As part of its response to the opioid crisis, United States Attorney Rachael S. Rollins sent a letter to all skilled nursing facilities (SNFs) in Massachusetts warning that refusing to provide care for persons with opioid use disorder (OUD) violates the Americans with Disabilities Act (ADA) and that the US Attorney’s Office will aggressively enforce these protections.
The ADA, which prohibits discrimination based on disability, protects individuals with OUD. Since 2018, the US Attorney’s Office has entered into 10 settlement agreements with entities owning a total of 51 SNFs for refusing to admit individuals prescribed medications for opioid use disorder (MOUD), including buprenorphine (Suboxone), vivitrol, and methadone. To ensure compliance with the nondiscrimination provisions of the ADA, SNFs must evaluate each applicant individually to determine suitability for admission, rather than enacting a blanket policy denying admissions to all persons treated with MOUD.
“Medications can be a crucial tool in battling the opioid crisis. In many instances, these prescription treatments save lives,” said US Attorney Rollins. “Yet each year, countless people are turned away from skilled nursing facilities solely because they are on prescribed MOUD. This puts vulnerable people in the awful position of either risking their life by not taking their MOUD or risking their life by continuing their opioid use. Denying access to necessary healthcare based solely on someone’s substance use disorder exacerbates the tremendous damage opioids already cause residents of our Commonwealth and their loved ones.”
Courts may impose civil penalties for ADA violations, which could be as high as $92,383 for a first violation, and potentially double that amount for subsequent violations. These ADA enforcement actions are part of a larger effort by the United States Attorney’s Office to eliminate discriminatory barriers to treatment for Opioid Use Disorder in the medical community, in the criminal justice system, and in housing.
Issue:
Under Title III of the ADA, no individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of a place of public accommodation. Specifically, discrimination includes the imposition or application of eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any goods, services, facilities, privileges, advantages, or accommodations, unless such criteria can be shown to be necessary. A public accommodation may impose legitimate safety requirements that are necessary for safe operation, but safety requirements must be based on actual risks and not on mere speculation, stereotypes, or generalizations about individuals with disabilities. Refusing an individual admission to a facility based solely on the fact that they are being treated for OUD could be seen as a violation of Title III of the ADA.
Discussion Points:
- Review policies and procedures on discrimination and admission screening. Ensure that facility policies include prohibiting discrimination on the basis of any disability.
- Educate appropriate staff on Title III of the ADA and how denying admission to the facility based upon OUD could be seen as discrimination. Document that the trainings occurred and file the signed training document in each employee’s education file.
- Periodically audit for individuals who were denied admission to the facility to ensure that their denial was not in violation of Title III of the ADA.
