Post on 23-Jan-2022
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CivilRightsComplianceforPatientsWhatYouNeedtoKnowandHowtoHelpYourFacilitiesComply
Objectives
•Attheendofthissessiontheparticipantwill:• IdentifyCivilRightslawasitpertainstohealthcare• Understandrecentenforcementactivity• UnderstandthecomponentsofasuccessfulCivilRightscomplianceprogram
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WHATISTHELAW?
WhatistheLaw?
• Section504oftheRehabilitationActof1973• TitleVIoftheCivilRightsActof1964• AgeDiscriminationActof1975• U.S.DepartmentofHealthandHumanServicesTitle45CodeofFederalRegulations– Parts80,84and91
• Section1557oftheAffordableCareAct• ProposedLaw HHSTitle45CFRPart92• Otherapplicablefederalrightsstatutes
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Section504
• Hearingimpaired• Centerresponsibilityforassessment,careplanning• Signlanguageinterpreterifrequested
• Centerexpense
• Languagebarriers• Centerresponsibilityforassessment,careplanning• Interpreterprovided
CivilRightsActof1964AgeDiscriminationActof1975• CivilRightsAct
• TitleVIpreventsdiscriminationbygovernmentagenciesthatreceivefederalfunding
• AgeDiscriminationAct• Doesnotcoveremploymentdiscrimination• LawstatesnopersonintheU.S.shall,onthebasisofage,beexcludedfromparticipationin,bedeniedthebenefitsof,orbesubjectedtodiscriminationunderanyprogramoractivityreceivingfederalfinancialassistance
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U.S.HHSTitle45CFRParts80,84,and91• Part80
• EffectuatestheprovisionsofTitleVIofCRAof1964• NopersonintheU.S.shallonthegroundsofrace,color,ornationaloriginbeexcludedfromparticipationin,bedeniedthebenefitsof,orbeotherwisesubjectedtodiscriminationunderanyprogramoractivityreceivingfederalfinancialassistanceforDHHS
• Part84• ReferstoSection504• Noqualifiedhandicappedpersonshall,onthebasisofhandicap,beexcludedfromparticipationin,bedeniedbenefitsof,orotherwisebesubjectedtodiscriminationunderanyprogramoractivitywhichreceivesbenefitsfromfederalfinancialassistance
• Part91• Prohibitsdiscriminationbasedonthebasisofageinprogramsoractivitiesreceivingfederalfinancialassistance
AffordableCareActSection1557• 2010‐ AffordableCareAct
• Prohibitsdiscriminationonthebasisofsexinhealthcare
• ExtendedtoallindividualsenrolledincoveragethroughtheHealthInsuranceMarketplacesandcertainotherhealthcoverageplans
• AllHHShealthprogramsarecoveredbythisrule
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ProposedLaw– 45CFRPart92
• PurposeistoimplementSection1557ofACA• Prohibitsdiscriminationonthebasisofrace,color,nationalorigin,sex,age,disabilityorassociationincertainhealthprogramsandactivities
• Individualsshallnotbeexcludedfrom,bedeniedthebenefitsof,orbesubjectedtodiscriminationunderanyhealthprogramoractivitythatisadministeredbytheExecutiveAgencyoranyentityestablishedunderTitleIoftheACA
PURPOSE&DEFINITIONS
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Purpose
•Mustbeabletoprovidepropercaretopatients
•Thelawswearediscussingtodayareintendedtoprovideallpatientswithmeaningfulaccesstoservices
DiscriminationTypesAffordableCareActandProposedRule• Race• Color• Nationalorigin• Sex• Age• Disability• Association
• Cannotdiscriminateagainstanindividualonthebasisofrace,color,nationalorigin,age,disability,orsexofanindividualwithwhomtheindividualisknownorbelievedtohavearelationshiporassociation
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DiscriminationTypesAffordableCareActandProposedRule• Disability
• Visuallyimpaired• Blind,lowvision
• Hearingimpaired• Deaf,hardofhearing
• LimitedEnglishProficiency(LEP)• IndividualwhoseprimarylanguageforcommunicationisnotEnglishandwhohaslimitedabilitytoread,write,speak,orunderstandEnglish
DiscriminationTypesAffordableCareActandProposedRule• Gender• GenderIdentity
• Individual’sinternalsenseofgender,whichmaybedifferentthanthatindividual’ssexassignedatbirth– transgender
• Thewayanindividualexpressesgenderidentityisfrequentlycalledgenderexpression
• Mayormaynotconformtosocialstereotypesassociatedwithgender
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DiscriminationTypes‐ Other
• Religion• MaritalStatus• SexualOrientation• Pregnancy
• Falsepregnancy• Terminationofpregnancy• Recoveryfromchildbirthorrelatedmedicalconditions
• GeneticInformation• Amnesty• Statusascoveredveterans
Non‐Discrimination– SampleStatement
• Thecoveredentitycannotdenybenefitsto,orotherwisediscriminateagainstanypersononanygroundsprohibitedbyfederal,stateorlocallawsonthebasisofrace,color,religion,nationalorigin,gender,genderidentity,sexualorientation,age,disability,maritalstatus,pregnancy,ancestry,geneticinformation,amnestyorveteranstatusinadmissionto,participationin,orreceiptoftheservicesandbenefitsunderanyofitsprogramsandactivities.
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ENFORCEMENT
EvaluationoftheComplaint• OfficeofCivilRights(OCR)carefullyreviewsallcomplaintsreceived
• TheentityidentifiedinthecomplaintmustbeunderOCR’sjurisdiction
• Thecomplaintmustallegeanaction,policyorprocedurecoveredbyrelevantlawsandregulationsprohibitingdiscrimination
• Thecomplaintmustbefiledwithin180daysfromwhenthecomplainantkneworshouldhaveknownoftheallegeddiscrimination
• Consentrequiredfromcomplainantswherethenamemustberevealedinordertoinvestigate• Casewillnotproceedifcomplainantrefusestoconsent
• Complainantmaybecontactedformoreinformationtodetermineifabovecriteriaaremet
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OCRwilldismissif….
• Nolegalauthority• Complaintfailstostateaviolationofthelaw• Complaintisnotfiledtimelyandwaivernotgranted• Complaintisunclearorincomplete
• 20daystosubmitmoreinfoifrequested• Allegationshavebeenresolved• Allegationsinvestigatedandresolvedbyanotheragency• Sameallegationshavebeenfiledbythecomplainantinstateorfederalcourt
• Allegationsareforeclosedbypreviousdecisions
InvestigationProcess
• CaseOpened• Notification
• Lettersofnotificationissuedtocomplainantandcoveredentity
• InformationGathered• OCRisneutralfact‐finder• Interviewwitnesses,includingthecomplainant• Obtaindocumentation• Sitevisitswhereappropriate
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DeterminationofFindings
• InsufficientevidencetosupportconclusionthatthecoveredentityfailedtocomplyOR
• Preponderanceofevidencesupportsrecipientfailedtocomply
• Lettersenttocomplainantandrecipientcontainsfactbasedfindings
Resolution– NonCompliance
• OCRcontactscoveredentitytonegotiatevoluntaryresolution• Writtenresolutionagreement• Describesremedialactiontoaddressareasofnon‐compliance• ImplementationmonitoredbyOCR
• Ifcoveredentityrefusestonegotiatevoluntaryresolution:• OCRinformsof30dayrequirementtoengageinnegotiations• LetterofFindingprovidingfactualandlegalbasisforfindingofnoncompliance
• Ifthecoveredentitycontinuestorefusenegotiations• OCRissuesLetterofImpendingEnforcement
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EnforcementActions
•Administrativeenforcementtosuspend,terminate,orrefusetograntorcontinuefederalfinancialassistancetotherecipient
•PossiblereferraltoDOJ•Maydeferanyneworadditionalfederalfinancialassistancetothecoveredentity
•Anissuemayoccurinonlyonecenter,butmayimpactALLcentersinportfolio
EnforcementExamples• March2013
• MDNursingHomeSettlementAgreement• Failuretoprovidesignlanguageinterpreterservicestoadeafpatient• 30monthenforcement– includedprovisionsforauxiliaryaids/services,training,outreach,advisorycommittee,monitoringandreporting
• August2015• 3deafresidentssueILnursinghome(civillawsuit)forfailuretoprovideinterpretersinorderto
communicatewithstaff,participateindailycare,orunderstandtreatmentsprovided• July2015
• VANursingHomeSettlementAgreement• Failuretoprovideauxiliaryaidsandservices• Failuretoprovideinterpreterstocommunicatewithresident’scompanionsregardingcare&treatment• 3yearenforcement‐ includedprovisionsforprovidingauxiliaryaids/servicesandinterpreters,designatedADAAdministrator,complaintresolutionprocess,training,notificationrequirements,periodiccompliancereports,monetaryfundtotrainotherVAfacilitiesonbestpractices,monetarycompensationtocomplainants
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HOWTOCOMPLY
HowtoComply
• Note:RecommendationsweareprovidingarebasedonourspecificexperienceandtheProposedAnti‐DiscriminationLaw
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CivilRightsComplianceElements
• Coordinator• Policies&Procedures• Postings• Training• IdentificationofServices• ProvisionofServices• InvestigationofGrievances•Monitoring
CivilRightsCoordinator
• DesignateaCivilRightsCoordinator• Corporate• Eachbusinesslocation
• ResponsibleforoversightoftheCivilRightsProgramelements
• Responsibleforinvestigatinggrievancesallegingnon‐compliance
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Policies&Procedures
• InadditiontoinformationinyourCodeofConduct,EmployeeHandbook,ResidentsRightsPolicyandotherstandardpolicies:
• DevelopwrittenpoliciestoaddressCivilRightsProgram• Non‐Discrimination• Grievanceprocess• CommunicationwithLEPPersons• ProcedureforAuxiliaryAids
Postings• NoticeofNon‐Discrimination
• CoveredEntity(CE)doesnotdiscriminate• CEprovidesappropriateauxiliaryaidsandservices
• IncludingQualifiedInterpretersandinformationinalternateformats• Freeofchargeandinatimelymanner
• CEprovideslanguageassistanceservices• Howtoobtainaidsandservices• Identificationofresponsibleemployeeandcontactinformation• Availabilityofgrievanceprocedure/howtofileagrievance• HowtofilediscriminationcomplaintwithOCR• Englishlanguageand15toplanguagetaglines
• Taglines:shortstatementsinnon‐Englishthatindicatetheavailabilityoflanguageassistanceservicesfreeofcharge
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RecommendedPostings
• AdditionalPostings• Recommended,butnotRequired
• SeparateCivilRightsGrievancePosting• ConfidentialDisclosureProgram(e.g.,hotline)
• Note:RecommendationsarebasedontheProposedAnti‐DiscriminationLaw
Training
•Whoshouldbetrained?• Allstaff
• Locationlevel• Corporatelevel
• Contractors(e.g.,physiciansandphysicianextenders)• Regularvolunteers(e.g.,weekly,monthly)thatarelikelytocomeincontactwithpatients
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Training
• Howtrained?• On‐Line• Classroom• CollectAcknowledgment• OtherMethods(e.g.,intranetpostings,corporatenewsletters)
• Frequency?• UponHire• Annually• Periodicasnecessary
Training– OtherResources
•DedicatedIntranetPage• Links
• HowtoarrangeforInterpreterServicesandLanguageAssistance• ReferenceGuides
• CueCardsandotherlanguageaids• FAQs• StateResources• TrainingInformation• CorporateCivilRightsContactInformation
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IdentificationofServices• Pre‐Admission
• Disabilitiesorcommunicationbarriersshouldbedocumentedinthepre‐admissionassessment• E.g.,hardofhearing,LEP,signlanguageneeds
• Admission• Admissionpacketincludesnoticeofnon‐discrimination• Documentpatient’sunderstandingofinterpreterservicesthatareavailablefreeofcharge• Documentuseoffamilymember,advocate,orfriendofresidentthathasbeendesignatedasaninterpreter• Documentmethodofcommunicationwithpatient’scompanion
• Designeetocommunicatewithstaffonpatient’sbehalf• Anypersonwithwhomstaffwouldnormallycommunicateregardingthepatient’scare,conditionortohelppatientactontheadvice,information,orinstructionsfromstaff
• Considerspecificadmissionform• Ongoing
• SpecificCarePlan• Monitorfornewormodifiedservices
ProvisionofServices‐ LEP• LanguageAssistanceRequirements
• Musttakereasonablestepstoensuremeaningfulaccessforthepatient• Mustbeprovidedfreeofcharge,beaccurateandtimely,andprotecttheprivacyoftheLEPindividual
• InterpreterServices• Telephonicorvideoremoteinterpreter(VRI)
• Arrangecontractinadvance• HIPAABusinessAssociate
• Ensurestafftrainedonaccesstovendor/system• On‐siteinterpreterortranslatorservices
• Arrangecontractinadvance• HIPAABusinessAssociate
• Ensurestafftrainedonprocessforarrangingservices
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QualifiedInterpreters‐ LEP
• Qualified Interpreters• On‐siteorthroughVideoRemoteInterpreting(VRI)• Abletointerpreteffectively,accurately,andimpartially,bothreceptivelyandexpressively,usinganynecessaryspecializedvocabularyOR
• Hasdemonstratedproficiencyin,andhasaboveaveragefamiliaritywithspeakingorunderstanding,bothspokenEnglishandatleastoneotherspokenlanguage• ForanLEPindividual,abletointerpreteffectively,accurately,andimpartially,bothreceptivelyandexpressively,toandfromsuchlanguageandEnglish,usinganynecessaryspecializedvocabulary
InterpreterOptions‐ LEP
• OtherOptions• Bi‐lingualstaff
• Consider24/7needsfortranslation• Backupmethodshouldbeavailable
• Familymembers/companions• ItemstoConsider
• Confidentialityconcerns• ShouldbeHIPAAdesignee
• Emotionalinvolvement• Otherfactorsthatmayadverselyimpactcommunication
• Ifused,documentinwriting
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InterpreterRestrictions‐ LEP• Acoveredentitymaynot:
• RequireanLEPtoprovideowninterpreter• RelyonanadultaccompanyinganLEPindividualtointerpretunless:
• Emergencyinvolvinganimminentthreattosafetyandwelfareofindividualandnoqualifiedinterpreterisavailable
• LEPindividualspecificallyrequestsaccompanyingadulttointerpret• Relyonminorchildtointerpretunless:
• Emergencyinvolvinganimminentthreattosafetyandwelfareofindividualandnoqualifiedinterpreterisavailable
• Note: AnLEPindividualisnot requiredtoacceptlanguageassistanceservices
ProvisionofServices– Deaf/HardofHearing
• Furnishappropriateauxiliaryaidsandservicestoensureeffectivecommunication• Personwithdisability• Companionswithdisabilities
• Qualifiedinterpreters(signlanguage)• On‐Site
• Arrangecontractinadvance• HIPAABusinessAssociate
• Ensurestafftrainedonprocessforarrangingservices• VideoRemoteInterpreting(VRI)
• Arrangecontractinadvance• HIPAABusinessAssociate
• Ensurestafftrainedonaccesstovendor/system
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AuxiliaryAids
• InterpreterServicesaren’ttheOnlyOption• AdditionalAidsandServicesAvailable• ItemstoConsider
• Whatisthepatientcomfortableusing?• Familymemberneeds• StaffEducationonobtainingservices• Ensureitemsavailableinadvance
AuxiliaryAidsandServicesHearingImpaired/LEP• Notetakers• Computer‐aidedtranscriptionservices•Writtenmaterials• Exchangeofwrittennotes• Telephonehandsetamplifiers• Assistivelisteningdevices• Telephonescompatiblewithhearingdevices• Closedcaptiondecoders
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AuxiliaryAidsandServicesHearingImpaired/LEP• Openandclosedcaptioning,includingreal‐timecaptioning• Voice,text,andvideo‐basedtelecommunicationproductsandsystems
• Texttelephones(TTYs),videophones,captionedtelephones• Videotextdisplays• Accessibleelectronicandinformationtechnology
• Telephones,informationkiosks,transactionmachines,internetsites,multimedia
AuxiliaryAidsandServicesVisuallyImpaired• Qualifiedreaders• Tapedtexts• Audiorecordings• Braillematerialsanddisplays• Magnificationsoftware• Opticalreaders• Secondaryauditoryprograms(SAP)• Largeprintmaterials• Accessibleelectronicandinformationtechnology
• Telephones,informationkiosks,transactionmachines,internetsites,multimedia
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ServiceAnimals
• Serviceanimalsreferstodogs• Reasonableaccessmustbeprovidedtotheresident
• Residentmustbeabletocarefortheanimal• Theresidentisresponsibleforanycostassociatedwiththeanimal’swellbeing
• Theanimalmustbecontrolled• Itisnotreasonabletoexpectstafftocarefortheanimalorforthecentertopayforveterinarianbills,animalfood,litterboxesandlitter,etc.
Monitoring
• MonitorCivilRightsProgramElements• InterviewCivilRightsCoordinatorandsampleofstaff
• Knowledgeofprogramrequirements• Howtoidentifyinterpreterorlanguageassistanceservices• Didyoureceiveanygrievances,howresolved?
• Checkfortraining– Employees,VendorsandVolunteers• Observeifrequiredpostingsareinplace• Reviewdocumentationatpre‐admission• Reviewadmissionpacketdocumentation– noticeofnon‐discrimination• Reviewsampledocumentationofinterpreterservicesdiscussion/formuponadmission
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OTHERRESOURCES
Resources
• OCRWebsite• http://www.hhs.gov/civil‐rights/index.html
• ADAWebsite• http://www.ada.gov/
• ContactInfo• SueSmithsue.smith@genesishcc.com• LauraLoftislaura.loftis@genesishcc.com
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QUESTIONS?