for all pre-recorded patient video resources.
- Use Telecommunication Relay Services as an alternative to video appointments.
- Offer video conferencing to connect to an interpreter virtual appointment for real-time sign language or oral interpretation.
HIPAA Rules Regarding Interpretation Services
When using interpreter services (as part of telehealth visits or regular office visits), a covered entity may use and disclose protected health information regarding an individual without an individual’s authorization as a healthcare operation, in accordance with the Privacy Rule, in the following ways:
- When the interpreter is a member of the covered entity’s workforce (i.e., a bilingual employee, a contract interpreter on staff, or a volunteer);
- When a covered entity engages the services of a person or entity, who is not a workforce member, to perform interpreter services on its behalf, as a business associate. A business associate agreement or other contract that includes satisfactory assurances that the business associate will comply with HIPAA requirements should be signed by both parties prior to disclosure of any protected health information.
In addition, a covered health care provider may use or disclose protected health information to the patient’s family member, close friend, or any other person identified by the individual as his or her interpreter for a particular healthcare encounter. In these situations, that interpreter is not a business associate of the healthcare provider. As with other disclosures to family members, friends or other persons identified by an individual as involved in his or her care, when the individual is present, the covered entity may obtain the individual’s agreement or reasonably infer, based on the exercise of professional judgment, that the individual does not object to the disclosure of protected health information to the interpreter.
Resources
Department of Health and Human Services website on telehealth:
Improving access to telehealth – Department of Health & Human Services:
ADA Requirements: Effective Communication:
https://www.ada.gov/resources/effective-communication/
American Translators Association – Search for an interpreter in your area:
https://web.atanet.org/directory/individuals.php
National Council on Interpreting in Health Care – Review the council’s list of Interpreter Associations under the Resources menu:
Additional resources are listed at the end of the HHS OCR Guidance on Nondiscrimination in Telehealth: Federal Protections to Ensure Accessibility to People with Disabilities and Limited English Proficient Persons web page:
