Clarity ASL Interpreting Patrick Hoarty · NIC

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Interpreters for Deaf Patients and Customers: A Simple Guide for Businesses

This page is for medical offices, clinics and other businesses that serve Deaf and Hard of Hearing people. Here is what you need to know, in plain words.

Do we have to provide an interpreter?

  • Yes, when one is needed to communicate clearly.
  • Federal law (the ADA) covers businesses that serve the public. That includes doctors' offices.
  • Size does not matter. The ADA rules for serving the public apply to businesses of any size. (The 15-employee rule some people know is for ADA employment rules, not for serving customers or patients.)
  • Other federal laws also cover providers and health programs that get federal money.
  • Rhode Island law also bans disability discrimination by businesses in the state.

Full info: ADA.gov: Effective Communication · ADA.gov: Primer for Small Business

Who pays for the interpreter?

  • The business pays.
  • You may not charge the patient a fee or surcharge for the interpreter.
  • This is true even if an interpreter was booked and the patient could not make it. You may charge a normal missed-appointment fee only if you charge it to all patients.

Full info: 28 CFR 36.301(c): Charges · DOJ guidance on missed appointments

Can the patient bring a family member to interpret?

  • You may not require a patient to bring someone to interpret.
  • Do not use a child to interpret, except in an emergency where someone's safety is in danger right now and no interpreter is available.
  • An adult who came with the patient may interpret only in an emergency, or when:
    • the Deaf person asks for it,
    • the adult agrees, and
    • it is appropriate in the situation.
  • Even then, do not rely on someone who may not be fair or accurate, like a person who is upset or has a personal stake.

Full info: ADA.gov: Effective Communication

When is an interpreter needed?

  • It depends on the person and the situation.
  • A short, simple visit (like a blood test) may go fine with written notes.
  • A medical history or a serious diagnosis generally needs an interpreter.
  • Ask the patient what works for them. The ADA encourages this. If your practice gets federal health funding (for example, Medicaid), federal rules say you should give primary consideration to the aid the patient asks for.

Full info: ADA.gov: Effective Communication · HHS: Effective Communication

Can we ask for advance notice?

  • Yes. You may ask for reasonable notice.
  • If someone walks in without notice, you should still try to help.

Full info: ADA.gov: Effective Communication

What about a Deaf family member or friend?

  • If a patient's family member or friend is Deaf, and they are an appropriate person for you to talk with, you must communicate clearly with them too.
  • Example: a patient's Deaf spouse, when you need to talk with them about care.

Full info: ADA.gov: Effective Communication

Can we use video interpreting (VRI)?

  • Yes, if it works for the person.
  • The video must be smooth, with no lag, and clear.
  • The picture must be big enough to show the interpreter's face, arms, hands and fingers.
  • The sound must be clear.
  • Staff must know how to set it up quickly.
  • If the person cannot see the screen well, an in-person interpreter may be needed.

Full info: 28 CFR 36.303: Auxiliary aids and services

What if it costs too much?

  • You do not have to provide an aid if it would be a significant difficulty or expense. The law calls this an "undue burden."
  • This is judged against the size and money of your business, and of any parent company.
  • Even then, you must still offer another aid that works, if one is available.
  • Having fewer resources can matter here, but it does not excuse a business from the rule altogether.

Full info: ADA.gov: Effective Communication

Is there help with the cost?

Federal tax credit (IRS Form 8826)

  • For small businesses: last year you had $1 million or less in gross receipts, or 30 or fewer full-time employees.
  • The credit is half of your eligible costs above $250, up to $5,000 a year.
  • Interpreter costs count. You can claim it every year you have eligible costs.
  • File IRS Form 8826 with your tax return.
  • You cannot also deduct the amount you take as a credit.
  • The "Section 190" deduction is for things like ramps and doorways. It does not cover interpreters.

Full info: IRS: Tax benefits for businesses · IRS Form 8826

Rhode Island Medicaid

  • If your patient has Rhode Island Medicaid fee-for-service, your office may be able to bill Medicaid for interpreter time during a face-to-face office visit. This applies to certain provider types, like physicians, nurse practitioners and behavioral health providers. The interpreter does not bill Medicaid.
  • Medicaid managed care health plans handle interpreter services for their own members.

Full info: RI EOHHS interpreter billing guidelines (PDF)

Neighborhood Health Plan of Rhode Island

  • Neighborhood pays providers for interpreter services for its members.
  • Neighborhood's own policy says the interpreter must be registered and rostered with proper certification. This is the plan's rule.
  • Neighborhood does not pay for travel time, wait time, cancellations, parking, meals or after-hours fees.
  • Questions: Neighborhood Provider Services, 1-800-963-1001

Full info: Neighborhood interpreter payment policy (PDF)

Tax rules depend on your business. Talk with a tax advisor before you claim a credit.

Where can we find an interpreter?

Book Clarity ASL Interpreting

I provide ASL interpreting for medical offices and businesses in Rhode Island and Massachusetts. I'm happy to help you plan ahead.

Book an interpreter: 978-437-7326 [email protected] Request form

In Rhode Island? You can also request me through RICDHH: RICDHH interpreter request form

Sources

This page is general information, not legal or tax advice. Last reviewed October 2026.