THE FACTS

Facility staff are obligated to conduct an individualized assessment under federal regulations (Section 504 of the Rehabilitation Act of 1973).

WHAT TO SAY

“As you may know, In May 2024, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a new rule under Section 504 of the Rehabilitation Act of 1973. The new rule, entitled “Discrimination on the Basis of Disability in Health and Human Service Programs or Activities,” clarifies that medical providers (including behavioral health facilities) must conduct an individualized inquiry to determine whether the facility can meet the person’s needs and that they cannot deny access based solely on the presence of a diagnosis, such as a bleeding disorder.”

You can remind the facility that “all medical providers that receive federal financial assistance, including mental health and substance use treatment providers, must follow this new rule”.

WHAT TO SEND

If the facility does the individualized inquiry and still denies your patient stating medical complexity, refer to MASAC Document 289. If denied due to infusion/injections, refer to ASAM.