ADA compliance isn’t a set-it-and-forget-it thing. Compliance standards must be followed and will evolve just as your website does. There are guidelines all website contributors must know to stay within ADA guidelines. It is generally not burdensome but it does require some web managers to change their workflows. For example, loading images up to your ecommerce site will always need some of that alternative text (alt tags) mentioned above.
This is the reason why I think web design firms have to position themselves as solution providers and not just web guys/gals. A client doesn't need a website, they need sales. The website is just part of that solution but it's not the solution and unlike web design, service like email marketing automation, SEO, and PPC requires an experienced professional.

Since March 15, 2012, ADA compliance with the 2010 Standards will be required for new construction and alterations. In the period between September 15, 2010 and March 15, 2012, covered entities may choose between the 1991 Standards ADA Compliance (without the elevator exemption for Title II facilities), the Uniform Federal Accessibility Standards (Title II facilities only), and the 2010 Standards ADA Compliance.
I own a medical practice in California with 5 employees. Since I have under 15 employees am I exempt from needing to have my website comply with the ADA? I know that my physical practice is exempt from ADA policies regarding employment (under 15) but I don’t know if that extends to websites. My website is not an important part of my practice and I don’t really want to sink any funds into it if I don’t need to. 
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