November 13, 2023
Molly Burgdorf
U.S. Department of Health and Human Services, Office for Civil Rights
Hubert H. Humphrey Building, Room 509F
200 Independence Avenue SW
Washington, DC 20201
Attention: Disability NPRM, RIN 0945–AA15
Dear Ms. Burgdorf,
The National Committee for Quality Assurance (NCQA) thanks you for the opportunity to provide feedback on the Department of Health and Human Services’ (HHS) updates and amendments to section 504 of the Rehabilitation Act of 1973 to prohibit discrimination on the basis of disability.
NCQA is a private, 501(c)(3) not-for-profit, independent organization dedicated to improving health care quality through our Accreditation and measurement programs. We are a national leader in quality oversight and a pioneer in quality measurement. Leveraging our strengths as a trusted third party, we are committed to helping organizations navigate the challenges associated with moving to an equitable health care system. Our mission to improve the quality of health for all Americans, with a focus on health equity and support for meaningful value-based payment models, propels our daily work. NCQA is pleased to provide the following comments on the proposed updates outlined for section 504.
NCQA commends HHS for proposing updates to section 504 that promote consistency with Title II of the Americans with Disabilities Act (ADA) and provide clarity to areas not addressed through existing legislation, such as web, mobile and kiosk accessibility and accessible medical equipment. People with disabilities are often underserved by the health care system. They can face unique challenges to accessing timely and appropriate care and can experience significant health disparities and poorer health outcomes than people without disabilities due to lack of access, inappropriate care or discrimination.
NCQA has several standards-based programs that offer the opportunity to improve access to and provision of care, address discrimination and reduce disparities for individuals with disabilities. These include Health Equity Accreditation programs, which focus on identifying and addressing disparities in clinical performance and individual experience that impact health outcomes, and PCMH Recognition, which focuses on patient-centered and responsive primary care. We also offer programs that address long-term services and supports, case management and population health management, via our Health Plan Accreditation and Population Health Program Accreditation programs.
NCQA is actively exploring how future versions of these existing standards-based programs, as well as other developing programs, like our Virtual Primary and Urgent Care program, can best meet the unique needs of this population and improve its experience with—and outcomes from —the health care ecosystem. Our Health Information and Effectiveness Data Set (HEDIS®) currently has four measures that require a disability stratification, leveraging Medicare-specific eligibility criteria. We are interested in expanding this stratification to additional HEDIS measures as part of our ongoing effort to highlight disparities in care and hold plans accountable for reducing disparities.
The recent rise in the use of telehealth has tremendous potential to affect key access issues facing the disability community (e.g., lack of accessible public transportation). However, as we noted in The Future of Telehealth Roundtable: The Potential Impact of Emerging Technologies on Health Equity report (2022), current telehealth technology may be inaccessible to patients with disabilities, such as those with vision impairment, limited upper body mobility or certain cognitive, physical, sensory and mental health needs. We support the HHS proposal to use a technical standard for assessing compliance for accessibility of both web content and mobile applications, given the proliferation of their use in connecting to and delivering health care services.
NCQA also encourages creators of future virtual health tools to focus on the specific needs faced by the disability community, and to intentionally consider equity in the design and implementation of digital health care solutions. Examples of functionality that will increase access for the disability community include standards and solutions that enable appropriate interpretation of sign language, closed captioning on screens where services are provided and synchronous access for family members and qualified readers, interpreters and speech-to-speech translators.
Thank you for the opportunity to comment. We remain committed to working with the Department of Health and Human Services to build a more equitable, sustainable and responsible American health care system. We welcome a discussion on our experience and recommendations to continue to strengthen HHS’s work to protect the civil rights of individuals with disabilities and advance equity for all. If you have any questions, please contact Eric Musser, Assistant Vice President of Federal Affairs, at (202) 955-3590 or at musser@ncqa.org.
Sincerely,
Margaret E. O’Kane
President