Responses to the data challenges of the Affordable Care Act: Surveys of providers to assess access to care for people with disabilities and the presence of accessible exam equipment

Recognizing that barriers to care for people with disabilities include lack of facility and equipment access, Section 4302 of the Affordable Care Act, requires that Information be collected on locations where individuals with disabilities access primary care, the number of providers whose facilities and medical diagnostic equipment are accessible, and the number of provider employees who have been trained in disability awareness. Moreover, Section 4203 of the ACA requires development of accessibility standards for medical diagnostic equipment while the US Justice Department plans to issue regulations governing the availability of such equipment in healthcare settings. Against this new policy backdrop, and recognizing that access data are not currently collected on a national scale, this paper reviews data currently available, drawing strongly on the California experience where, starting in June 2011, all Medicaid health plans will be required to audit primary and specialty care providers to obtain information on facility and equipment access. Five California health plans have conducted such audits for 2,389 provider facilities since 2006, and their data show that only 8.4% of providers have height adjustable exam tables, 3.6% have accessible scales, and restroom access is problematic. The findings from these audits and other sources are presented, along with an evaluation of the process issues involved in data collection. Drawing from the current efforts, we summarize the challenges for fully meeting the data collection mandates of the ACA, link the accessible equipment standards mandate and regulatory process to the data requirements, and identify potential policy and methodological strategies.