Presented by Cary LaCheen, JD, on September 26, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. Cary LaCheen
National Center for Law and Economic Justice
275 Seventh Avenue, Suite 1506
New York, NY 10001
P 212-633-6967, f 212-633-6371
lacheen@nclej.org, www.nclej.org
The cost of poor communication for people with disabilities:
A review of disability rights laws
Copyright © 2013 National Center for Law and Economic Justice and MAXIMUS, Inc. All rights reserved.

2. Which federal disability
rights laws apply?
Often more than one of these laws applies.

3. • Meaningful access and equal opportunity to
participate/benefit
• Reasonable accommodations
• No discriminatory effect from program admin
• Effective communication
• Accessible electronic/information technology
Federal disability rights law
requirements

4. • It’s about policies, procedures (with operational details)
and staff compliance
• One size does not fit all
• One exception does not fit all
• Assumptions result in ADA/504 violations
• Accommodations should be easy to get
• RFP and contract language matter
• Compliance monitoring is essential
Rules of thumb for ADA/504
compliance

5. • Must provide effective communication with individuals
with disabilities
• Includes applicants, participants, beneficiaries, members
of the public, and “companions” (e.g., relatives, friends,
advocates)
• Must provide auxiliary aids and services needed for
effective communication
Effective communication requirement

6. Auxiliary aids and services
For individuals who are deaf or hard of hearing:
• Qualified sign language interpreters; notetakers; computer
transcription services; written materials; written notes;
telephone handset amplifiers; assistive listening devices;
telephones compatible with hearing aids; closed caption
decoders; open and closed captioning; and others
• Voice, text, and video-based products and systems,
including text telephones (TTYs); videophones and
captioned telephones; videotext displays; accessible
electronic and information technology

7. Auxiliary aids and services continued
For blind/visually impaired individuals:
• Qualified readers; taped texts; audio recordings;
Brailled materials and displays; screen reader
software; magnification software; optical readers;
secondary auditory programs; large print
materials; accessible electronic and information
technology; and others

8. Auxiliary aids and services
Which ones do you have to provide?
• What is effective for the individual
• Length, complexity of the communication
• Must be provided in a way that protect privacy and
independence
• People with disabilities other than sensory impairments:
Use low reading a level

9. • Must use TTY or relay services
• Telephone emergency services: provide direct access to
TTY users – not relay
• Policies can have a discriminatory effect unless you make
exceptions
• Voicemail, auto-answering, routing systems (IVR) must be
accessible
• Email and texting are effective alternatives for some
Telephone accessibility

10. Website accessibility
Websites must be accessible to:
• Blind/visually impaired people using assistive technology
• Vision impaired people who don’t use assistive technology
• Deaf/hearing impaired people
• People with seizure disorders
• People who use only a mouse, not keyboard

11. Website accessibility continued
Accessibility means, for example:
• Web pages and attachments in format accessible to
assistive technology
• Non-text elements need text description
• Tables need text labels for each box
• Page layout logical for screen reader user
• Videos captioned and described
• Text/color adjustable

12. Website accessibility continued
You will need:
• Knowledgeable web-designer/webmaster
• Web accessibility testing with computer programs and
people with disabilities
• Monitoring/posting procedures

13. Website accessibility continued
Two technical accessibility standards:
• Section 508 standards
• WC3 Guidelines (WCAG)
Not the same but will be very similar after 508 standards revised.
• Every state has an accessible website or technology law/policy
adopting on or both standards
• DOJ: website access required (no standards specified)
• Complying with neither violates ADA/504
• HHS- Exchange websites: 508 compliance sufficient

14. • Must be accessible
Information kiosks

15. • Accessible Exchange websites, online applications,
information, and notices
• Call centers must be accessible
• Ability to apply online, by phone, by mail, and in person
Health care reform

16. • No right to first choice of auxiliary aid/service
• Can provide alternative if provides an equal opportunity to
participate/benefit
• Defense: fundamental alteration or undue burden
- Burden is on you to prove
- “It costs too much” not sufficient
- Program budget/earnings relevant
Limits on obligations

17. • Meaningful access to LEP individuals
• Federal agencies - Language Access Implementation Plan
Communication with individuals with
limited English proficiency (LEP)

18. Communication with individuals with
limited English proficiency (LEP) continued
How to provide access:
• Bilingual staff
• Oral interpretation (in-person and remote)
• Verbal or written translations of documents

19. Communication with individuals with
limited English proficiency (LEP) continued
In deciding what to do/for whom, should consider:
• Number or portion of LEP persons
• Frequency of contact with the program
• Nature/importance of program/activity
• Resources and costs

20. Communication with individuals with
limited English proficiency (LEP) continued
Health and Human Services (HHS) requirements:
• Translate vital documents into languages used by 5% or
1000 (whichever is less) of population eligible to be served
or affected, and
• Give written notice of right to get vital documents orally
translated to other languages
• Strong evidence of compliance

21. Risks if don’t comply
Lawsuits/admin complaints have been filed against
• Social Security Administration - notices in alternative formats
• Treasury Department - inaccessible paper currency
• Atlanta transit agency - inaccessible website, bus schedules
• Universities - inaccessible technology
• Banks - not accepting relay calls
• Countless health care providers - no sign language interpreters
Defendants lost or settled and agreed to provide accessibility
ADA/504 enforcement agencies look at telephone/web/print
information accessibility during investigations/compliance
reviews