Legal reference · HHS Section 504 2024 · 45 CFR Part 84 · WCAG 2.1 AA · Effective communication · Training video captions

HHS Section 504 2024 final rule: WCAG 2.1 AA captions for health programs and activities

Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794) prohibits discrimination on the basis of disability by any entity receiving federal financial assistance. The Department of Health and Human Services (HHS) has regulated Section 504 at 45 CFR Part 84 since 1977 — but for nearly fifty years, those regulations were largely unchanged. In May 2024, HHS published a comprehensive final rule that updated 45 CFR Part 84 for the first time (89 Fed. Reg. 40,066, RIN 0945-AA04, effective July 8, 2024). The 2024 rule is not a minor amendment — it added statutory text that the original 1977 rule pre-dated (the ADA Amendments Act of 2008, the ACA Section 1557), strengthened the effective-communication standard to explicitly require auxiliary aids and services (including captioning) for people with hearing disabilities, and — most significantly for digital accessibility — added a new web and mobile accessibility provision at § 84.22 requiring WCAG 2.1 Level AA conformance for the web and mobile content of covered entities. The covered entities under 45 CFR Part 84 are entities that receive federal financial assistance from HHS: hospitals (Medicare/Medicaid participating providers), Federally Qualified Health Centers (FQHCs), state and local health departments receiving HHS grants, substance-abuse treatment programs, mental health programs receiving SAMHSA funding, home health agencies, clinical laboratories, nursing facilities, and research institutions receiving NIH or HRSA funding. The 2024 rule's WCAG 2.1 AA web-content provision directly reaches training video hosted on the web and mobile platforms of these entities.

TL;DR

The 2024 HHS Section 504 final rule (45 CFR Part 84 as amended, 89 Fed. Reg. 40,066, effective July 8, 2024) added three new requirements that directly bear on training video captioning for HHS-funded health entities: (1) § 84.22 — WCAG 2.1 Level AA for web content and mobile applications, including video content; (2) § 84.21 — effective communication via auxiliary aids and services (including captioning) for individuals with hearing disabilities; (3) § 84.23 — integration mandate requiring that programs be operated in the most integrated setting appropriate. For training video: workforce training video hosted on the entity's web platform (LMS, SharePoint, intranet, HealthStream, MyChart) must meet WCAG 2.1 AA SC 1.2.2 captions; hearing-impaired staff must be provided with accurate captions as an auxiliary aid under § 84.21; hearing-impaired patients must have accessible patient-education video under §§ 84.21 and 84.22. This rule is distinct from — and adds to — the existing obligations under HIPAA § 164.530(b) (workforce training documentation), Section 1557 (ACA nondiscrimination for covered healthcare providers and health plans), and Section 504 generally (which this rule amends). For public health entities (state agencies, public hospitals), ADA Title II further reinforces the same WCAG 2.1 AA standard.

The 2024 rule: what changed from the 1977 regulation

The 1977 Part 84 regulation was functional but minimal by modern standards. It required that programs be accessible to individuals with disabilities and that covered entities provide auxiliary aids to ensure effective communication — but it did not specify digital accessibility standards, did not reference WCAG, did not address web or mobile content, and pre-dated the internet entirely. The 2024 rule made the following substantive changes relevant to digital accessibility and captioning:

§ 84.22 — Web and mobile accessibility (new)

Section 84.22 is the most significant new provision for digital accessibility. It requires that all "web content and mobile applications" of covered entities conform to WCAG 2.1 Level AA. The provision is modelled on the 2024 DOJ Title II rulemaking and the 2024 Section 1557 rulemaking, both of which adopted the same WCAG 2.1 AA standard concurrently. Key aspects of § 84.22:

Video is web content. Video hosted on a covered entity's website, LMS, intranet, or mobile application is "web content" for § 84.22 purposes. This expressly includes training video (workforce training, patient education video, community health video) hosted on the entity's digital properties.
WCAG 2.1 Level AA SC 1.2.2 applies. SC 1.2.2 (Captions, Prerecorded) requires captions that "accurately convey the audio" for all prerecorded synchronized video. Generic auto-captions that mangle medical vocabulary do not satisfy the "accurately convey the audio" standard. (See WCAG captions prerecorded for what "accurately convey the audio" means in practice.)
Compliance timeline. The rule was effective July 8, 2024. The compliance timeline for WCAG 2.1 AA web content follows the entity's size — large entities (those that receive substantial federal financial assistance) face a shorter timeline than small entities. The final rule's preamble sets a one-to-three-year transition period depending on entity size and the type of content involved. New web content published after the rule's effective date should be WCAG 2.1 AA conformant from the date of publication; back-catalogue content faces the phased timeline.
Exceptions. § 84.22 contains a fundamental-alteration and undue-burden exception consistent with Section 504's existing undue-hardship standard. Covered entities that cannot achieve WCAG 2.1 AA compliance for specific content without fundamental alteration or undue burden must provide accessible alternatives (including via the effective-communication provision at § 84.21).

§ 84.21 — Effective communication (strengthened)

The 1977 rule required auxiliary aids but gave covered entities discretion in the form. The 2024 rule strengthened § 84.21 to more closely track the language of Title II's effective-communication regulation (28 CFR § 35.160), requiring that covered entities provide auxiliary aids and services necessary to ensure effective communication with individuals with hearing, vision, or speech disabilities. For training video:

Hearing-impaired employees of covered entities are entitled to effective communication in workforce training — which includes accurate captions on training video as an auxiliary aid.
Hearing-impaired patients and clients of covered entities are entitled to effective communication in health programmes — which includes accurate captions on patient-education video, telehealth recordings, and consumer health information video.
The entity must provide the auxiliary aid of the individual's choice unless providing it would result in a fundamental alteration or undue burden, in which case the entity must provide an alternative auxiliary aid that ensures effective communication. Accurate captions (as opposed to a text transcript without synchronisation) are the standard auxiliary aid for video content.

§ 84.23 — Integration mandate (new)

Section 84.23 codifies an integration mandate analogous to the Olmstead integration mandate under Title II — requiring that programs be made available to individuals with disabilities in the most integrated setting appropriate. For training video, the integration implication is that hearing-impaired staff should be able to access the same training platform and the same training content as hearing staff, with captions as the accessibility mechanism — rather than being routed to alternative training formats or separate delivery systems.

Covered entities under the 2024 HHS Section 504 rule

Any entity that receives "federal financial assistance" from HHS is subject to 45 CFR Part 84. The coverage is broad and includes organisations that do not think of themselves primarily as HHS-regulated entities:

Hospitals. All Medicare-participating and Medicaid-participating hospitals. Medicare and Medicaid participation constitutes "federal financial assistance" for Part 84 purposes. This includes private non-profit hospitals, for-profit hospital systems, critical access hospitals, and academic medical centres.
Federally Qualified Health Centers (FQHCs). Community health centres funded under Section 330 of the Public Health Service Act. There are approximately 1,400 FQHC organisations operating more than 14,000 service delivery sites in the US. All are directly covered by the 2024 rule.
State and local health departments. Any public health department that receives grants, cooperative agreements, or other financial assistance from HHS (CDC, HRSA, SAMHSA, ASPR, ACF, CMS). State Medicaid agencies. Local health departments receiving CDC or HRSA funding.
Substance-abuse treatment programs. Programs receiving SAMHSA (Substance Abuse and Mental Health Services Administration) Block Grant or discretionary grant funding. These include residential treatment programs, opioid treatment programs (OTPs), outpatient counselling programs, and recovery community organisations.
Mental health programs. Community Mental Health Centers (CMHCs) and other mental health entities receiving SAMHSA Community Mental Health Services Block Grant funding.
Home health agencies. Medicare and Medicaid-certified home health agencies. All receive federal financial assistance through the Medicare and Medicaid reimbursement system.
Clinical laboratories. CLIA (Clinical Laboratory Improvement Amendments) certified laboratories that participate in Medicare/Medicaid. Clinical labs at hospitals and independent reference labs.
Nursing facilities. All Medicare-certified and Medicaid-certified skilled nursing facilities and nursing homes. Training video in nursing facilities — including annual CMS-required training, dementia-care training, abuse prevention training — is covered by § 84.22 and § 84.21.
Research institutions. Any university, research hospital, or independent research organisation receiving NIH grants, HRSA grants, AHRQ grants, or other HHS research funding. NIH grants are the most common trigger — any university receiving NIH research funding for any research project is a covered entity under Part 84 across its entire campus and all programmes, not just the research project receiving the grant.
Head Start / Early Head Start programs. Funded directly by ACF (Administration for Children and Families). Training video for Head Start staff — including annual Early Childhood Learning & Knowledge Center (ECLKC) required training — is covered.

Interaction with HIPAA, Section 1557, and ADA Title II

The 2024 HHS Section 504 rule does not operate in isolation — it applies simultaneously with three other regulatory frameworks that many HHS-covered entities are already subject to:

HIPAA § 164.530(b) (workforce training)

HIPAA's workforce training requirement obligates covered entities to train all workforce members on privacy and security policies. This training obligation is documentation-focused — the covered entity must be able to demonstrate that training was provided and appropriate for each workforce member's functions. The 2024 Part 84 rule adds an accessibility dimension: the training must be provided in a form that is accessible to hearing-impaired workforce members (§ 84.21 effective communication) and the web platform on which it is hosted must meet WCAG 2.1 AA (§ 84.22). A hospital that documents HIPAA training completion in HealthStream but has delivered that training via video with inaccurate auto-captions has both a HIPAA documentation gap (was the training "appropriate" for the hearing-impaired employee's functions?) and a Part 84 § 84.21 effective-communication failure. See HIPAA training captions.

Section 1557 (ACA nondiscrimination)

Section 1557 (as updated by the 2024 HHS final rule at 45 CFR Part 92) covers "covered healthcare programs" — covered healthcare providers, health plans, and health insurance issuers that receive federal financial assistance or are administered by HHS. Section 1557's effective-communication provision (§ 92.207) and WCAG 2.1 AA web-content provision (§ 92.106/§ 92.107) are largely parallel to the new Part 84 §§ 84.21 and 84.22. For entities covered by both Part 84 and Part 92 (which includes most CMS-participating hospitals, health plans, and FQHCs), both frameworks simultaneously require WCAG 2.1 AA captioning on training and patient-education video. Satisfying one satisfies both on the technical standard; the enforcement mechanisms differ (OCR investigates both, but Part 84 complaints may travel a different investigation path than Part 92 complaints). See Section 1557 captions.

ADA Title II (for public health entities)

Public hospitals, state health departments, county health departments, public university medical centres, and Veterans Health Administration (VA) facilities are ADA Title II-covered entities in addition to being HHS Section 504 covered entities. ADA Title II's 2024 DOJ final rule (28 CFR Part 35, effective 2026-04-24) requires WCAG 2.1 AA for web content, including SC 1.2.2 video captioning. For these entities, ADA Title II, Part 84, and Part 92 (for those also covered by Section 1557) all independently require WCAG 2.1 AA-accurate captions on training and patient-education video. Three regulatory frameworks. One technical standard: WCAG 2.1 AA SC 1.2.2 accuracy. One captioning solution satisfies all three. See ADA Title II captions.

Training video caption obligations for specific entity types

The practical captioning obligation under the 2024 Part 84 rule differs by entity type:

Hospitals

Hospital training video — Epic EHR training, HIPAA awareness, Joint Commission-required competency training, annual employee safety training, fall-prevention training, hand-hygiene training, fire safety training, hazardous-materials training — is workforce training video hosted on HealthStream, Relias, Epic Learning Home, SharePoint/Stream, or another LMS. Under § 84.22, all of this video on the hospital's web/mobile platforms must meet WCAG 2.1 AA SC 1.2.2. Under § 84.21, hearing-impaired employees must receive effective communication in this training via accurate captions. See Epic EHR training captions and HealthStream captions for the platform-specific workflows.

Federally Qualified Health Centers (FQHCs)

FQHCs operate with small training-operations teams and typically use simpler LMS infrastructure than hospital systems — often HealthStream, Relias, or a third-party online training platform like MedTrainer, Compliance 360, or Relias Learning. HRSA Health Center Program requirements include training on clinical quality improvement, cultural competency, and language access; the 2024 Part 84 rule requires this training to be accessible to hearing-impaired staff. The FQHC vocabulary in training video (HRSA program terminology, UDS measures, Health Center Program designations, Sliding Fee Discount Program, PCMH certification terms, scope-of-project language) is a systematic auto-caption failure point that requires a glossary-biased approach.

State health departments

State health departments receiving CDC, HRSA, or SAMHSA funding face Part 84 obligations for their web-based training content. State public-health training programs (public health workforce training, communicable disease training, emergency preparedness training) hosted on state agency LMS platforms or the CDC's TRAIN learning management system must meet WCAG 2.1 AA. State health departments also face their state's own digital accessibility laws — state digital accessibility laws for California, Colorado, Washington, Texas, and others apply independently.

NIH-funded research institutions

Any university that receives NIH funding is an HHS-covered entity across all its programs, not just the NIH-funded research. This includes most research universities in the United States. The practical implication: training video on a NIH-funded university's LMS (Canvas, Brightspace, Moodle, or institutional Kaltura) must meet WCAG 2.1 AA under Part 84 § 84.22 — in addition to the ADA Title II obligation for public universities and AODA obligations for Canadian universities receiving NIH-equivalent Canadian federal funding. See Canvas LMS captions and Brightspace captions.

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FAQ — HHS Section 504 2024 rule and training video captions

When did the 2024 HHS Section 504 rule take effect?

The final rule was published May 9, 2024 (89 Fed. Reg. 40,066) and became effective July 8, 2024. The WCAG 2.1 AA web-content provision at § 84.22 provides phased compliance timelines for existing content: new web content published after July 8, 2024 should conform to WCAG 2.1 AA at publication. For existing back-catalogue web content (including training video hosted before the rule's effective date), the rule provides a transition period — one year for large entities receiving substantial HHS financial assistance, two years for smaller entities. Entities should have completed compliance for new content already and should be actively working through back-catalogue remediation under the transition-period timeline.

How is the 2024 HHS Section 504 rule different from the general Section 504 captions obligation?

The pre-2024 Section 504 obligation (covered in our Section 504 captions reference) applied to all federal-financial-assistance recipients broadly — education, housing, transportation, health, employment. The obligation was to provide accessible programs and effective communication but the technical standard for web and digital accessibility was not specified in the regulations. The 2024 HHS rule is specific to HHS-funded entities and adds: (1) an explicit WCAG 2.1 AA standard for web and mobile content at § 84.22 — which the prior rule did not include; (2) a strengthened effective-communication provision at § 84.21 that more closely tracks the ADA Title II model; (3) an integration mandate at § 84.23. The 2024 rule provides more specific, actionable requirements for digital accessibility than the general Section 504 framework — which is why it's important to know the specific rule, not just the general statute.

Does the 2024 rule apply to private for-profit hospitals?

Yes. The federal financial assistance trigger is Medicare and Medicaid participation. A for-profit hospital that participates in Medicare and Medicaid receives federal financial assistance through the reimbursement system and is covered by 45 CFR Part 84. Private for-profit hospital chains (HCA Healthcare, Tenet Healthcare, Community Health Systems, etc.) are covered entities under Part 84 because they participate in Medicare and Medicaid, despite being for-profit and not receiving HHS grants directly. The 2024 rule's WCAG 2.1 AA requirement applies to their employee training video and patient-education video on the same basis as non-profit hospital systems.

How does OCR enforce the 2024 Section 504 WCAG 2.1 AA requirement?

HHS Office for Civil Rights (OCR) enforces 45 CFR Part 84. OCR investigates complaints filed by individuals who allege Section 504 violations by covered entities. A complaint from a hearing-impaired hospital employee alleging that required training video lacks accurate captions would trigger an OCR investigation of the hospital's WCAG 2.1 AA compliance under § 84.22 and effective-communication compliance under § 84.21. OCR can also conduct compliance reviews of covered entities without a complaint trigger. OCR enforcement outcomes range from technical assistance and voluntary compliance agreements to formal findings of noncompliance and, for persistent non-compliers, referral to the DOJ for enforcement proceedings or suspension of federal financial assistance — the latter being the equivalent of losing Medicare/Medicaid certification.

What's the simplest way for a hospital to comply with both HIPAA workforce training and the 2024 Part 84 § 84.22 requirement simultaneously?

Caption every required training video to WCAG 2.1 AA SC 1.2.2 accuracy. A VTT file attached to each HealthStream or Learning Home course video satisfies § 84.22 (WCAG 2.1 AA conformance), § 84.21 (effective communication for hearing-impaired staff), and HIPAA § 164.530(b) (training appropriate to the functions of each workforce member, including hearing-impaired members). Glossary-biased captioning — using a hospital-specific glossary that includes HIPAA vocabulary, Epic/EHR vocabulary, Joint Commission terminology, and the hospital's own program names — produces the "accurately convey the audio" accuracy that SC 1.2.2 requires. The resulting VTT file serves as the single compliance artefact that satisfies all three frameworks simultaneously.