On January 6, 2017, the Architectural and Transportation Barriers Compliance Board (Access Board) released its final rule entitled Standards for Medical Diagnostic Equipment, as required by Section 4203 of the Patient Protection and Affordable Care Act (ACA). These standards are intended to ensure that diagnostic equipment used in “physician’s offices, clinics, emergency rooms, hospitals, and other medical settings, is accessible to, and usable by, individuals with accessibility needs, and shall allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible.”[1] This final rule makes changes and addresses comments to a notice of proposed rulemaking (NPRM) issued by the Access Board on February 9, 2012.[2]
While the Access Board has no enforcement authority over these standards, compliance may become mandatory when adopted by an enforcing authority (such as the U.S. Department of Justice (DOJ), within its authority under the Americans with Disabilities Act) or if federal agencies such as the Department of Health and Human Services (HHS) adopt these standards as mandatory for healthcare providers receiving payment from the agency. Finally, private parties may enforce these standards to some degree via lawsuits against noncompliant providers.
Transfer Surfaces Must Meet a Minimum Height Standard of 17″-19″
The NPRM proposed a standard of adjustable transfer heights with a minimum of 17”-19” and a maximum of 25” and requested comments on all three requirements. Most commenters supported both the adjustability requirement and the maximum height requirement, but opinions varied significantly on the minimum requirement. It should be noted that, of course, there is nothing to prevent a transfer height higher than 25”, so long as transfer is provided at 25” as well.
Commenters to the NPRM as well as an Access Board-convened advisory committee were unable to arrive at a consensus on the minimum height requirement, and therefore the Access Board determined that there was insufficient information to designate a single minimum height at this time. Specifically, the final rule states that “there is insufficient data on the extent to which and how many individuals would benefit from a transfer height lower than 19 inches.” Therefore, the final rule establishes a five-year period during which any low transfer height between 17 and 19 inches will meet the standards. In addition, the Access Board has commissioned a study “to quantify the portion of the population that would benefit from a low transfer height below 19 inches.” After five years, the minimum height requirement will automatically sunset, so the Access Board intends to amend the rule after the completion of the study and before the sunset date in order to establish a permanent single minimum standard.
Transfer Surfaces Must Be Measured to the Highest Point of the Uncompressed Transfer Surface
The NPRM proposed to measure the height of the transfer surface from the floor to the top of the transfer surface, and asked for comments on whether this measurement should be taken with the surface in a compressed or uncompressed state. The majority of commenters and the Advisory Committee recommended an uncompressed measurement to ensure consistency of measurement. The Advisory Committee also recommended that measurement be taken to the highest point of the transfer surface (including bolsters and contours). The final rule accepts both of these recommendations, and states that the surface shall be measured “from the floor to the top of the uncompressed transfer surface.”
Transfer Surface Heights Must Be Adjustable
In the NPRM, the Access Board did not propose any intermediate transfer heights. In other words, so long as the transfer surface could be used at the minimum and maximum heights, no other heights were required. They sought comments on whether this should be the case. A number of commenters expressed support for intermediate heights, as for many people it is critical to transfer straight across from a mobility device to an examination surface rather than up or down. The final rule expresses that the preferable way to achieve this is via continuous adjustment throughout the transfer height range. However, some hydraulic systems adjust incrementally, and the final rule requires that between the minimum and maximum height there be at least four increments, spaced at least 1” apart.
Applied Policy Congratulates the Access Board on the Finalization of This Rule
Applied Policy worked closely with the Access Board for more than 4 years as they developed these new standards, and we applaud them for their commitment to crafting a final rule dedicated to our shared goal of improving the lives and health of all people. If we can help your organization improve the lives of the people you serve, please don’t hesitate to contact us at gpugh@appliedpolicy.com or 202-558-5272.
[1] 29 U.S.C. 794f.
[2] Notice of Proposed Rulemaking – Medical Diagnostic Equipment Accessibility Standards, 77 FR 6916 (February 9, 2012)