Complying with the law while treating patients with special needs

Answers in Practice

Rachna Chaudhari

Rachna Chaudhari is the AAD's practice management manager. Her column offers tips in response to common member questions.

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Dermatology practices are increasingly faced with complying with new or changing laws and regulations. It can be a constant challenge to follow these issues and ensure compliance. Some of the most common questions the Academy’s practice management staff receive involve how practices should comply with the complex rules regarding patients with special needs. Below are answers to some of the most commonly asked questions.

What laws should my practice be aware of regarding patients with special needs?

There are two laws that affect how your practice should treat patients with special needs: the Americans With Disabilities Act (ADA) and Title VI of the 1964 Civil Rights Act. The ADA is a federal law that prohibits discrimination on the basis of disability. A disability is defined as “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.” Thus, a dermatology practice cannot refuse to see a patient simply due to their disability if they accept any payment from Medicare or Medicaid.

Title VI of the 1964 Civil Rights Act, another federal law, prohibits discrimination based on national origin. The Department of Health and Human Services (HHS) has expanded this definition to include patients with limited English proficiency (LEP). Thus, providers who accept Medicare or Medicaid payments must abide by the regulations and provide translation services to LEP patients. However, if your practice only accepts Medicare Part B payment, you do not have to abide by this regulation.

What types of services should I offer to comply with the ADA?

The ADA requires practices to accommodate patients with disabilities — which includes not only providing interpreter services, if necessary, but providing patients with access to your physical office building. Analyze your office space to ensure that patients in wheelchairs are able to enter the premises through a ramp or wider doors. Restrooms should be equipped with handicapped stalls and handicapped parking spaces should be available. For a helpful checklist on how to comply with these standards, visit

In addition to ensuring that your physical practice space can accommodate patients with disabilities, you must insure that staff can communicate with the patient. It is the practice’s responsibility to provide interpreter services for the patient free of charge. Although the ADA does not provide specific guidance on interpreter services, physicians have been found legally liable in cases where they did not offer and pay for interpreter services for patients with hearing or speech disabilities. (To read about one such instance, visit HHS has stated that physicians can use a variety of tools at their disposal to communicate with disabled patients including using handwritten notes to communicate with deaf patients or using telephonic translation services. Medicare will not reimburse you for any interpreter services. However, some insurance contracts will reimburse for these services; investigate this option through each carrier. [pagebreak]

Is my practice required to offer interpreter services to limited English proficiency patients?

Your practice is expected to voluntarily comply and offer interpretive services to LEP patients. HHS understands that small practices may not have the resources of larger hospital-based systems and therefore allows greater flexibility in their compliance. The agency states “there is no one size fits all’ solution for Title VI compliance with respect to LEP persons, and what constitutes reasonable steps’ for large providers may not be reasonable where small providers are concerned.” However, practices are expected to provide vital documents such as consent forms or treatment authorization forms in a manner in which patients can fully understand what they are authorizing. Providers can use patients’ family members to aid with translation services as well. However, if the patient is unable to abide by this request, the practice must determine a viable solution at no charge to the patient.

Can the practice collect any additional fees from the patient if the charges for the interpreter services are more than the charges for the visit?

No, the practice cannot collect any additional fees from the patient. Unfortunately, if the cost of the interpreter services is more than the charges for the visit itself, the provider has no recourse for collecting additional payment. Additionally, the provider cannot dismiss the patient from their practice for this reason. Neither Title VI nor the ADA allow practices to dismiss patients on the basis of their disability or limited language proficiency.

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If your practice requires help with translating patient authorization forms, Google offers free document translation at (It is a good idea to have translated documents reviewed by a native speaker if possible before using them with the general public to avoid embarrassing errors.) You can also contact your malpractice carrier as they may have these forms available in various languages. Your practice can also obtain a selection of the AAD’s pamphlets in Spanish at



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