Under Section 1557 of the Affordable Care Act, a covered dental practice must take appropriate steps to ensure that communications with patients, prospective patients, members of the public, and companions with disabilities are as effective as communications with others. The dental practice must furnish appropriate auxiliary aids and services where necessary to give such individuals with disabilities an equal opportunity to participate in, and enjoy the benefits of, a service, program, or activity of the dental practice.
Definitions:
Companion means:
- a family member, friend, or associate of an individual seeking access to a service, program, or activity of the dental practice, who, along with such individual, is an appropriate person with whom the dental practice should communicate.
Disability means:
- a physical or mental impairment that substantially limits one or more major life activities
- a record of such an impairment, or
- being regarded as having such an impairment.
The type of auxiliary aid or service necessary to ensure effective communication will vary according to:
- the method of communication used by the individual
- the nature, length, and complexity of the communication involved and
- the context in which the communication is taking place.
In determining what types of auxiliary aids and services are necessary, the dental practice must give primary consideration to the requests of individuals with disabilities. In order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability.
Auxiliary aids and services
The dental practice must provide appropriate auxiliary aids and services, including interpreters and information in alternate formats, to individuals with impaired sensory, manual, or speaking skills, where necessary to afford such persons an equal opportunity to benefit from the service in question.
Auxiliary aids and services include:
1. Effective methods of making aurally delivered information available to individuals who are deaf or hard of hearing, such as:
- Interpreters on-site or through video remote interpreting (VRI) services
- note takers
- real-time computer-aided transcription services
- written materials
- exchange of written notes
- telephone handset amplifiers
- assistive listening devices
- assistive listening systems
- telephones compatible with hearing aids
- closed caption decoders
- open and closed captioning, including real-time captioning
- voice, text, and video-based telecommunication products and systems, text telephones (TTYs), videophones, and captioned telephones, or equally effective telecommunications devices
- videotext displays
- accessible information and communication technology
2. Effective methods of making visually delivered materials available to individuals who are blind or have low vision, such as:
- Readers
- taped texts
- audio recordings
- Braille materials and displays
- screen reader software
- magnification software
- optical readers
- secondary auditory programs
- large print materials
- accessible information and communication technology.
Interpreters for individuals with disabilities
When a dental practice is required to provide an interpreter for an individual with a disability under Section 1557, the interpreting service must be provided to the individual free of charge and in a timely manner, via a remote interpreting service or an onsite appearance, by an interpreter who
- Adheres to generally accepted interpreter ethics principles, including client confidentiality; and
- Is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology and phraseology.
Dental practices covered by Section 1557 are required to comply with the requirements for providing effective communications to individuals with disabilities that apply to public entities, including giving primary consideration to the requests of individuals with disabilities when determining what types of auxiliary aids and services are necessary.
An interpreter for an individual with a disability for purposes of this section can include, for example:
- sign language interpreters
- oral transliterators (individuals who represent or spell in the characters of another alphabet)
- cued language transliterators (individuals who represent or spell by using a small number of handshapes.)
The dental practice must not require an individual with a disability to bring another individual to interpret for them. A covered dental practice must not rely on an adult accompanying an individual with a disability to interpret or facilitate communication except—
In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available; or
Where the individual with a disability specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances.
The dental practice must not rely on a minor child to interpret or facilitate communication, except in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available.
Video remote interpreting (VRI) services.
If the dental practice chooses to provide qualified interpreters via VRI services, the dental practice must ensure that it provides—
- Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;
- A sharply delineated image that is large enough to display the interpreter's face, arms, hands, and fingers, and the participating individual's face, arms, hands, and fingers, regardless of his or her body position;
- A clear, audible transmission of voices; and
- Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI.
ADA Member Advantage endorses CyraCom, a provider of phone and video interpretation.
Telecommunications
Where the dental practice communicates by telephone with individuals such as patients and prospective patients, text telephones (TTYs) or equally effective telecommunications systems must be used to communicate with individuals who are deaf or hard of hearing or have speech impairments.
When the dental practice uses an automated-attendant system, such as voicemail and messaging, or an interactive voice response system, for receiving and directing incoming telephone calls, the system must provide effective real-time communication with individuals using auxiliary aids and services, including TTYs and all forms of FCC-approved telecommunications relay systems, including Internet-based relay systems.
The dental practice must respond to telephone calls from a Telecommunications Relay Service in the same manner that it responds to other telephone calls.
Information and signage
The dental practice must ensure that interested persons, including persons with impaired vision or hearing, can obtain information as to the existence and location of accessible services, activities, and facilities.
The dental practice must provide signage at all inaccessible entrances to each of its facilities, directing users to an accessible entrance or to a location at which they can obtain information about accessible facilities. The international symbol for accessibility must be used at each accessible entrance of a facility.
Undue burden
The effective communications provisions of Section 1557 do not require a dental practice to take any action that it can demonstrate would result in a fundamental alteration in the nature of a service, program, or activity or in undue financial and administrative burdens. If the dental practice believes that the proposed action would fundamentally alter the service, program, or activity or would result in undue financial and administrative burdens, the dental practice has the burden of proving that compliance with Section 1557 requirements would result in such alteration or burdens.
The decision that compliance would result in such alteration or burdens must be made by the head of the dental practice or their designee after considering all resources available for use in the funding and operation of the service, program, or activity and must be accompanied by a written statement of the reasons for reaching that conclusion. If an action required to comply with the effective communications provisions of Section 1557 would result in such an alteration or such burdens, the dental practice must take any other action that would not result in such an alteration or such burdens but would nevertheless ensure that, to the maximum extent possible, individuals with disabilities receive the benefits or services provided by the dental practice.