Sign Language Interpreting Services (SLIS)

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Issues Specific to Small Business and Practices


Doctors, nurses, dentists, specialists, therapists, and other health care providers must communicate effectively to provide appropriate, effective, quality health care services.

Federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing.  These laws include:

  • Section 504 of the Rehabilitation Act of 1973 – applies to federal health care services and facilities; and health care providers who are also recipients of federal financial assistance, usually provided by direct funding (such as federal Medicaid funds) or by grants (such as a federal research grant). 
  • Title II of the Americans with Disabilities Act – applies to all public (state and local) health care providers.
  • Title III of the Americans with Disabilities Act – applies to all private health care providers.

This memorandum focuses on the obligations of private health care providers.  However, most of these questions and answers will provide useful guidance for public health care providers (federal, state, and local) as well.

Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities by places of public accommodation.  42 U.S.C. §§ 12181 - 12189.  Private health care providers are considered places of public accommodation.  The U.S. Department of Justice issued regulations under Title III of the ADA at 28 C.F.R. Part 36.  The Department’s Analysis to this regulation is at 56 Fed. Reg. 35544 (July 26, 1991).

When would providing an auxiliary aid or service be an undue burden?

An undue burden is something that involves a significant difficulty or expense.  For example, it might be a significant difficulty to obtain certain auxiliary aids or services on short notice.  Factors to consider in assessing whether an auxiliary aid or service would constitute a significant expense include the nature and cost of the auxiliary aid or service; the overall financial resources of the health care provider; the number of the provider’s employees; the effect on expenses and resources; legitimate safety requirements; and the impact upon the operation of the provider.  28 C.F.R. § 36.104.  Showing an undue burden may be difficult for most health care providers.  When an undue burden can be shown, the health care provider still has the duty to furnish an alternative auxiliary aid or service that would not result in an undue burden and, to the maximum extent possible, would ensure effective communication. 28 C.F.R. § 36.303(f).

Must a health care provider pay for an auxiliary aid or service for a medical appointment if the cost exceeds the provider’s charge for the appointment?

In some situations, the cost of providing an auxiliary aid or service (e.g., a qualified interpreter) may exceed the charge to the patient for the health care service.  A health care provider is expected to treat the costs of providing auxiliary aids and services as part of the overhead costs of operating a business.  Accordingly, so long as the provision of the auxiliary aid or service does not impose an undue burden on the provider’s business, the provider is obligated to pay for the auxiliary aid or service.

Can a health care provider charge a deaf or hard of hearing patient for part or all of the costs of providing an auxiliary aid or service?

No.  A health care provider cannot charge a patient for the costs of providing auxiliary aids and services.  28 C.F.R. § 36.301(c).

Can health care providers receive any tax credits for the costs of providing auxiliary aids and services?

Eligible small businesses may claim a tax credit of up to 50 percent of eligible access expenditures that are over $250, but less than $10,250.  The amount credited may be up to $5,000 per tax year.  Eligible access expenditures include the costs of qualified interpreters, CART services, and other auxiliary aids and services. Omnibus Budget Reconciliation Act of 1990, P.L. 101-508, § 44.  Please consult with your financial or tax advisor on this issue.

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