Medical diagnostic equipment (MDE) is equipment used in, or in conjunction with, medical settings by health care providers for diagnostic purposes. Examples of MDE include:

• examination tables
• examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures)
• weight scales
• mammography equipment
• x-ray machines

A regulation, also called a “rule,” is a set of requirements issued by a federal agency to implement laws passed by Congress. When Congress passed the ADA, it gave the Department the authority to make regulations that explain the rights and requirements of Titles II and III of the ADA.

The Department made this rule using a process sometimes called “notice and comment rulemaking.” As part of this process, the Department published a Notice of Proposed Rulemaking (NPRM). The NPRM was basically a first draft of the regulation. It let the public know about the requirements the Department was considering and gave an opportunity for feedback.

The Department got feedback from the public on the NPRM. Based on that feedback, the Department made changes to certain parts of the rule. A description of the feedback the Department got and how it updated the rule is available in the appendix to the rule.

Title II of the ADA requires state and local governments to make sure that their services, programs, and activities are accessible to people with disabilities. Title II applies to all services, programs, or activities of state and local governments. These include health care services, programs, and activities that state and local government entities offer through or with the use of MDE. Title II uses the term “public entities” to describe who it applies to, but in this fact sheet, we call these “state and local government entities.”

Like the rest of Title II, the rule applies to all state and local governments (which includes any agencies or departments of state or local governments) as well as special purpose districts, special district governments, and other instrumentalities of state or local government.

Examples of state and local government entities include:

• Public hospitals
• Public health care clinics
• Public colleges’ and universities’ health care systems

State and local government entities that contract with other entities to provide public services also have to make sure that their contractors follow Title II. For example, if a state agency has a non-profit organization run a health clinic on behalf of the agency, the agency needs to make sure that the non-profit organization follows Title II.

For more information about the responsibilities of state and local governments under Title II, visit our State and Local Governments page.

• A technical standard says specifically what is required for something to be accessible. For example, the existing ADA Standards for Accessible Design are technical standards that say what is needed for a building to be physically accessible under the ADA, like how wide a door has to be or how steep a ramp can be.
• In 2017, the U.S. Access Board issued technical standards on the accessibility of MDE in physicians’ offices, clinics, emergency rooms, hospitals, and other medical settings. We call these the “MDE Standards.”
• This rule adopts the MDE Standards and makes them enforceable under the ADA by incorporating them into the Department’s ADA Title II regulation.

• The rule generally requires all MDE that state and local government entities purchase, lease, or otherwise acquire after October 8, 2024 to be accessible, until the entities have the amount of accessible MDE specified in the rule.
• State and local government entities may choose to acquire additional accessible MDE as long as they have the amount specified in the rule.

• By August 9, 2026, any state or local government entity that uses an examination table must purchase, lease, or otherwise acquire at least one examination table that meets the MDE Standards, unless the entity already has one.
• By August 9, 2026, any state or local government entity that uses a weight scale must purchase, lease, or otherwise acquire at least one weight scale that meets the MDE Standards, unless the entity already has one.

• State and local government entities must also address barriers caused by a lack of existing accessible MDE. Examples of access barriers could include exam tables that are not height adjustable or weight scales that do not accommodate wheelchairs.
• State and local government entities do not necessarily have to make all of their existing MDE accessible.
• The rule requires state and local government entities to operate each service, program, or activity offered through or with the use of MDE so that the service, program, or activity as a whole is readily accessible to and usable by individuals with disabilities. This approach is similar to the program accessibility requirements in the Department of Justice’s existing regulation implementing Title II of the ADA.
• State and local government entities can meet this requirement in many ways. For example, they can provide services at another location, through home visits, or by acquiring accessible MDE.

• State and local government entities cannot deny health care services to a patient with a disability that they would otherwise provide because they lack accessible MDE.
• State and local government entities cannot require a patient with a disability to bring someone along with them to help if patients without disabilities are not required to do the same.

• The rule requires state and local government entities to ensure that their staff can successfully operate accessible MDE, assist with transfers and positioning of individuals with disabilities, and carry out the rule’s requirements for existing MDE.
• At all times when services are provided to the public, state and local government entities are expected to have staff who can operate accessible MDE.
• Often, the most effective way for state and local government entities to ensure that their staff can successfully operate accessible MDE is to provide staff training on the use of accessible MDE.

• Under the current ADA rules, state and local government entities do not need to make changes that would be a fundamental alteration or cause undue financial and administrative burdens. They still do not need to do that under this rule.
• For more information about fundamental alteration and undue burdens, see the Department’s State and Local Governments page.

• The rule allows state and local government entities to use different designs, products, or technologies as alternatives, as long as the state or local government can prove that the alternatives provide the same or more accessibility and usability as the MDE Standards.