Doctors’ offices are supposed to be accessible to people with disabilities, but rules outlining what that means are going unenforced. Now, an independent federal agency is calling for change.

The National Council on Disability wants the U.S. Department of Justice and the Department of Health and Human Services to issue new regulations outlining exact parameters for what constitutes accessible medical and diagnostic equipment.

The standards already exist. They were published in 2017 by the Access Board, a federal agency devoted to accessibility for people with disabilities, in consultation with the Food and Drug Administration. But since the so-called Standards for Accessible Medical Diagnostic Equipment haven’t been formally adopted by the federal agencies responsible for enforcement, they lack teeth.

The recommendations from the National Council on Disability, which is charged with advising the president and Congress on disability issues, come in a 75-page report outlining the barriers still present as people with disabilities seek health care.

Despite requirements in the Americans with Disabilities Act, Section 504 of the Rehabilitation Act and the Affordable Care Act that full and equal access be provided to health care services and facilities, the report notes that basics like examination tables, weight scales, examination chairs and imaging equipment “are usually inaccessible for people with physical disabilities.” And, health care facilities generally lack trained staff to help people with disabilities transfer safely to such equipment.

Even when accessible equipment is available, the council said that medical staff often don’t know how to use it. As a result, people with disabilities say that health care professionals frequently skip portions of exams or even refuse care, the report found.

Currently, individuals with disabilities can file complaints with the Justice Department and the Department of Health and Human Services over inaccessible medical and diagnostic equipment, but the National Council on Disability said this remedy is inadequate.

“Thirteen percent of American adults have some form of disability impacting their functional mobility, which means there are a significant number of Americans who experience significant barriers to health care exams and preventative care for the absence of accessible examination tables, examination chairs and other medical and diagnostic equipment,” said Andrés Gallegos, chairman of the National Council on Disability. “As someone who has experienced this firsthand, I can attest that health equity for people with mobility disabilities will remain elusive, absent formal adoption of the MDE standards by enforcing federal agencies.”

The Departments of Justice and Health and Human Services did not respond to requests for comment about whether they are considering regulations to adopt the Access Board standards.