On September 14, 2023, the Biden administration issued a proposed rule update1 regarding the U.S. Department of Health and Human Services’ (HHS) interpretation of Section 5042 of the Rehabilitation Act of 1973.3 Section 504 prohibits federally funded organizations and employers from discriminating against people with disabilities, and each administrative agency of the federal government provides policies that reflect how it interprets Section 504. HHS’ oversight includes policies that govern hospitals or health centers that receive federal funding through programs such as Medicare and Medicaid.
The proposed rule and comment submission box can be accessed through the Federal Register at this link.
HHS’ Section 504 proposed rule change suggests adding a new policy called Subpart J, which can be found on page 190 of the proposed rule. Subpart J targets the lack of accessible medical equipment for people with disabilities in medical facilities. HHS currently uses the U.S. Access Board’s guidance on accessibility standards for medical diagnostic equipment.4 The board’s standards provide suggestions on how to make certain medical diagnostic equipment—specifically, examination tables, examination chairs, weight scales, mammography equipment, X-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals—accessible to disabled people. HHS’ proposed rule broadens the U.S. Access Board’s accessibility standards by expanding the definition of medical examination equipment to include equipment used for treatment purposes.
The Center for American Progress encourages people, especially those within reproductive rights and disability rights groups, to submit a personalized public comment generally supporting the proposed rule change. Individuals may choose to highlight how disabled people do not currently receive necessary health services due to inaccessible evaluation and examination equipment and the potential benefits of Subpart J in improving the health of people with disabilities by ensuring access to needed equipment and services. Comments are due on November 13, 2023.
This toolkit will:
- Explain how to submit a comment.
- Provide suggestions on how to format and what to include in the comment.
- Give key statistics on how inaccessibility in health care affects disabled people.
Remember: Anyone can submit public comments into the Federal Register. CAP highly encourages individuals and organizations to submit unique public comments to ensure everyone’s voice is heard and comment is counted.
How to submit a comment
- Visit the proposed rule webpage in the Federal Register.5
- Click on the green “Submit a formal comment” button beneath the rule title.
- Type your comment. You may also attach it as a file.
- Enter your email address, if you choose to provide it. You can also select the checkbox to opt to receive email confirmation of your submission and a tracking number, but it is not required.
- Select whether you are an individual, an organization, or whether you want to be anonymous. Note that if you select “individual” or “organization,” the content of the comment and your name will be made viewable publicly.
- Select the box that says: “I have read and understand the statement above.”
- Review your comment and click “Submit comment.” You may also preview your comment if you would like.
Format and outline for comments
- Introduction: Introduce yourself or your organization. If applicable, feel free to include information about your disability if you feel comfortable.
- State your support for the proposed rule change: Make sure you clearly write that you support the proposed rulemaking to make medical equipment more accessible for people with disabilities.
- Explain why you care: This is a chance to talk about how the accessibility of medical equipment used for evaluation, diagnostics, and treatment affects disabled people’s ability to receive the reproductive health care individuals need. You can use a personal story or a story of someone you know. Feel free to use some of the key statistics provided below to help support your point. Some personal stories or topics that may be helpful to highlight include:
- A time when you or someone you know went without routine or preventive medical care or faced difficulties or delays in accessing care because medical equipment was inaccessible
- A time when you or someone you know went without routine or preventive medical care or faced difficulties or delays in accessing care because accessible medical equipment was unavailable
- A time when you or someone you knew was denied access to medical equipment by a health care provider
- Finalize your thoughts: Restate your strong support for the proposed rule change around making medical diagnostic equipment more accessible.
Key points and statistics to include
- Up to 1 in 4 adults6 have some type of disability, according to the Centers for Disease Control and Prevention.
- The United States has added 2.7 million7 more adults with disabilities in the past two years. This is a significant increase in contrast to previous years.
- The United States has more than 1 million women with chronic physical disabilities8 who are of child-bearing age, and at least 4.1 million people9 are parents with disabilities.
- Disabled people report significant and varied barriers10 to accessing reproductive health care, including:
- Discrimination and lack of provider training,11 which is further compounded for disabled people of color12
- Barriers to care, including unaccommodating physical infrastructure, such as narrow doorways or examination tables or nonadjustable chairs, as well as scales, X-rays, and mammography machines that cannot be used by people who have difficulty or who cannot stand13
- Reproductive health exam or treatment rooms inaccessible for people with physical disabilities14
- Disabled people are much less likely to receive recommended cancer screenings.15 One comprehensive study showed that disabled women were much less likely to receive Pap smears (as low as 66.1 percent) compared with nondisabled women (81.4 percent). Disabled women were also much less likely to have a mammogram (as low as 61.2 percent) when compared with nondisabled women (72.8 percent).
- Disabled people are more likely to be diagnosed with breast cancer at later stages16 and have higher breast cancer mortality rates17 compared with their nondisabled peers.
- Disabled people are more likely to have pregnancy complications than nondisabled people, resulting in their babies being born early and having low birth weights.18
- All people, including individuals with disabilities, have the right to decide if, when, and how to start and raise a family as well as to have healthy pregnancies and postpartum periods.
Conclusion
Thank you for your consideration. We encourage you to make your voice heard and submit a comment in support of the updated interpretation of Section 504 of the Rehabilitation Act of 1973. Your feedback and personal experiences matter and can help ensure the Department of Health and Human Services follows through on ensuring people with disabilities have access to needed medical diagnostic equipment.
If you have questions, want to let us know you used this tool to submit a comment, want to let us know what you submitted, or have further suggestions, feel free to email us at [email protected].