ACL Policy Round Up: Accessible medical equipment, web accessibility, HCBS waitlists, and More

By Vicki Gottlich, Deputy Administrator for Policy and Evaluation

In this policy round up:

• Input Needed
  • DOJ proposed rule on accessible medical diagnostic equipment under Title II of the ADA (Comments due 2/12)
  • HUD proposes “30-Day Notice” rule for nonpayment of rent (Comments due 1/30)
  • CMS issues proposed rule that would establish appeal rules for hospital observation status (Comments due 2/26)
• Report on waiting lists for Medicaid HCBS services
• New CMS health equity briefs on Medicaid and CHIP
• HHS and ED update resource on inclusion in early childhood programs
• EEOC publishes article on workplace accessibility

Input Needed by 2/12: DOJ proposed rule on accessible medical diagnostic equipment under Title II of the ADA

The Department of Justice is seeking comments on a proposed rule that seeks to improve access to medical diagnostic equipment (MDE) for people with disabilities. Examples of MDE include examination tables, dental chairs, and mammography and x-ray equipment. The Notice of Proposed Rulemaking clarifies how public entities such as hospitals and health care clinics operated by state or local governments can meet their obligations under the Title II of the Americans with Disabilities Act (ADA). 

The proposed technical standards for MDE are based on standards developed by the Access Board and used in HHS’ recent proposed rule implementing Section 504 of the Rehabilitation Act. The HHS Sec. 504 proposed rule applies to entities that receive federal funding or assistance while the DOJ Title II proposed rule applies to public entities (i.e., state and local governments).

You can submit comment online, by mail, or in person by February 12, 2024.

For more on this proposed rule, see DOJ’s fact sheet and press release. Visit ACL’s Disability Rules page to learn about and track the many upcoming, proposed, and final rules from across the federal government that seek to protect the rights of people with disabilities.

Input Needed by 1/30: HUD proposes “30-Day Notice” rule for nonpayment of rent

The Department of Housing and Urban Development (HUD) is seeking comments on a proposed rule that would require tenants of certain HUD-funded housing to receive 30-day advance notice before an eviction due to nonpayment of rent is filed in court. The proposed rule would apply to public housing agencies with tenants in public housing and owners of properties participating in HUD Multifamily project-based rental assistance programs.

It would also require the 30-day notice to include instructions on how tenants can correct lease violations for nonpayment of rent as well as information on how to recertify their income and request a minimum rent hardship exemption, if applicable, to avoid eviction.

Under the proposed rule, notice must be provided in formats that are accessible to people with disabilities and provide meaningful access for people with limited English proficiency.

Comments can be submitted online or by mail until January 30.

Report on Waiting Lists for Medicaid HCBS Services

KFF has published a new report, A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2023. The report provides insight into one important measure of unmet need for home and community-based services (HCBS) across states.

A few highlights from the report include: 

• The number of states with waiting lists hasn’t changed significantly over time. Currently, 38 states have them.
• As of 2023, there are over 692,000 people on waiting or interest lists for HCBS services.
• Most people on waiting or interest lists for HCBS live in states that do not screen for eligibility before adding people to lists.
• Most people on waiting or interest lists are eligible for other HCBS services, but those services may not fully meet their needs.

New CMS health equity briefs on Medicaid and CHIP

CMS released a set of health equity data briefs on Medicaid and the Children’s Health Insurance Program (CHIP). The briefs cover Mental Health/Substance Use Disorder Services, the Section 1915(c) Waiver Program, and Well-Child Visits.
Highlights from the new data briefs include:

• Nearly all states operate a 1915(c) waiver program that provides access to critical long-term services in home or community-based care settings. Compared to Medicaid beneficiaries not in a waiver program, the population participating in these waiver programs tend to be older adults (ages 65+) and non-Hispanic White.
• 93% of children under the age of one received a well-child visit paid for by Medicaid or CHIP in 2020. 
• Nearly a quarter of enrollees between the ages of 21 to 64 received a behavioral health service paid for by Medicaid or CHIP in 2020.
• Asian/Pacific Islander (API) and Hispanic enrollees receive behavioral health services at lower rates than other racial and ethnic groups. API enrollees receive services at nearly one third the rate of other racial and ethnic groups. 
• Over 40% of enrollees who were eligible for Medicaid based on disability received services for a behavioral health condition—nearly double the rate for other adult eligibility categories.

CMS has previously released health equity data briefs that we discussed here. 

HHS and ED update resource on inclusion in early childhood programs

The Departments of Health and Human Services and Education recently released an updated joint policy statement on supporting the inclusion of children with disabilities in early childhood programs.

The policy statement reiterates expectations for inclusive early childhood settings and updates recommendations for state and local agencies that implement Individuals with Disabilities Education Act, Head Start, child care, home visit, preschool, and public school programs to increase inclusive early learning opportunities for all children. It also includes evidence-based models and examples of inclusion, as well as resources to support high-quality individualized programming and inclusion of children with disabilities in early childhood programs.

EEOC publishes article on workplace accessibility

The EEOC released an article that provides an overview of the laws that federal agencies must comply with to provide people with disabilities access to accommodations to ensure they are able to participate fully in the workplace

The article focuses on accommodations that improve access to job facilities, physical spaces, and information technology. These include accommodations like automated doors, handrails and stair treads, accessible parking spaces, and adaptive computer hardware and software, providing ASL interpreters, and providing written materials in large print or Braille.

It also provides information about where agencies can find additional resources to help them comply with anti-discrimination and accessibility laws, including resources from the Access Board, DOJ, ODEP, and more.