The healthcare sector, specifically related to digital accessibility, came under a fair amount of scrutiny during the COVID pandemic when telehealth was forced on the high-risk individuals who needed it most. Unfortunately, many were also left out due to the inaccessibility of websites, vaccine registrations, non-accessible PDF forms to avoid in-person contact, and so forth. Perhaps, then, it is no surprise that the recent landmark final rule from the Department of Health and Human Services (HHS) sheds significant light on modernizing and strengthening Section 504 of the Rehabilitation Act of 1973.
With these regulations, there is certainly a path for the accessibility of the healthcare landscape set up for significant changes. This blog will explore the digital accessibility requirements for healthcare organizations and outline a strategic timeline for compliance with these new regulations.
History of the Landmark Final Rule
The journey towards inclusive healthcare began with the Notice of Proposed Rulemaking in September 2023, inviting public comments to shape the regulations.Our team here at Allyant provided a lengthy response to each digital and document-specific requirement within these proposed regulations at that time. We saw many of our comments both assessed in this Final Rule and strongly considered based upon some of the changes implemented between the original proposed rule and the final ruling recently released.
This culminated in the publication of the final rule on May 1, 2024. Ultimately, this rule aims to ensure equitable access for people with disabilities, impacting a wide range of healthcare services and settings— not just digital accessibility.
Scope of the Final Rule
The final rule encompasses nearly every aspect of accessibility. This is well documented in the HHS team’s Fact Sheet, which can be found here. To provide a summary, this ruling and the forthcoming formal regulations include:
- Medical Treatment: Discrimination in medical care has led to significant health disparities for individuals with disabilities. The new rule ensures medical decisions are made fairly, preventing biases and stereotypes from affecting treatment choices.
- Value Assessment Methods: Value assessments are crucial for deciding treatment options, but they often undervalue the needs of people with disabilities. The final rule prohibits discriminatory practices in these evaluations, ensuring equitable access to healthcare for all.
- Child Welfare Programs and Activities: Individuals with disabilities face discrimination in child welfare services, impacting everything from child placement to family reunification. The new regulations enforce nondiscrimination, ensuring fair treatment for all families involved in the system.
- Accessible Medical Equipment: Inaccessible medical equipment has long excluded people with disabilities from essential healthcare services. The new regulations require facilities to have accessible medical equipment within two years, reducing these barriers and promoting better health outcomes.
- Web and Mobile Accessibility: As healthcare moves online, it’s vital that digital platforms are accessible to everyone. The new rule mandates compliance with WCAG 2.1 AA standards, ensuring websites and mobile apps are usable by individuals with disabilities.
The final rule posted within the Federal Register is extremely lengthy—the full PDF form can be found here and includes 130 pages explaining these requirements and how compliance will be determined. It is likely important to note that the digital accessibility requirements are outlined in a few small sections on page 128 of this 130-page document.
Who Needs to Comply with these new Regulations?
The new HHS Accessibility regulations have broad implications for healthcare providers across the United States, particularly those receiving federal financial assistance. Compliance is not just a requirement but an essential step towards ensuring that all individuals, regardless of their abilities, have equal access to healthcare services. Here’s a closer look at the types of organizations that need to adhere to these updated rules:
- Hospitals
Hospitals are often the first point of contact for many seeking medical care. These regulations require them to make their facilities, digital platforms, and services accessible to individuals with disabilities, ensuring no patient is left behind due to physical or technological barriers. - Clinics and Health Centers
Clinics and community health centers, which provide vital healthcare services to diverse populations, must comply with the new accessibility standards. This includes making sure their websites, appointment systems, and medical equipment are accessible to everyone. - Long-term Care Facilities
Long-term care facilities, including nursing homes and assisted living centers, serve a significant number of individuals with disabilities. The regulations mandate that these facilities provide accessible environments and digital tools to support the health and well-being of their residents. - Mental Health Treatment Centers
Mental health treatment centers must also adhere to the new rules, ensuring that their services, including telehealth options and digital resources, are accessible. This is crucial for supporting individuals with mental health conditions and ensuring they have equitable access to care. - Dental and Vision Providers
The new regulations include dental and vision care providers. These providers need to ensure their facilities and digital tools, such as patient portals and appointment systems, are fully accessible to individuals with disabilities. - Educational Institutions
Educational institutions that provide healthcare training or receive federal health funding must comply with these standards. This includes ensuring that digital learning platforms and physical facilities are accessible to students with disabilities, promoting an inclusive learning environment. - Telehealth Providers
Telehealth has become a vital part of healthcare delivery, especially post-pandemic. Providers must ensure their telehealth services, apps, and websites meet accessibility standards, allowing individuals with disabilities to access healthcare remotely without barriers. - Insurance Companies
Insurance companies, specifically those involved in federal programs or receiving federal financial assistance in any form, must also comply with these new HHS regulations. This covers a wide variety of digital assets, including websites for insurance policy information, claims processing and customer support, including when provided or distributed in PDF format.
The Countdown to Compliance for Healthcare Organizations
Healthcare organizations must adhere to a clearly defined timeline to comply with the new HHS Accessibility regulations as it relates to their websites, mobile apps, and other web apps or digital documents. One thing I would urge every healthcare organization to consider is not viewing this timeline as a starting line but as a crucial countdown to compliance, highlighting the urgency and importance of getting started with at least some level of immediate action. Here’s a detailed overview of the key dates and why quick action is imperative:
- 1. May 9, 2024: Final Rule Published
The final rule was published in the Federal Register on this date, marking the formal announcement of the regulations. This formally started the compliance clock for healthcare organizations within this final ruling. - 2. July 8, 2024: Regulations Take Effect
As outlined in the final rule, these regulations take effect 60 days after publication in the Federal Register. This short window underscores the need for healthcare providers to start planning immediately to meet the new accessibility requirements, as the clock is already ticking. - 3. May 11, 2026: Deadline for Larger Organizations
Organizations with 15 or more employees must ensure their web and mobile platforms comply with WCAG 2.1 AA standards by this date per the final rule. While two years may seem like ample time, it will pass quickly. The extensive work required to audit, update, and ensure digital compliance demands a proactive approach, starting now to avoid a last-minute rush. In fact, from my experience working with many large healthcare providers, it can take 6-8 months to get a standard website into a solid state of conformance. This can easily jump to 12+ months for complex mobile and web applications. - 4. May 10, 2027: Deadline for Smaller Organizations
One welcome caveat in these regulations came for smaller organizations with fewer than 15 employees, as they have an additional year to meet the same digital accessibility standards. However, they should not view this as an excuse to delay but rather use this longer timeline to their advantage. Given limited resources, smaller entities might find it even more critical to start early.
Two years may seem distant, but the complexity of achieving full compliance with the WCAG success criteria means time is of the essence. I would also strongly recommend that healthcare organizations begin establishing detailed plans and making the necessary updates to their digital platforms and services now so they don’t compound the challenge of meeting conformance within the required timelines.
For example, your team is likely to deploy new web pages or digital documents weekly, if not daily. By deploying inaccessible content, you’re furthering your path to conformance within the two-year time horizon. Additionally, perhaps you are building a new website or mobile application. If that is being designed and developed without ongoing accessibility reviews, you may be heading towards the release of a non-conformant product within the next 6-12 months. Building with accessibility in mind from the get-go in most every case will significantly reduce time and resources to conformance.
By taking action today, healthcare providers not only meet regulatory requirements but also demonstrate their commitment to inclusivity and equitable access to healthcare for all individuals. Embracing this challenge now will help avoid the pitfalls of rushed implementations and ensure a smoother transition to compliant and accessible services.
Digital Compliance Requirements
Healthcare organizations are now required to ensure that their digital platforms are accessible under the new HHS regulations. This definition is outlined in Subpart I of the final publication. Within this subpart, it is outlined that websites, mobile apps, and digital documents must be accessible to all. Here’s a breakdown of the specific areas that need attention:
- 1. Web Content
Organizations must make sure that their websites, including brochure sites, appointment scheduling systems, and patient portals, are accessible to all users. This involves adhering to Web Content Accessibility Guidelines (WCAG) 2.1 AA, which cover everything from text alternatives for images and heading levels to complex menus and modals. - 2. Digital Documents
All digital documents, including PDFs, must be accessible to people with disabilities. This ensures that important information, such as medical records, brochures, and forms, is available to everyone, regardless of their ability to see or interact with standard document formats. There is some confusion with organizations thinking that pre-existing documents are not required to be accessible. This is outlined further within the exceptions, where it is clarified that conventional electronic documents that are available as part of web content or mobile apps before the date the organization is required to comply are excluded unless such documents are currently used to apply for, gain access to, or participate in the organization’s programs or activities. - 3. Mobile Apps
Mobile applications must be designed to be accessible, providing user-friendly experiences for telehealth services, health information access, and pharmacy details. This is crucial for ensuring that individuals with disabilities can use these essential services without barriers, as many healthcare services have moved to a mobile app-first approach for all users.
The WCAG 2.1 AA standards serve as the benchmark for these requirements, providing a comprehensive framework to ensure that all digital content is accessible. With that said, we encourage teams, specifically when building or developing new applications, to consider at least testing against WCAG 2.2 AA conformance.
Meeting these standards means not just complying with regulations but also committing to an inclusive healthcare system that serves everyone equitably. By focusing on digital compliance now, healthcare organizations can ensure that their services are accessible to all, setting the stage for a more inclusive future and significantly reducing their organization’s legal risk with a recent precedent recently set in a DOJ settlement with an Illinois Clinic.
Impact of Procurement on Compliance: Ensuring Accessibility in Third-Party Digital Solutions
The new HHS Accessibility regulations extend beyond in-house digital platforms, noting explicitly the need for healthcare organizations to ensure that third-party software and services also meet accessibility standards. Whether it’s telehealth solutions, patient portals, or appointment scheduling apps, compliance with these regulations is crucial. Here’s why paying attention to third-party digital tools is essential:
- 1. Scope of Third-Party Digital Content
The final rule specifies that accessibility requirements apply not only to content created directly by healthcare organizations but also to content provided through contractual, licensing, or other arrangements. This means that digital tools such as telehealth software, patient portals, website chatbots, and appointment scheduling applications from third-party vendors must also comply with Web Content Accessibility Guidelines (WCAG) 2.1 AA standards. - 2. Telehealth Vendors and Software
Telehealth has become a critical component of healthcare delivery—and ensuring that these services are accessible is essential. Organizations must verify that their telehealth vendors provide platforms that are accessible to individuals with disabilities, ensuring equal access to remote healthcare services. - 3. Patient Portals and Appointment Scheduling
Patient portals and appointment scheduling systems, often managed by third-party providers, must be user-friendly and accessible. These tools are vital for managing healthcare needs, and organizations must ensure that vendors adhere to accessibility guidelines, providing an inclusive experience for all patients.
Procurement Cycles vs. Compliance Timeline
From my direct experience, many healthcare organizations typically follow a 6 to 12-month procurement cycle for third-party software. With a 22-month compliance timeline for these new regulations from the time I wrote this blog, it’s crucial to integrate accessibility checks into the procurement process immediately. This means evaluating and selecting vendors that comply with accessibility standards, allowing ample time to address any non-compliance issues before the deadline.
Allyant: Your Trusted HHS Compliance Partner
Navigating the complexities of the new HHS Accessibility regulations will likely be overwhelming for many organizations. Trusted partners who bring long-standing expertise in driving digital and document conformance will be critical for almost every organization, and our team here at Allyant would be happy to help reduce the stress and define a clear roadmap for conformance. We offer a full suite of tools and services designed to ensure your healthcare organization meets accessibility standards efficiently and effectively.
CommonLook Clarity: Advanced PDF Compliance Management
Our CommonLook Clarity product is the easiest way for your healthcare organization to assess and roadmap a path to conformance for all your digital documents. Clarity is a cutting-edge automation solution that focuses on ensuring PDF accessibility across your websites, intranets, and internal networks. This tool streamlines the management of PDF documents, offering your team critical visibility into accessibility issues that exist within your digital documents today. Our team would be happy to provide you with an initial Clarity report for your website, allowing you to make informed decisions and allocate resources more efficiently, ensuring that your PDFs meet the required HHS ruling standards.
ProcureEnsure: Accessible and Streamlined Procurement
To support your third-party software compliance, Allyant offers ProcureEnsure, a no-cost service that provides free procurement assessments. Whether you’re procuring new software or renewing existing third-party applications, we deliver comprehensive accessibility testing results within 5-7 business days. Each assessment includes native screen testing to guarantee both accessibility and usability, ensuring that your existing third-party applications are compliant with the defined HHS regulations. This service also enables your organization to make informed purchasing decisions that reduce your organization’s risk while ensuring ALL patients have the necessary access they desire.
Quick Wins with Full-Service Accessibility Support
As the only full-service accessibility communications provider, Allyant is equipped to help you achieve quick wins on your path to compliance. From industry-leading PDF management solutions to live-user accessibility testing of your websites and mobile applications and even accessible print solutions, we provide the expertise and tools you need to meet the new HHS Accessibility regulations promptly and effectively.
Build Your Path to Conformance
The HHS final rule represents a significant step towards an inclusive healthcare environment. By adhering to the outlined digital accessibility requirements and following the compliance timeline, healthcare organizations can not only meet regulatory standards but also enhance the quality of care for all patients.
As the healthcare industry adapts to these new requirements, the emphasis on accessibility underscores a broader commitment to equitable, patient-centered care.
To ensure that your organization is at the forefront of accessible healthcare—reach out to our team at Allyant to start your compliance journey today!
