The Department of Justice (Department) has published a Notice of Proposed Rulemaking (NPRM) explaining how we propose updating the regulations for Title II of the Americans with Disabilities Act (ADA) to lay out specific requirements for the accessibility of medical diagnostic equipment (MDE).

This NPRM proposes to adopt specific technical standards that state and local governments would have to follow to meet their existing obligations under Title II of the ADA for MDE accessibility. The NPRM asks the public for comments about this proposal.

Purpose of this fact sheet: This fact sheet gives a plain language summary of the NPRM. The summary is designed to provide introductory information about this proposal for people who may not have a legal background. For all of the details of our proposal, please read the NPRM.

What is Title II of the Americans with Disabilities Act (ADA)?

Title II of the ADA requires state and local governments’ services, programs, and activities to be accessible to people with disabilities. In Title II, state and local governments are also called public entities. Title II applies to all services, programs, or activities of state and local governments. This includes health care services, programs, and activities that state and local governments offer through or with the use of MDE.

What is a Notice of Proposed Rulemaking (NPRM)?

Rulemaking is the process that federal agencies use to write regulations. A regulation (also called a “rule”) is a set of requirements issued by a federal agency to implement laws passed by Congress. When Congress passes laws, many details are often left to federal agencies to flesh out in regulations. For example, when Congress passed the ADA, it gave the Department the authority to issue regulations that explain the rights and obligations under Titles II and III of the ADA.

An NPRM is a stage in the rulemaking process that happens before an agency adopts a final regulation. It is like a first draft of a regulation. It lets the public know what the agency is considering and provides an opportunity for public feedback.

An NPRM is a proposal, not a final regulation. So, this NPRM is not an enforceable rule right now. This NPRM has been published so that the public can provide us with feedback on our proposal for the rule before we adopt a final rule.

What is medical diagnostic equipment?

Medical diagnostic equipment (MDE) is equipment used in, or in conjunction with, medical settings by health care providers for diagnostic purposes. Examples of MDE include:

1. examination tables;
2. examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures);
3. weight scales;
4. mammography equipment; and
5. x-ray machines.

Who would be covered by this proposed rule?

Title II of the ADA applies to all public entities, including state and local governments, and departments, agencies, special purpose districts, special district governments, and other instrumentalities of state or local government. In this fact sheet, we call these state and local government entities. State and local government entities that offer health care services, programs, and activities through or with the use of MDE, such as public hospitals and healthcare clinics, would be covered by this proposed rule. State and local government entities that contract with other entities to provide public services (like state agencies that contract with non-profit organizations that run clinics on the state’s behalf) also have an obligation to ensure that their contractors follow Title II.

Reasons for this Proposed Rule

People with disabilities continue to experience barriers to accessing medical care because of inaccessible MDE. Barriers such as exam tables that are not height adjustable, mammography machines that require a person to stand, and weight scales that do not accommodate wheelchairs result in inequities and exclusion from basic health services for individuals with disabilities, contributing to poor health outcomes. The proposed rule would establish enforceable standards for accessible MDE, a significant and concrete step toward addressing health disparities experienced by people with disabilities.

You can find more information about why the Department of Justice is proposing this rule in the NPRM in the section called “Need for the Adoption of MDE Standards.”

Highlights of the Proposals in the NPRM

Some of the specific proposed requirements found in the NPRM are highlighted below. Review the full NPRM to get an understanding of the entire proposal.

Proposal: Adopt the U.S. Access Board’s MDE Standards as the technical standards for accessible MDE.

1. A technical standard says specifically what is required for something to be accessible. For example, the existing ADA Standards for Accessible Design are technical standards that say what is needed for a building to be physically accessible under the ADA, such as how wide a door has to be or how steep a ramp can be.
2. In 2017, the U.S. Access Board issued technical standards on the accessibility of MDE in physicians’ offices, clinics, emergency rooms, hospitals, and other medical settings.
3. This NPRM proposes to make the U.S. Access Board’s MDE Standards enforceable under the ADA by adopting and incorporating them into the Department of Justice’s ADA Title II regulation.

Proposal: Require state and local government entities to ensure that their services, programs, and activities that use MDE are accessible to individuals with disabilities.

1. The rule would prohibit state and local government entities that provide health care from denying services that they would otherwise provide to a patient with a disability because they lack accessible MDE.

2. The rule would also prohibit a health care provider from requiring a patient with a disability to bring someone along with them to help during an exam.

Would state and local government entities always have to comply with the MDE Standards?

Under the current ADA rules, state and local government entities do not need to make changes that would be a fundamental alteration or cause undue financial and administrative burdens. They still would not need to do this under the proposed rule. For more information about fundamental alteration and undue burden, see our State and Local Governments page on ADA.gov.

Proposal: Establish requirements for newly acquired MDE.

1. The rule would require that all MDE that state and local government entities purchase, lease, or otherwise acquire after the rule goes into effect be accessible, until they have the required amount of accessible MDE.
2. State and local government entities may choose to acquire additional accessible MDE after they have the required amount of accessible MDE.
3. State and local government entities do not need to make changes, including purchasing, leasing, or acquiring accessible MDE, if doing so would be a fundamental alteration or cause undue financial and administrative burdens.

Proposal: Establish requirements for existing MDE.

1. In addition to establishing requirements for newly purchased, leased, or otherwise acquired MDE, the rule would require that state and local government entities address access barriers resulting from a lack of existing accessible MDE. Examples of such access barriers could include exam tables that are not height adjustable or weight scales that do not accommodate wheelchairs.
2. The proposed rule would not necessarily require state and local government entities to make all of their existing MDE accessible. Instead, it adopts an approach analogous to the concept of program accessibility that already exists in the Department of Justice’s existing regulation implementing Title II of the ADA.
3. The rule would require that services, programs, or activities of state and local government entities, when viewed in their entirety, be readily accessible to and usable by individuals with disabilities.
4. State and local government entities could comply with this requirement in many ways, such as by providing services at another location, through home visits, or by acquiring accessible MDE.

Proposal: Require qualified staff to be able to operate accessible MDE.

1. The proposed rule would require state and local government entities to ensure that their staff are able to successfully operate accessible MDE, assist with transfers and positioning of individuals with disabilities, and carry out the rule’s requirements for existing MDE.
2. At all times when services are provided to the public, state and local government entities would be expected to have personnel who can operate accessible MDE in an appropriate and timely manner.
3. Often, the most effective way for state and local government entities to ensure that their staff can successfully operate accessible MDE is to provide staff training on the use of accessible MDE.

Proposed Time to Comply with the Rule Once It Is Finalized

1. Sixty days after the final rule is published, all MDE that state and local government entities purchase, lease, or otherwise acquire would be required to be accessible, until the entity has enough equipment to satisfy the rule’s scoping requirements. State and local government entities would also need to address access barriers resulting from a lack of existing accessible MDE.
2. Within two years after the publication of the final rule, state and local government entities that use exam tables would be required to have at least one exam table that meets the MDE Standards.
3. Within two years after the publication of the final rule, state and local government entities that use weight scales would be required to have at least one weight scale that meets the MDE Standards.

We Want Your Feedback

1. This fact sheet gives a high-level summary of the NPRM. For more details about our proposal, you should read the NPRM.
2. We have also published an analysis of the costs and benefits of the proposed rule. This is called a Preliminary Regulatory Impact Analysis (PRIA).
3. If you need information in an alternative format, you can call the ADA Information Line at 800-514-0301 (voice) or 1-833-610-1264 (TTY).

The Americans with Disabilities Act authorizes the Department of Justice (the Department) to provide technical assistance to individuals and entities that have rights or responsibilities under the Act. This document provides informal guidance to assist you in understanding the ADA and the Department’s regulations.

Guidance documents posted to this website are not intended to be a final agency action, have no legally binding effect, and have no force or effect of law. The documents may be rescinded or modified in the Departments’ complete discretion, in accordance with applicable laws. The Departments’ guidance documents, including this guidance, do not establish legally enforceable responsibilities beyond what is required by the terms of the applicable statutes, regulations, or binding judicial precedent. For more information, see 1-19.000 – Principles for Issuance and Use of Guidance Documents, https://www.justice.gov/jm/1-19000-limitation-issuance-guidance-documents-1.