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Originally Processed With FOIA(s): FOIA Number: S S FOIA MARKER This is not a textual record. This is used as an administrative marker by the George Bush Presidential Library Staff. Record Group/Collection: Donated Historical Materials Collection/Office of Origin: Frieden, Lex, Collection Series: Government Records Subseries: Reference Materials OA/ID Number: 52033 Folder ID Number: 52033-002 Folder Title: ADA Regulations [1990-1991] [2] Stack: Row: Section: Shelf: Position: G 5 2 5 5 TEL : Apr 03,91 14:12 No.005 P. 11 RECOMMENDATIONS FOR REGULATIONS TO IMPLEMENT THE AMERICANS WITH DISABILITIES ACT Submitted to the Equal Employment Opportunity Commission November 20, 1990 Mark A. Rothstein Law Foundation Professor of Law and Director, Health Law and Policy Institute University of Houston TEL: Apr 03,91 14:13 No 005 P. 12 1. Coverage of Genetic Conditions New developments in molecular genetics, especially those resulting from the Human Genome Project, will enable geneticists to detect individuals who will develop adult-onset diseases (e.g. Huntington's disease), predispositions or increased risks of adult-onset disease (e.g. cardiovascular disease), and unaffected heterozygote carriers of recessive disorders (e.g. cystic fibrosis). Employers would have substantial economic incentives to refuse to hire, retain, or promote such individuals. Even as to individuals who will never develop a genetic disorder, any genetic-based discrimination should be unlawful. Therefore, the EEOC should interpret § 3(2) of the ADA as protecting individuals from discrimination based on their genotype. II. Employment Entrance Examinations and Records A. Predictive value of examinations The legislative history of the ADA makes clear that in entrance examinations pursuant to § 102(c) (3) the tests used must "actually and reliably predict the substantial, imminent degree of harm required." (House Report at 73). Many employers currently use a variety of medical screening procedures of a dubious scientific basis. There is no compendium of occupational medical information on the predictive value of screening tests and even the most diligent employers have difficulty in evaluating the often misleading claims of medical assessment companies and manufacturers. The EEOC should investigate the appropriateness of commonly used screening measures (e.g. x-rays, strength testing, pulmonary function testing) and indicate which tests are of proven value and under what circumstances. Itshould indicate what tests may and may not be used. Consultation with the National Institute for Occupational Safety and Health is urged. TEL: Apr 03,91 14:14 No 005 P. 13 2 B. Test disclosures Under current law and practice, applicants and employees are often not informed about what medical tests are being performed (e.g. on a blood or urine sample), what the results are, or if there is a medical basis for an adverse employment decision. Such practices have encouraged surreptitious testing using illegal or irrelevant criteria, with employers virtually unaccountable. The EEOC should require that any applicant or employee subject to a lawful medical examination must be told in advance what tests will be run, have access to test results, and be notified in writing if an adverse employment decision is based on medical information. C. Medical records Employers conducting lawful, job-related medical assessments may need to obtain information about the individual's medical condition. Current practice is for employers to require that the individual sign a release authorizing the health care provider to release the records. Hospital records and medical records of an individual's treating physician often contain much information of a highly confidential, non-job related nature. It is infeasible for the health care provider to "sanitize" the records before disclosure, The EEOC should prohibit employers from requesting or requiring that applicants and employees authorize a release of medical records that are likely to contain medical information of a non-job related nature. An employer may only require that the individual authorize his or her health care provider to respond to specific, job-related questions. III. Medical Exclusions A. "High probability of substantial harm" TEL: Apr 03,91 14:15 No. 005 P. 14 3 Employers are permitted to exclude individuals from employment if their medical condition poses a "high probability of substantial harm." (House Report at 73). This is a very important, but difficult issue. The most difficult issue is deciding when a currently capable individual may be excluded on the basis of a future health risk. The EEOC should publish guidelines on appropriate considerations in medical screening. The following factors, discussed in detail in M. Rothstein, Medical Screening and the Employee Health Cost Crisis (BNA Books 1989), should be considered in evaluating the appropriateness of "predictive" medical screening: (1) job-relatedness of the medical criteria underlying the screening process: (2) degree of correlation between the specific screening measures used and the job-related medical criteria; (3) severity of the future injury or illness; (4) severity of the consequences of the injury or illness; (5) absolute risk of future illness; (6) relative risk of future illness; (7) latency period; (8) individualized determination of fitness; and (9) possibility of reasonable accommodation. B. Deference to the judgment of the individual's personal physician. The legislative history indicates that an adverse, medically-based employment decision may be "challenged" by an applicant or employee on the basis of a conflicting medical opinion by the individual's own physician. In the event of a conflict of medical opinion, deference is to be given to the opinion of the individual's physician. (House Report at 73). This represents a major change from current law, in which employers have sole discretion in the first instance and, if it is challenged under a state disability law, it is given deference by the court. The EEOC should explain the nature of this change, indicate the rationale of Congress, and refer to the body of case law under the Social Security Act and state workers' compensation law that parallels the ADA. TEL: Apr 03,91 14:15 No 005 P. 15 4 C. Paternalistic exclusions The legislative history also indicates Congressional opposition to "paternalistic exclusions" of individuals with disabilities by employers. (House Report at 73). If individual autonomy is to be preferred over employer paternalism, then the individuals need to be apprised of all material facts so they can make an informed decision. In the workplace setting, this requires informing applicants and employees about the possible risks to their health from workplace exposures and activities. The EEOC should require employers to inform applicants and employees about all conditions in the workplace that may cause impairments or may aggravate existing impairments. The EEOC should coordinate this rulemaking with the Occupational Safety and Health Administration. D. Health benefits costs The most likely future basis of employment discrimination against individuals with disabilities is the desire of employers to avoid employing people who may be a drain on health care benefits. This trend already has begun, as evidenced by the growing numbers of employers who refuse to hire individuals who smoke cigarettes, even if only off work. Although § 501(c) permits health insurance risk underwriting, the ADA prohibits discrimination in employment opportunities based on actual or perceived health care costs, including the health care costs of dependents pursuant to § 102 (b)(4). The EEOC should indicate that discrimination on the basis of health insurance costs violates the ADA. IV. Disclosure of Employer-Generated Medical Information A. Adoption of ACOM Principle 7. TEL: Apr 03,91 14:15 No 005 P. 16 5 Section 102 (c)(3)(B)(i) prohibits the disclosure of specific medical findings to nonmedical personnel. This provision is consistent with Principle 7 of the Code of Ethics of the American College of Occupational Medicine (ACOM), which provides: 7. Physicians should treat as confidential whatever is learned about individuals served, releasing information only when required by law or by overriding public health considerations, or to other physicians at the request of the individual according to traditional medical ethical practice; and should recognize that employers are entitled to counsel about the medical fitness of individuals in relations to work. but are not entitled to diagnosis or details of a specific nature. The EEOC should require that physicians rendering medical services to companies must comply with ACOM Principle 7. B. Separate medical files Section 102 (c)(3)(B) requires that medical records be kept in separate, confidential files. For small companies or remote locations of larger companies there are often no medical departments. Medical examinations of applicants and employees are usually performed by physicians in private practice under contract to the company. It is infeasible to have these physicians store the records, when they may examine large numbers of applicants and employees only once, The EEOC should interpret § 102 (c)(3)(B) to permit the storage of medical records by facilities without medical departments in either of the following ways: (1) storage at any other medical facility of the company; or (2) storage in some other department of the facility where they are separate from personnel records, are confidential, and accessible to nonmedical personnel only upon the consent of the individual or legal process. V. Medical Claims A significant, but largely unrecognized threat to the confidentiality of employee medical TEL: Apr 03,91 14:15 No 005 P. 17 6 information exists in the method of paying employee health insurance claims. Perhaps most pronounced at large, self-insured companies, these breaches of confidentiality are very common. When a health care provider submits a bill for payment it will customarily contain an explanation of the nature of the services rendered, either by description or code number. These bills are processed by the benefits office, not the medical department, and access to the information may be widespread. The EEOC should initiate rulemaking proceedings to determine the most effective way of protecting the privacy of health insurance claims information. One possible option is for each employee to have a separate medical claims number and have claims submitted by number only. VI. Waivers The ADA does not indicate whether applicants and employees may waive their rights. If waivers were permitted (e.g. giving employers access to an individual's non-job related medical records), the widespread requirement of waivers -- such as currently exists -- would completely frustrate the purpose of the ADA. The EEOC should declare that rights under the ADA may not be waived. LEGI-SLATE Report for the Federal Register Fri, March 1, 1991 9:50am (EST) Text of the Federal Register for LEGI-SLATE ID No. 384079 L-S ID No.: 384079 (3360 lines) PAGE: 56 FR 8578 NO. 40 02/28/91 EQUAL EMPLOYMENT OPPORTUNITY COMMISSION 29 CFR Part 1630 Equal Employment Opportunity for Individuals With Disabilities AGENCY: Equal Employment Opportunity Commission. ACTION: Notice of proposed rulemaking. SUMMARY: On July 26, 1990, the Americans with Disabilities Act (ADA) was signed into law. Section 106 of the ADA requires that the Equal Employment Opportunity Commission (EEOC) issue substantive regulations implementing title I (Employment) within one year of the date of enactment of the Act. Pursuant to this mandate the Commission is publishing a proposed new part 1630 to its regulations to implement title I and sections 3(2), 3(3), 501, 503, 508, 510 and 511 of the ADA as those sections pertain to employment. These regulations prohibit discrimination against qualified individuals with disabilities in all aspects of employment. DATES: To be assured of consideration, comments must be in writing and must be received on or before April 29, 1991. The Commission will consider any comments received on or before the closing date and thereafter adopt final regulations. Comments that are received after the closing date will be considered to the extent practicable. ADDRESSES: Written comments should be submitted to Frances M. Hart, Executive Officer, Executive Secretariat, Equal Employment Opportunity Commission, 1801 "L" Street NW., Washington, DC 20507. As a convenience to commenters, the Executive Secretariat will accept public comments transmitted by facsimile ("FAX") machine. The telephone number of the FAX receiver is (202) 663-4114. (This is not a toll-free number) Only public comments of six or fewer pages will be accepted via FAX transmittal. This limitation is necessary in order to assure access to the equipment. Comments sent by FAX in excess of six pages will not be accepted. Receipt of FAX transmittals will not be acknowledged, except that the sender may request confirmation of receipt by calling the Executive Secretariat Staff at (202) 663-4078. (This is not a oll-free number) Comments received will be available for public inspection in the EEOC Library, room 6502, by appointment only, from 9 a.m. to 5 p.m., Monday through Friday except legal holidays, from March 14, 1991, until the Commission publishes the rule in final form. Persons who need assistance to review the comments will be provided with appropriate aids such as readers or print magnifiers. To schedule an appointment call (202) 663-4630 (voice), (202) 663-4630 (TDD). Copies of this notice of proposed rulemaking are available in the following alternate formats: large print, braille, electronic file on computer disk, and audio-tape. Copies may be obtained from the Office of Equal Employment Opportunity by calling (202) 663-4395 (voice) or (202) 663-4399 (TDD). FOR FURTHER INFORMATION CONTACT: Elizabeth M. Thornton, Deputy Legal Counsel, (202) 663-4638 (voice), (202) 663-7026 (TDD). SUPPLEMENTARY INFORMATION: The Commission actively solicited and considered public comment in the development of proposed part 1630. On August 1, 1990, the Commission published an advance notice of proposed rulemaking (ANPRM), 55 FR 31192, informing the public that the Commission had begun the process of developing substantive regulations pursuant to title I of the ADA and inviting comment from interested groups and individuals. The comment period ended on August 31, 1990. In response to the ANPRM, the Commission received 138 comments from various disability rights organizations, employer groups, and individuals. Comments were also solicited at 62 ADA input meetings conducted by Commission field offices throughout the country. More than 2400 representatives from disability rights organizations and employer groups participated in these meetings. The format of the regulations reflects congressional intent, as expressed in the legislative history, that the regulations implementing the employment provisions of the ADA be modeled on the regulations implementing section 504 of the Rehabilitation Act of 1973, as amended, 34 CFR part 104. Accordingly, in developing these regulations, the Commission has been guided by the section 504 regulations and the case law interpreting those regulations. It is the intent of Congress that these regulations be comprehensive and easily understood. Proposed part 1630, therefore, defines terms not previously defined in the regulations implementing section 504 of the Rehabilitation Act, such as "substantially limits," "essential functions," and "reasonable accommodation. Of necessity, many of the determinations that may be required by this proposed part must be made on a case by case basis. Where possible the regulations establish parameters to serve as guidelines in such inquiries. The Commission is also issuing interpretive guidance concurrently with the issuance of part 1630 in order to ensure that qualified individuals with disabilities understand their rights under these regulations and to facilitate and encourage compliance by covered entities. Therefore, proposed part 1630 is accompanied by a proposed appendix. This proposed appendix represents the Commission's interpretation of the issues discussed and the Commission will be guided by it when resolving charges of employment discrimination. The proposed Appendix addresses the major provisions of the regulations and explains the major concepts of disability rights. One especially complex area for which the Commission has attempted to provide additional definitions and parameters involves the question of how to determine whether an employer regards a particular individual as having an impairment that substantially limits the major life activity of working. This question arises only when the individual is being regarded as substantially limited in working as opposed to substantially limited in any of his or her other major life activities. Also, it does not apply when an individual has an actual disability, or has a record of being an individual with a disability. The Commission has proposed, in the appendix to part 1630, that an employer be considered to regard an individual as substantially limited in the major life activity of working if the employer's qualification standard excluding individuals with a particular impairment, would, if assumed to be generally applied by employers facing comparable hiring decisions, exclude the individual from a class of jobs or from a broad range of jobs in various classes. The Commission invites specific comment on this proposal. More detailed guidance on specific issues will be forthcoming in the Commission's Compliance Manual. Several Compliance Manual sections and policy guidances on ADA issues are currently under development and are expected to be issued prior to the effective date of the Act. Among the issues to be addressed in depth are the theories of discrimination; definitions of disability and of qualified individual with a disability; reasonable accommodation and undue hardship, including such matters as the scope of reassignment and supported employment; and pre-employment inquiries. To assist us in developing this guidance, the Commission requests comment from disability rights organizations, employers, unions, State agencies concerned with employment or worker's compensation practices, and interested individuals on the following specific questions concerning the application of Title I of the ADA. Insurance 1. What are the current risk assessment or classification practices with respect to health and life insurance coverage in the area of employment? 2. Must risk assessment or classification be based on actuarial statistics? 3. What is the relationship between "risk" and "cost?" 4. Must an employer or insurance company consider the effect on individuals with disabilities before making cost saving changes in its insurance coverage? Worker's Compensation 1. Is submission of medical information to worker's compensation offices a permissible use of information obtained as a result of a medical examination or inquiry? 2. Is an inquiry into the history of an individual's worker's compensation claims a prohibited pre-employment inquiry? Is such an inquiry ever permissible as an inquiry that is job-related and consistent with business necessity? 3. What has been the experience of federal contractors subject to section 503 of the Rehabilitation Act with respect to State worker's compensation requirements? Collective Bargaining Agreements 1. Can the effect of a particular accommodation on the provisions of a collective bargaining agreement ever be considered an undue hardship? For example, may an employer decline to restructure a job or refuse to grant light duty because to do so would violate seniority or other provisions of the collective bargaining agreement? 2. What is the relationship between collective bargaining agreements and the accommodation of reassignment to a vacant position? 3. Should a position be considered "vacant" when the employer has other obligations, such as consent decrees or arbitration agreements, with respect to filling the position? 4. If a necessary reasonable accommodation is challenged as a violation of a collective bargaining agreement, would the employer or union violate the confidentiality requirements of the ADA by explaining that the accommodation was made to comply with the ADA? Executive Order 12291 and Regulatory Flexibility Act The Commission has determined that this proposed rule will not exceed the threshold level of $100 million and thus is not a major rule for the purposes of Executive Order 12291. In making this determination the Commission prepared a Preliminary Regulatory Impact Analysis. The text of the Analysis appears below. The Commission certifies that this proposed rule will not have a significant economic impact on a substantial number of small business entities. Therefore, a regulatory flexibility analysis under the Regulatory Flexibility Act is not required. Preliminary Regulatory Impact Analysis Executive Summary The following analysis estimates three economic effects likely to result from the regulation implementing Title I of the Americans with Disabilities Act. Reasonable accommodation expenses are estimated at approximately $16 million, productivity gains are estimated at more than $164 million and decreased support payments and increased tax revenue is estimated at about $222 million. Lost benefits of not promulgating the rule could exceed $400 million. It appears that the rule is unlikely to have a significant economic impact on smaller entities. Because small entities employ fewer workers, the chance that an individual small business will be required to take reasonable accommodation is quite low. Further, the availability of tax credits, the two-year exemption period and the lack of reporting requirements all reduce the economic effect of the rule on these firms. Introduction The Equal Employment Opportunity Commission (EEOC) has drafted regulations to implement title I of the Americans with Disabilities Act (ADA), requiring equal employment opportunity for qualified individuals with disabilities, and sections 3(2), 3(3), 501, 503, 508, 510, and 511 of the ADA as those sections pertain to the employment of qualified individuals with disabilities. The Commission is required by the ADA to issue regulations to enforce Title I within one year of the date of enactment. The regulation raises no issues for discretionary rulemaking. Title I of the ADA is an unusual statute in that it contains a level of detail more commonly found in regulations, leaving very little room for regulatory discretion, and thus limits regulatory costs to those preset by the Congress in its choice of statutory requirements. The regulation merely explains and provides guidance on the statutory requirements by relying primarily on existing case law, which is another limitation on Commission discretion in constructing the regulation. NOTE /1/ Case law is a result of experiences encountered in implementing the Rehabilitation Act of 1973. The purpose of this preliminary regulatory impact analysis is to determine the costs and benefits of the proposed rule as required by Executive Order 12291, 46 FR 131391 (1981) This preliminary analysis suffers from a number of constraints. The ADA establishes very stringent time frames for developing implementing regulations. The limited time available necessitates the use of very rough estimates that can readily be drawn from existing literature. Additionally, a lack of regulatory alternatives available to the Commission and a scarcity of data relevant to the regulation at hand prevent this analysis from being an ideal application of cost benefit analysis. Even more limiting is the lack of a clear definition of costs associated with the rule as benefits, costs or simply transfers. Nevertheless, this analysis will address the five areas proscribed as necessary elements of a regulatory impact analysis by the Office of Management and Budget./2/ These areas are: (1) Statement of potential need for the proposal, (2) an examination of alternative approaches, (3) an analysis of benefits and costs, (4) rationale for choosing the proposed regulatory action, and (5) a statement of statutory authority. Also included in the final section of this preliminary regulatory impact analysis is a regulatory flexibility analysis. NOTE /2/ "Appendix V, Regulatory Impact Analysis Guidance", Regulatory Program of the United States Government, April 1, 1990-March 31, 1991, The Executive Office of the President, Office of Management and Budget, pp. 653- 666. Background On July 26, 1990, the ADA was signed into law. The Commission invited public comment on the development of regulations through the publication of an advanced notice of proposed rulemaking on August 1, 1990. As directed by the legislative history, the regulations are modeled on those implementing section 504 of the Rehabilitation Act of 1973, as amended, 34 CFR part 104. Substantively, the regulations parallel the act. Succinctly stated, the act and the regulations prohibit employers from discriminating in employment decisions against qualified individuals with disabilities. This includes the requirement that employers make reasonable accommodation to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the employer can demonstrate that the accommodation would impose an undue hardship on the operation of its business. There are certain economic effects expected as a result of title I : (1) Reasonable accommodation expenses, (2) reduction of social welfare payments and an increase in tax revenues, and (3) increased labor productivity. As will be discussed, these costs can be viewed as being positive (benefits), negative (costs) or neutral (transfers). Government administrative costs in implementing Title I could also be considered an economic effect. Statement of Potential Need for the Proposal Beyond the legislative requirements for the regulations, Office of Management and Budget (OMB) guidance requires regulatory impact analyses to establish the potential need for a proposal by demonstrating that "(a) market failure exists that is (b) not adequately resolved by measures other than Federal regulation."/3/ The labor market failures at issue here include those addressed by other equal employment opportunity requirements. These failures have been explained in three different ways in the seminal works of Becker, Thurow and Arrow. These works originally addressed race discrimination but they are applicable to discrimination against disabled workers./4/ Becker treats discrimination as a commodity in which employers, co-workers and consumers all have to determine their discrimination coefficient, that is, their taste for discrimination or how much discrimination will affect their utility. /5/ Here the market failure is the substitution of a human capital factor (that is, a qualification for or contributor to labor productivity) with factors unrelated to productivity, such as race, sex, or disability. Becker indicates that individuals and firms are willing to accept the reduced productivity arising from using such factors because they prefer not to be associated (due to uncomfortableness or displeasure) with blacks, women or disabled workers in the work place. Becker's general theorem on market discrimination assumes that all employees in a given market are either perfect substitutes or perfect complements. Discrimination by employers converts minority or female wage rates into a net wage rate with the added costs of discrimination. The discrimination cost adds to the actual wage rate by adding costs from employees, customers, unions and others who prefer not to associate with certain classes of individuals. This cost of discrimination makes the black, female, or disabled worker more expensive to the firm and therefore stimulates the employer to discriminate in wages or to fail to hire these individuals. The effect on the labor market is that it artificially constricts the labor pool and allows a non-human capital factor to be considered in labor decisions, thus reducing gross productivity. NOTE 13/ "Appendix V, Regulatory Impact Analysis Guidance", Regulatory Program of the United States Government, April 1, 1990-March 31, 1991, The Executive Office of the President, Office of Management and Budget, p. 653. NOTE /4/ The term "disabled worker" is used to refer to applicants and employees covered by the act. It is not intended to be a legal term but is simply a term of convenience for this analysis. NOTE /5/ Becker, Gary S. The Economics of Discrimination, The University of Chicago Press, 1957 Thurow relies strongly on the marginal productivity theory in labor economics./6/ The author explains that in studying discrimination, the important source of income is individual labor. Labor income is determined by labor's marginal productivity, its contribution to the firm's production. Firms are expected to set labor costs equal to labor's marginal productivity. As productivity increases, income should increase. In explaining employment discrimination, Thurow rejects Becker's notion of tastes for discrimination. Instead he sees the discriminator as a profit maximizer. Given a situation where firms pay black, female, ethnic or disabled workers less for comparable work, Becker would suggest that a portion of these workers' marginal productivity must go to buy off discrimination tastes. Thurow would argue that it occurs because the firm knows it can use that portion of a black, female, ethnic or disabled worker's marginal productivity as profit. Thurow's theory has limited applicability to hiring discrimination because if firms were able to capture wage disparities as profits, they would place a greater demand on these workers. This seems to be a particular weakness with respect to disabled workers because of the high rate of disabled unemployment. Nevertheless, Thurow provides a theoretical basis for observed wage disparities between equally qualified disabled and non-disabled workers. Thurow's theory also points out another market failure having to do with human capital. Although Thurow's theory could not create an artificially constricted labor market, as Becker's theory does, it would reduce returns on human capital investments for certain workers. /7/ As a result, disabled workers (and others that are discriminated against in the manner described by Thurow) would be less willing and less able to make human capital investments. This will result in a less qualified work force than would be expected in a perfectly competitive market. This again can have serious national productivity effects. NOTE /6/ Thurow, Lester C. Poverty and Discrimination, The Brookings