The U.S. Department of Health and Human Services (HHS) has issued a final rule entitled “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.” The rule’s purpose is to update, clarify, and strengthen the regulation that implements Section 504 of the Rehabilitation Act of 1973. Section 504 generally prevents disability discrimination in programs and activities that receive federal financial assistance.

The final rule updates and clarifies several areas the current rule does not specifically address. These areas include:

• Medical Treatment – The rule acknowledges that disability discrimination in medical treatment leads to significant health disparities and worse health outcomes. This discrimination may occur in areas such as organ transplantation, life-sustaining treatment, clinical research participation, and crisis standards of care. The rule emphasizes that medical treatment decisions by those who receive federal financial assistance may not be based on biases, stereotypes, value judgments about the lives of those with disabilities, or the notions that those individuals will burden others.
• Value Assessment Methods—While value assessment methods are important for cost containment and quality improvement efforts for interventions such as medicine and treatments, they may lead to disability discrimination. The final rule prohibits this type of discrimination, which may occur when assessment methods place a lower life-extension value on individuals with disabilities.
• Child Welfare Programs and Activities – All individuals participating in the child welfare system can experience discrimination. The final rule establishes detailed requirements to ensure nondiscrimination in child welfare services, including visitation, reunification services, placement, parenting skills programs, and in- and out-of-home services.
• Web and Mobile Accessibility – The final rule defines accessibility for websites and mobile applications. It also requires compliance with the Web Content Accessibility Guidelines (WCAG) 2.1 AA. This approach is consistent with the final rule recently issued by the Civil Rights Division of the U.S. Department of Justice entitled “Nondiscrimination on the Basis of Disability; Accessibility of Web Information and Services of State and Local Government Entities.”
• Accessible Medical Equipment – The final rule adopts the U.S. Access Board’s standards for accessible medical equipment. As a result, within two years of the effective date, federal funding recipients with examination tables and/or weight scales must have at least one accessible version of the equipment.
• Integration—Section 504’s existing regulation already requires programs and activities to be administered in the most integrated setting appropriate to people with disabilities. The final rule clarifies the rights and responsibilities of recipients to comply with this duty and the right of people with disabilities to be served in the most integrated setting.

The final rule also improves consistency with judicial rulings and legislative changes, including amendments to Section 504 and the enactment of the Americans with Disabilities Act (ADA). New sections added to the final rule include the following:

• Service Animals – Recipients receiving federal funding must permit trained service animals except in certain circumstances.
• Maintenance of Accessible Features—Recipients must maintain the required accessible facilities and equipment for people with disabilities in operable and working order.
• Personal Services and Devices—Recipients need not provide personal services and devices to individuals with disabilities unless they customarily do so for everyone.
• Mobility Devices – Recipients must allow people with disabilities to use manual or power-driven mobility devices in areas open to pedestrian use, except in certain circumstances.
• Communications – Recipients must provide auxiliary aids and services to ensure effective communications with individuals with individuals with hearing, vision, and speech impairments.
• Direct Threat – Recipients need not permit individuals to participate in programs or activities if they pose a direct threat to the health or safety of others.
• Retaliation and Coercion in Response to Disability Discrimination – Under Section 504, Recipients may not retaliate against individuals who complain or object to an unlawful act.
• Limitations – Recipients need not take any action that would fundamentally alter the nature of their program or create undue financial or administrative burdens. If the action does not constitute a fundamental alternate or undue burden, they must take action to ensure that people with disabilities receive benefits or services to the maximum extent possible.

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