JUN 2 1992 The Honorable Bob Graham United States Senator Post Office Box 3050 Tallahassee, Florida

32315 Dear Senator Graham: This is in response to your letter on behalf of your constituent, Mr. Doug Heisler, Vice President of Humana, Inc., regarding the Americans with Disabilities Act (ADA) requirements relating to hospitals. Mr. Heisler requests a reconsideration of ADA regulatory requirements for the construction of accessible hospital facilities because of the economic burden the new law will place on hospital construction. The standards at issue were first developed as Guidelines by the Architectural and Transportation Barriers Compliance Board (Board), and were incorporated as an appendix to the Department of Justice's regulations implementing the ADA with respect to public accommodations, and commercial facilities. 56 Fed. Reg. 35,544. During development, the Guidelines received intensive public scrutiny. The Board held 14 public hearings and received over 12,000 pages of comments and testimony from more than 2,300 individuals. The Board carefully considered all comments, including extensive comments received from Humana, Inc., and completed a Regulatory Impact Analysis as required by Executive Order 12291. As a result of this process, numerous changes were made in the final Guidelines. cc: Records; Chrono; Wodatch; Breen; Lusher; McDowney. :udd:breen:cong.humana.merge 01-00843

-2In developing regulations under ADA, the Board and the Department of Justice have made every effort to consider and be responsive to the needs of industry as well as the needs of persons with disabilities. We believe that the ADA requirements for new construction of hospital facilities accurately interpret the statute and are fair and balanced. They were developed after extensive public comment and with concern to the costs that these rules would impose on the provision of health care services. The rules were examined by the Board, the Department of Justice, and the Office of Management and Budget under Executive Order 12291. It would be, therefore, duplicative and unnecessary to reexamine the ADA's rules again so soon after such a complete and exhaustive regulatory process. In addition, section 504 of the Rehabilitation Act of 1973 and Federal regulations implementing section 504 have required the construction of accessible hospitals for entities receiving Federal funds since the late seventies. Because most hospitals in this country receive Federal funds on a regular basis, we expect that the ADA's requirements are supplemental in nature and should prove to add little economic burden. I hope that you find this information helpful. Please let me know if I can be of further assistance. Sincerely, John R. Dunne Assistant Attorney General Civil Rights Division 01-00844

Doug Heisler March 18, 1992 The Honorable Bob Graham United States Senate U.S. Capitol Humana Washington, D.C. 20510 Re: Americans with Disabilities Act Dear Senator Graham: I am writing this letter both as a healthcare consumer and Vice President, Design & Construction for Humana Inc. Humana Inc. is one of the largest health care companies in the world. The company is noted for its pioneering role in developing integrated health care systems that include high quality hospital services and a variety of health insurance plans. Humana Inc. owns and operates over 77 hospitals in 19 states, one of which you represent. The Americans with Disabilities Act, Public Law 101-336 (the "ADA") became law in January, 1992. I totally support the concept of making all buildings accessible to disabled person and a national standard for disabled access is more desirable to the design and construction industry than many different regulations for each state or city. Many states have adopted their own separate

building code for hospitals; however, regulations implementing the ADA, as applied to hospitals, are either excessive or ambiguous, and go far beyond accessibility. Strict compliance will mean higher healthcare costs to the consumer, a subject that is being discussed every day by state and national officials and candidates. The issue of health care cost containment is debated almost daily in the national media. Humana Inc. operates its own design and construction department which, over the last ten years, has been responsible for over three billion dollars of hospital new construction and renovation. As such, I can speak to the level of regulation of hospital construction, which is one of the most, if not the most, regulated building construction in the United States. There are specific regulations for hospitals in the areas of fire protection, room and door size, bathroom accommodations, and many more. Whole chapters of every building code are dedicated to hospital design which, as a requirement to the basic function and mission of a hospital, must be designed and built to accommodate wheelchairs, oversized beds, and other facilities for the temporarily and permanently nonambulatory patient. 01-00845

March 18, 1992 Page 2 Humana I am asking your support in calling for a review of the regulations implementing the ADA. In the absence of clear, reasonable regulations, hospitals must accomplish new construction and renovation according to individual interpretations without total confidence that they are accomplishing their activities in the least burdensome and least restrictive manner possible. Again, I emphasize that I support making public accommodations accessible to the disabled; however, the economic burden to the hospital construction and operation industries must be balanced

against the perceived inaccessibility to the disabled patient and visitor. As one of your constituents, Humana Inc. requests your support in taking action to contain healthcare costs by calling for a realistic appraisal of the feasibility and economic impact of full implementation of the ADA as promulgated in the regulations covering public accommodations as applied to hospitals. I will look forward to your reply in this matter. Sincerely yours, Doug Heisler Vice President Design and Construction DH:md cc: George Atkins - Humana Inc. 01-00846