SPECIAL BULLETIN COVID-19 #83: Title II Americans with Disabilities Act (ADA) and Section 504 Rehabilitation Act (RA) Protections during the COVID-19 Pandemic

Wednesday, May 6, 2020

Federal law requires all Medicaid providers in North Carolina to comply with the Americans with Disabilities Act (ADA) and Rehabilitation Act, which includes providing reasonable accommodations for people living with disabilities.

On March 28, 2020, the U.S. Department of Health and Human Services Office of Civil Rights (OCR) issued the Bulletin "Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)" (https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf) to ensure that entities covered by civil rights authorities keep in mind their obligations under laws and regulations that prohibit discrimination on the basis of race, color, national origin, disability, age, sex, and exercise of conscience and religion in HHS-funded programs.

OCR remains in close coordination with federal partners to help ensure that the nation’s response effectively addresses the needs of at-risk populations. To this end and as resources allow, government officials, health care providers, and covered entities should not overlook their obligations under federal civil rights laws to help ensure all segments of the community are served by:

  • Providing effective communication with individuals who are deaf, hard of hearing, blind, have low vision, or have speech and other communication barriers through the use of qualified interpreters, picture boards, other communication devices and other means;
  • Providing meaningful access to programs and information to individuals with limited English proficiency through the use of qualified interpreters and through other means;
  • Making emergency messaging available in plain language and in languages prevalent in the affected area(s) and in multiple formats, such as audio, large print, captioning, and ensuring that websites providing emergency-related information are accessible and compliant with section 508 of the US Rehabilitation Act guidelines;
  • Addressing the needs of individuals with disabilities in emergency planning, including, but not limited to individuals with:
    • Mobility, movement and other physical limitations,
    • Individuals who use assistive technology, auxiliary aids, or durable medical equipment, and service animals,
    • Individuals with sensory, speech, and other communication barriers,
    • Individuals with cognitive, intellectual disability, and other developmental disability support needs,
    • Individuals with immunosuppressed conditions including HIV/AIDS;
  • Respecting requests for religious accommodations in treatment and access to clergy or faith practices as practicable.

Considerations for Caregivers Regarding Accompanying a Family Member into a Hospital or Medical Facility

The United States Centers for Disease Control (CDC) has issued guidance regarding allowing visitors who are essential for the patient’s physical or emotional well-being and care (https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html). 

This guidance includes the following:

Manage Visitor Access and Movement Within the Facility

  • Limit visitors to the facility to only those essential for the patient’s physical or emotional well-being and care (e.g., care partners).
  • Support visiting caregivers with functional support needs in their efforts to assist with the patient.
  • Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets.
  • Limit points of entry to the facility and visitation hours to allow screening of all potential visitors.
  • Actively assess all visitors for fever and COVID-19 symptoms upon entry to the facility. If fever or COVID-19 symptoms are present, the visitor should not be allowed entry into the facility.
  • Establish procedures for monitoring, managing, and training all visitors, which should include:
    • All visitors should be instructed to wear a facemask or cloth face covering at all times while in the facility, perform frequent hand hygiene, and restrict their visit to the patient’s room or other area designated by the facility,
    • Informing visitors about appropriate Personal Protective Equipment (PPE) use according to current facility visitor policy.
  • If visitation to patients with COVID-19 occurs, visits should be scheduled and controlled to allow for the following:
    • Facilities should evaluate risk to the health of the visitor (e.g., visitor might have underlying illness putting them at higher risk for COVID-19) and ability to comply with precautions,
    • Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the patient’s room,
    • Visitors should not be present during aerosol generating procedures (AGPs) or other procedures,
    • Visitors should be instructed to only visit the patient room. They should not go to other locations in the facility.

For individuals with a cognitive impairment or intellectual disability, it is important to ensure the individual has adequate support for decision making and treatment.  These individuals may need to have a caregiver accompany them in either the ambulance or in the hospital.  Accompaniment should be allowed in accordance with the guidance above.

Contact

NC Medicaid Contact Center: 888-245-0179