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Telehealth

The ADA prohibits healthcare providers from discriminating on the basis of disability. This is true when health care is provided in person or through “telehealth.”

What is telehealth?

Telehealth is health care that is provided by video, phone, or other electronic methods. Telehealth includes virtual appointments with healthcare providers, messages that are sent to and from healthcare providers through an electronic portal, and at-home health monitors that help healthcare providers track their patients’ symptoms.

Telehealth has become an important and common way for patients to receive health care. But sometimes discrimination and other problems can prevent people with disabilities from fully accessing that care.

It is important for healthcare providers who offer telehealth services to give patients with disabilities the same opportunity to participate in telehealth as individuals without disabilities are given. If you are a healthcare provider who offers telehealth services, you can use the information below to help you better understand your responsibility not to discriminate based on disability when providing those services. If you are a patient with a disability, the information below can help you better understand your right to equal access to telehealth.

A telehealth provider must effectively communicate with patients with disabilities

To make sure that patients with disabilities can communicate effectively while participating in telehealth, providers may need to provide communication aids and services. The communication aids or services that are effective for an individual patient may depend on the context. The provider should work with the patient to figure out what would be effective for them. The provider may not charge the patient for any aids or services the patient needs.

Here are some examples of aids and services that healthcare providers who offer telehealth may need to provide:

Situation Potential Solution
A nurse practitioner’s office uses telehealth to hold virtual appointments with patients by video. A patient who is deaf or has hearing loss schedules a virtual appointment with that office. To ensure effective communication during the appointment, the provider might need, for example, to:
  • give the patient the chance to request a communication aid or service when scheduling an appointment
  • provide a qualified sign language interpreter during the appointment, or
  • ensure that the telehealth platform can support effective real-time captioning.

A sign language interpreter is qualified if they can interpret effectively, accurately, and impartially, using any necessary specialized vocabulary. This includes having the skill to interpret what the patient with a disability is saying and to express the healthcare provider’s statements back to the patient.

If an interpreter is needed, the provider should make sure that the telehealth platform lets the interpreter join the session, even if the interpreter is in a different physical location than the patient and the provider. The provider can’t require the patient to bring their own interpreter or real-time captioner.

A physical therapy practice uses a telehealth platform to send patients messages and videos showing how to do physical therapy exercises. One of the physical therapists is sending messages and videos to a client who is blind or has a visual disability. To effectively communicate with this patient, the practice may need to make sure, for example, that:
  • its telehealth platform is compatible with screen readers
  • its videos have audio descriptions, or audio tracks that describe and give context for what is happening on screen.
A physician’s office allows patients to attend appointments virtually using a telehealth platform. A patient with an intellectual disability and/or their support person wants to schedule a virtual appointment for the patient. To effectively communicate with this patient, the practice may need, for example, to:
  • offer additional time before the appointment so the patient can become familiar with how the telehealth platform works
  • make sure the telehealth platform allows a support person to log in, regardless of whether the support person is in the same room as the plaintiff or is logging in from somewhere else
  • take more time during the appointment as needed to make sure the patient understands what is being discussed.

A healthcare provider is not required to provide communication aids and services if providing them would place an “undue burden” on the provider. An undue burden can be a major difficulty or expense. Whether an undue burden exists varies from healthcare provider to healthcare provider, and sometimes from one year to the next.

Communication aids or services are also not required in the rare situations where they would fundamentally change the nature of the provider’s services.

If an aid or service would result in an undue burden or fundamental alteration, the provider needs to provide an alternative aid or service if possible.

Learn more about these requirements and limitations in ADA Requirements: Effective Communication and Communicating Effectively with People with Disabilities.

Telehealth providers may sometimes need to make reasonable modifications to their typical practices to make sure patients with disabilities can access their services

Providers may also need to change their policies, practices, or procedures to avoid discriminating based on a patient’s disability. For example:

Situation Potential Solution
A dermatology practice usually offers telehealth appointments that are 30 minutes long. A patient of the practice wants to make a telehealth appointment. The patient has an intellectual disability. The practice may need to schedule a longer appointment for the patient to make sure they have enough time to communicate with their dermatologist.
A doctor’s office generally doesn’t let anyone but the patient attend telehealth appointments. A patient with a disability has a telehealth appointment with this practice and needs a support person to help them fully understand the doctor’s recommendations. The doctor’s office may have to make reasonable changes to its policy to allow the patient’s support person to attend the appointment. If the support person is not in the same room as the patient, the telehealth platform should allow that person to log in from a third location. If the patient needs more than one support person, the doctor’s office should make sure that its platform lets multiple additional people log in.

A healthcare provider doesn’t need to modify their practices in the rare situation where doing so would fundamentally change the nature of the provider’s services.

Learn more about how federal civil rights laws apply to telehealth.