What’s HHS and What Changed?

In April, the Title II deadlines requiring digital accessibility were extended by a year. Now, for many reasons, among which is parallel rulemaking with Title II, the Health and Human Services deadlines have also been extended by a year. So now, many of you are wondering how to take advantage of the HHS Extension.

The Section 504, HHS rule was published on May 9, 2024, giving healthcare-related services two years to comply for recipients with 15 or more employees and three years for those with fewer than 15. The deadlines are now:

• Recipients with 15 or more employees will now have until May 11, 2027, to comply.
• Recipients with fewer than 15 employees will now have until May 10, 2028, to comply.

For more information on the HHS Rule, check out my blog: Department of Health and Human Services requirements for ICT Accessibility

I’ve written a similar blog on the Title II extension. How to Take Advantage of the Title II Extension.  Spoiler alert, this blog is very similar. Same show, different theater.

Countdowns to the HHS Deadlines.

15 or more Employees

Fewer than 15 Employees

What Now?

Now, many healthcare-related services are wondering what they should do, particularly those with 15 or more employees.  

The extension can be a huge advantage for healthcare-related services if they handle it right. Conversely, it can be massively damaging and expensive if mishandled. I want to pause and first acknowledge that the extension is a setback for people with disabilities. Inaccessible healthcare creates barriers for people with disabilities and can deny access to fundamental resources. Full stop. Our focus from here out will be on how healthcare-related services can best handle the extension for the greatest positive impact on themselves and people with disabilities.

The Pitfalls

They’ve recently spent significant time and money on this. And, let’s face it, procrastination is inefficient and costs more. The temptation now is to shrug your shoulders, declare that now you’re a year ahead of schedule, then go about your business. Don’t do it! The best-case scenario is that a year from now, you will spend the same inefficient time and money repeating the same panicked rush.

Oh, by the way, you should already be accessible

The other thing to consider is that the HSS rule is yet another reason your digital assets should be accessible, not the first reason. From a regulatory perspective:

• Title III of the ADA says that anything facing the public needs to be accessible.
• Section 508 of the Rehabilitation Act requires digital accessibility within the federal government, and this includes entities receiving federal funding.
• OCR can still proactively investigate Section 504, HHS. Only the WCAG 2.1 level AA requirement has moved.

Moreover, there have been federal actions and enforcement items related to current HHS regulations, including:

• DOJ settlement with Hy‑Vee (vaccine website accessibility).
• DOJ settlement with Rite Aid (vaccine registration website accessibility).
• DOJ Statement of Interest in the Quest Diagnostics kiosk matter (kiosk accessibility and auxiliary aids).
• Ongoing OCR complaint intake and enforcement activity (OCR investigations, resolution agreements, and remediation requirements for covered healthcare entities).

Waiting until the new HSS rule (or to see what else is going to happen) is like saying I’m going to wait to take cover until the archer notches their third arrow. There is a clear present risk now, and making sure everyone, regardless of ability, can access your digital content is the right thing to do. Hopefully, this helps you build a case to keep your organization on track.

Taking Advantage of the HHS Extension

If you keep moving forward, you can do so on your terms. No more rushing, just steady, effective progress.

Step 1: Complete the effort to make your digital assets accessible

Before the HHS extension, you were likely rushing to bring as many of your digital assets conformant to the WCAG 2.1 AA guidelines as possible. Don’t stop. Doing so will cost you time and money. This is landing the plane before the flight is over, then spending a ton of fuel to get it back in the air. Finish this effort. If you hadn’t started… or were at some beginning step, like looking for a consultant to help, keep moving forward. Bringing your assets into compliance is not what needs to eventually be done; it is the first step in what needs to be done. Do that first step now.

Step 2: Set up Monitoring

Even in the world of AI, automation can only catch a subset of accessibility issues. This is why manual audits are so important. However, automated monitoring is a great way to measure progress and monitor for regression. You’ve spent a lot of time and effort bringing your digital assets as close to conformance with the guidelines as you could. You want to know early if something changes. This will help maintain your low-risk profile and avoid the high cost of issues that go unnoticed for a long time and grow.

Step 3: Assess your Accessibility Maturity

You may be wondering what accessibility maturity is. If you want to dig deeper into it, check out my blog, W3C Accessibility Maturity Model Explained. In short, accessibility maturity is how mature your capabilities to create and present accessible digital assets are. It’s not just about whether you can do it, but how efficiently and cost-effectively you can do it, and how sustainable it is. It involves all aspects of the organization that influence digital accessibility. The W3C Accessibility Maturity Model (AMM) is a good place to start, but you’re likely going to want to pull in a consultant to really help you get it right. The more you bake accessibility into your organization, the less likely your risk profile is to increase, and the more likely people with disabilities will be to have access to everything you offer. Moreover, it is the key to avoiding costly panicked efforts like the one you likely just experienced.  

Step 4: Build a roadmap

The maturity assessment will measure your level of maturity around digital accessibility and show you the gaps in your capabilities. Now you need a roadmap to plan the actionable and incremental steps you need to take to close those gaps and work your way toward something more efficient and cost-effective. The most effective approach we’ve seen with our clients is a roadmap that outlines incremental steps that are easily accomplished and build on each other. They should also be designed to adapt. In other words, as you progress through the roadmap, you’re going to learn, and as you learn, you’ll want to modify the roadmap appropriately. It should have flexibility written in and not be a rigid dictation.

Step 5: Progress steadily through the roadmap

I know. This goes without saying. You went through the trouble of having a roadmap made, of course, you’re going to execute on it, right? …right? I’ve been doing this for thirteen years, and I’m still amazed at the number of times I circle back with a client, and they still haven’t started on the roadmap. Competing priorities are a threat to both starting and progress. Being aware of this and being intentional about not letting it derail you can be the difference between success and failure. This is also why it is so important to make sure that each step on the roadmap is easily consumable. The easier it is to execute the next step, the less likely it will be overridden by a competing priority.

The other key is accountability. We often provide project management services to our clients during this step. A big part of it is that being accountable to a third party helps them maintain focus on progress.

Step 6: Reassess your digital assets

Hopefully, you’ve been monitoring what you can throughout the year. That will help a lot. You should still have your assets manually audited again to ensure you hit the deadline with your best foot forward. The third-party objective assessment will go a long way in defending that you’re doing all you can to comply with the HHS Rule and ensure people with disabilities have access to your digital assets. The strategy for this can vary. Depending on what has happened over the past year, you may not need to assess to the level you did the first time. A good accessibility consultant can advise you on the best approach for this. The good news is that with the steady incremental progress you’ve been making for a year, and the fact that you had everything audited the year before, you’re likely to avoid the same level of costly remediation you went through the first time. This should feel more like maintenance and polish.

Now that the deadline has passed…

Now you’re cruising along the highway. The only thing you have to do now is keep cruising. Keep working the road map and maturing your capabilities with steady, measured progress. Keep monitoring what you can through automation and find a regular and reasonable schedule for third-party objective audits. Mostly, be proud that you created an efficient and effective way to ensure your digital environments are accessible to everyone.