While on-site American Sign Language (ASL) interpreters are the gold standard for individuals who are deaf or hard of hearing (HOH), advancements in technology have made video remote interpreting (VRI) a viable option in some scenarios.
As such, it’s important for healthcare organizations to know and understand the VRI requirements to remain compliant with federal laws.
This is especially important now. Since the pandemic, we’ve seen an uptick in adoption of video interpreting technologies, and wanted to make sure anyone new to using an ASL interpreter in a telehealth or VRI session knew the applicable laws.
Below we’ll discuss specific regulations covered under the Americans with Disabilities Act (ADA), Section 1557 of the Affordable Care Act (ACA), and Section 504 of the Rehabilitation Act, as related to providing communication assistance to deaf or HOH individuals over video.
First, what’s the difference between Section 504, Section 1557, and the ADA?
All three are non-discrimination laws prohibiting the discrimination on the basis of disability. (Section 1557 is broader than this, as discussed below.) They all work in tandem with and build on each other.
- Section 1557 is the nondiscrimination provision of the ACA. It prohibits discrimination on the basis of race, color, national origin, sex, age, or disability. It applies to healthcare entities that receive federal funding.
- Section 504 of the Rehabilitation Act prohibits discrimination against people with disabilities in programs that receive federal funding, including healthcare and educational entities. It was the first civil rights disability law in the U.S.
- The ADA, perhaps the mostly widely known, prohibits discrimination on the basis of disability. The ADA covers almost all matters of public life, including employment, education, transportation, and healthcare.
The main differences include what entities the laws apply to, but when we’re discussing communication strategies, like using VRI for ASL speakers, all three laws use consistent directives, as we’ll explain below.
The role of effective communication for Section 1557, the ADA, and Section 504
Effective communication guidelines, in many ways, are the regulatory backbone of anti-discrimination laws covering those with communication impairments. Their goal is to “ensure that communication with people with these disabilities is equally effective as communication with people without disabilities.”
The good news is that they apply no matter the modality in which you choose an ASL interpreter (VRI or on-site), so you’re likely already familiar with effective communication provisions. But as a re-fresh, let’s take a look at what they entail for a video ASL visit.
Auxiliary aid or service
Auxiliary aids or services are the tools used to communicate with individuals who have a communication disability. Covered entities must supply an individual with an auxiliary aid or service when needed to communicate effectively.
For people who are blind, this could mean providing them with Braille materials or a qualified reader; for people who are deaf or HOH, this could mean providing a qualified notetaker or qualified ASL interpreter.
It boils down to whether or not the communication tool chosen is effective enough for the provider and patient to communicate as thoroughly with each other as the provider could with a hearing patient. Just as they would for on-site encounters, the covered entity needs to provide qualified ASL interpreters over video as well.
The choice of which tool to use depends on a few factors. These include the normal method of communication used by the individual; the length and difficulty of communication; and the complexity of the communication. For example, written communication for someone who is deaf may work for a simple transaction but would not be appropriate for a complex medical conversation.
Primary consideration: What does that mean, exactly?
The effective communication guidelines also discuss “primary consideration.” Title II entities (state and local government services) must give primary consideration to the choice of aid or service (VRI versus an in-person interpreter, for example) requested by an individual who is deaf or HOH. Title III entities (businesses and nonprofit organizations that serve the public), on the other hand, are encouraged to do so.
This does not mean that a covered entity is required to provide their patient with their preferred communication service. The covered entity must look at other variables in the unique context of that individual’s circumstance, but they must give the patient’s preference priority if possible when choosing a means to effectively communicate with the individual.
If the provider can show that VRI is both appropriate for the patient and for the clinical scenario, it can be a timely, effective option for both parties.
Standards for video
For VRI to be considered an effective means of communication for ASL speakers, the following performance standards must be met:
- Real-time, high-quality video and audio. The video must not lag or be choppy, blurry, or grainy, nor shall it create irregular pauses in communication.
- Sharp image. The image must be sharply delineated and large enough to display the interpreter’s face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of their body position.
- Audible voices. Voices must be clear and audible.
- Adequate training. Your organization’s staff needs sufficient training so they can quickly set up and use the VRI platform.
CLI is here to help with your ASL needs
VRI and other tele interpreting technologies can break down communication barriers — which is crucial in healthcare — but only if used in congruence with federal and state laws.
If you have any questions about using video ASL interpreters, or about any of the regulations surrounding their use, we’re here to help. Just like our ASL interpreters, we’re available 24/7/365.Sign up for our monthly industry newsletter now!