Compliance As a Path to Reduce Disability Health Disparities

…Moving from Minimum Standards to Meaningful Access in Healthcare Compliance

By Vanessa Rastović, JD

Introduction: Compliance Beyond Checklists

In healthcare, compliance is often treated as a defensive strategy — a way to avoid penalties, pass audits, and keep regulators at bay. For millions of Americans with disabilities, however, compliance is not simply about risk reduction. It is about whether they can access care at all.

When compliance programs stop at the minimum statutory requirements, they leave patients with disabilities at the margins. When compliance is reimagined as a driver of equity, it becomes a tool for systemic change.

The Legal Baseline: What Compliance Programs Cover

Healthcare compliance programs today focus primarily on avoiding violations of federal and state law. For disability access, that typically means:

• The Americans with Disabilities Act (ADA): requires reasonable modifications and physical accessibility.

• Section 504 of the Rehabilitation Act: prohibits discrimination by federally funded

programs.

• Section 1557 of the Affordable Care Act: bars discrimination on the basis of disability,

alongside race, sex, age, and national origin.

These are important protections. But in practice, many organizations approach them narrowly, making sure entrances are accessible, avoiding obvious discrimination, and including required nondiscrimination statements in notices. This “baseline” approach meets the letter of the law, but not the spirit of it.

The Chasm: When compliance falls short despite decades of civil rights protections, people with disabilities remain among the most underserved groups in health care. Several gaps persist:

• Data invisibility: Most electronic health records (EHRs) do not capture disability status because they’ve never been required to do so. Without this data, organizations cannot track disparities, measure outcomes, or demonstrate progress.

• Physical inaccessibility: Accessible exam tables, mammography machines, and dental chairs are still missing in many clinics. A patient may enter the building but still be unable to receive an exam.

• Communication barriers: People with intellectual and developmental disabilities often face inaccessible forms, rushed appointments, or lack of accommodations for supported decision-making.

• Misaligned audits: Compliance reviews typically focus on billing accuracy, coding, or privacy — not whether patients with disabilities are able to access services fairly and adequately.

The result: organizations may be “compliant” on paper while leaving disability health disparities invisible and therefore, beyond redress.

Compliance as an Equity Lever

This gap reveals an opportunity. Compliance is not just about keeping regulators satisfied — it can be a proactive tool to advance health outcomes. Compliance officers, risk managers, and legal counsel are uniquely positioned to bridge the divide between minimum requirements and meaningful inclusion.

“Disability health equity is not a side issue. It is central to the mission of healthcare. Compliance programs are uniquely positioned to bridge the gap between obligation and opportunity. ”

Some practical examples include:

• Integrating disability into compliance dashboards: Compliance programs routinely track fraud, billing, and privacy. Adding disability equity indicators — such as data capture rates, accessibility audits, or accommodation requests — brings visibility to disparities.

• Expanding QAPI reviews: Quality Assurance and Performance Improvement (QAPI) programs can include disability-specific measures, such as wait times for patients requiring accommodations.

• Cross-training staff: Compliance and clinical teams can jointly train staff on both regulatory requirements and disability cultural competence.

• Embedding accessibility into procurement: Compliance officers can ensure that new equipment and EHR systems meet accessibility standards before purchase. These strategies reduce legal risk, improve quality, and strengthen organizations’ reputations with regulators and funders.

Why Disability Matters Now

Americans with disabilities are the largest marginalized population in the United States. One in four adults reports living with a disability, and rates are even higher among low-income, rural, and minority communities. Yet,  disability remains underrepresented in health improvement and access to care initiatives.

This is beginning to change. Funders and regulators are signaling new expectations:

• CareQuest Institute for Oral Health has identified disability as a critical equity priority.

• The National Council on Disability (2023) called for disability to be explicitly recognized in health disparity designations.

• ONC’s USCDI Version 4 requires certified EHR systems to capture standardized disability data by 2026.  Compliance leaders who anticipate these shifts can position their organizations ahead of the

curve.

Reframing Compliance Culture

Making compliance a pathway to equity requires a cultural shift. Instead of being viewed solely as the “department of no,” compliance can become a partner in innovation. This means:

• Asking new questions: Not just “Are we compliant?” but “Are we serving our whole community?”

• Collaborating across teams: Partnering with quality, equity, and patient experience leaders.

• Using compliance authority constructively: Compliance officers often have Board access; this can be used to elevate disability equity as a governance priority. For compliance professionals, this is not about expanding workload but about aligning with broader organizational missions — quality, equity, and inclusion.

A Call to Action

Compliance professionals, attorneys, and risk managers are already trusted as guardians of integrity. By intentionally including disability equity in compliance programs, they can ensure that the protections promised by law translate into lived reality for patients. This is not optional. Regulators, funders, and accreditation bodies are increasingly expecting disability equity metrics. Organizations that ignore this risk may face penalties as well as reputational harm. Those that lead will gain trust, reduce liability, and demonstrate their commitment to all patients.

Conclusion: Compliance as the Floor, Not the Ceiling

Disability health equity is not a side issue. It is central to the mission of healthcare. Compliance programs are uniquely positioned to bridge the gap between obligation and opportunity. Compliance should not be seen as the ceiling — the minimum we must do to avoid penalties. It should be recognized as the floor — the solid foundation on which we build systems that protect rights, advance equity, and ensure that no patient is left behind.

About the Author

Vanessa Rastović is an accomplished attorney, math enthusiast, and person who also experiences disabilities while building a career marked by a deep commitment to social justice and advocacy for marginalized communities and universal inclusion. As a National Science Foundation awardee and Law Review member, Vanessa spearheaded public relations efforts for a non-profit that eradicates abuse. At the same time, her tenure at Legal Aid saw her providing crucial legal support to refugees, older adults, and people with disabilities, reflecting her unwavering dedication to these groups.

Vanessa Rastović, beyond her legal career, is an avid SCUBA diver; she loves exploring shipwrecks, observing aquatic wildlife up close, jogging, biking, and learning multiple languages.

Vanessa is an active member of the American Bar Association, including its Health and Administrative Law sections, the American Society of Law, Medicine, and Ethics, and the American Academy of Developmental Medicine and Dentistry. She serves on the Board of Harmony Health and serves on the City of Pittsburgh-Allegheny County Task Force on Disabilities.