I. Sources of Law for Health Care

A. Major Federal Legislation

Employer-Provided Benefits, Public Services, and Public Accommodations:     Americans with Disabilities Act of 1990 (ADA) 

Federally-funded Programs: § 504 of the Rehabilitation Act of 1973 (Rehabilitation Act) 

Medicaid and Medicare Programs: Balanced Budget Act of 1997 (BBA) 

Group Health Plans: Health Insurance Portability and Accountability Act of 1996 (HIPAA) 

B.  Implementing Regulations and Guidance Documents 

ADA Title I: Equal Employment Opportunity Commission (EEOC) 

 ADA Titles II & III: Department of Justice (DOJ) 

 Rehabilitation Act: various agencies 

 BBA & HIPAA: Health Care Financing Administration (HCFA) 

II. About the Legal Protections

• Legal protections vary by type of coverage.  The answers to questions will depend upon the type of health insurance a person has, i.e. whether it is public or private.

• Protections will also vary depending upon the type of health plan a person has.  For example, health maintenance organizations (HMOs) tend to be more heavily regulated than preferred provider organizations. 

III.  Public Health Insurance

• Federally funded programs are subject to the Rehabilitation Act, and state and local public services are subject to Title II of the ADA.  Basic requirements of both acts include nondiscrimination, reasonable modification, and community integration.  State civil rights laws may provide additional protections. 

• The BBA provides that Medicaid beneficiaries in Medicaid managed care retain their right to a state-level fair hearing and imposes other requirements on Medicaid managed care, such as a “prudent layperson” standard for emergency treatment. 

IV. Private Health Insurance 

• Employer-provided benefits, including insurance are subject to Title I of the ADA

• “Public accommodations” (this includes doctors’ offices, clinics, and hospitals and may include insurance policies) are subject to Title III of the ADA.  Title III has its own nondiscrimination, reasonable modification, and integration mandates. 

• HIPAA also contains anti-discrimination provisions that apply to group health plans.  It prohibits discrimination against individuals based on health status and regulates use of pre-existing condition clauses, among other things. 

• State law provides some basic managed care protections. 

• Employers that set aside funds and employee premiums to pay for health coverage have self-funded plans. Self-funded plans are not regulated by states but are governed by the Employee Retirement Income Security Act (ERISA). 

V. Common Issues

Private plans:

• ADA coverage of health care plans under titles I and III.

• Denials of or limits on coverage that adversely affect people with disabilities/a particular category of disability.

• Selective benefiting/discrimination among disabilities – placing special caps on treatment for certain kinds of illness and denying coverage for particular treatments for particular illnesses.

Providers:

• Bringing suit against providers of health care and MCO’s. 

• Physical and Communication access to health care services.

Public Plans: 

• Failure to provide rehabilitation services, failure to provide equipment to support independent living, support for institutional care but not home care.

• Policies or practices of state agency/MCO that preclude or discourage participation by individuals with disabilities.

• Contractual arrangements between MCO and providers that contain incentives for providers to delay or deny care to people with disabilities.

• Access to services

• Providing assistance to people with learning disabilities in understanding what their choices are and in navigating the system.

Support for this Web cast is provided by the National Institute for Disability and Rehabilitation Research (NIDRR) as part of its initiative to promote greater use of disability research findings by consumers, their families, service providers, and other non-researcher stakeholders.  Specific NIDRR project support comes from RIIL (Research Information for Independent Living), RRTC on Managed Health Care & Disability, and RTC on Health & Wellness. NIDRR is part of the U.S. Department of Education, and no endorsement of the opinions expressed as part of this Web cast by the Department should be inferred.