A Federal Overview of Civil Rights Compliance for Grantees Working together to improve ACCESS
Maria White, MA Senior Civil Rights Analyst U.S. Department of Health and Human Services Health Resources and Services Administration Office of Equal Opportunity, Civil Rights and Diversity Management
Participants can expect an overview of patient rights as applied to … • Title VI of the Civil Rights Act of 1964. • Executive Order 13166 a guidance document that enables participants to have meaningful access to federal funded and conducted programs. • Section 504 of the Rehabilitation Act of 1973 . • Americans with Disabilities Act of 1990 . • R Resources th thatt addresses dd h health lth lit literacy, cultural lt l competency, t limited English proficiency and how to file a complaint.
The Law: Title VI of the Civil Rights Act
No person in the United States shall, on the grounds of race, race color or national origin, be excluded from participation in, be de denied ed the e be benefits e so of,, o or be subjec subjected ed to discrimination under any program or activity receiving Federal financial assistance. Section 601 of the Title VI of the Civil Rights Act of 1964 42 U.S.C. Section 2000d et. seq. 3
Race, Color, National Origin Title VI addresses three bases:
• Race Race, • Color and • National Origin . 4
F2F Health Information Centers May Not: • Deny services, financial aid, or other benefits they provide • Provide a different service, financial aid or other b benefit, fit or provide id th them iin a diff differentt manner ffrom those provided to others under the program • Segregate or separately treat individuals in any matter related to the receipt of any service, fi financial i l aid, id or other th b benefit fit
“Breaking g Down the Language g g Barrier: Translating g Limited English Proficiency Policy Into Practice”
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Who Is a Limited English Proficient (LEP) Individual? • An individual who does not speak English as th i primary their i llanguage. • An individual who has a limited ability to read, write, it speak, k or understand d t dE English li h may b be limited English proficient, or “LEP”. • An individual may be eligible to receive language assistance with respect to a particular type of service, benefit, or encounter.
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The Heart of the Matter: Use Effective Practices for Title VI Compliance
Apply the four factor test to decide what steps to take to provide meaningful i f l access tto th the recipient’s p various services, access points, documents, etc. 8
Four Factor Analysis
An Analytical Framework to Best Comply with the Revised HHS LEP Guidance
1) Number and proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee;
2) Frequency with which LEP individuals come in contact with the program; p g ; 3) The nature and importance of the program , activity or service provided by the program to people served; 4) Cost and resources available to the grantee/recipient . 9
Applying the 4- Factors: Examples o Significant number: F2F HIC clinics may need immediately available oral interpreters p ((trained Bilingual g staff). ) o Moderate population: F2F HIC providers may want to have interpreters under contract or use a telephone service. o A F2F HIC in a rural area with a few LEP families: may want to use a telephone service.
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Two Types of Language Assistance ¾ Oral interpretation: p either in p person or via telephone interpretation service. ¾ Written translation: can range from translation of entire document to translation of a short description of a document document.
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Types of Vital Written Documents • • • • • • •
Paper and electronic documents such as publications, notices,
correspondence, web sites, and signs
Informed consent Complaint forms Intake forms that may have clinical consequences Notices of eligibility criteria for, rights in, denial or loss of, or d decreases iin b benefits fit or services i Notices advising LEP persons of free language assistance programs or services Applications to participate in a hospital program or activity or to receive hospital benefits or services
Interpreter Competency The F2F HIC should take reasonable steps to assess that the interpreter is able to:
9Demonstrate proficiency in both English and in the other language. 9D 9Demonstrate t t kknowledge l d off specialized i li d tterms or concepts appropriate to the need. 9Demonstrate an understanding of the need for confidentiality and impartiality. p without 9Understand the role of interpreter deviating to other roles. 13
Selecting Language Assistance Services Options for Oral Language Services: ¾ Trained Bilingual Staff, ¾ Staff Interpreters, ¾ Contractors, ¾ Telephone Lines & Video Teleconferencing, ¾ Trained Community Volunteers.
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Use of Family Members or Friends: Special Concerns Providers should respect LEP Persons’ desire to use an interpreter of their own choosing instead of free language assistance expressly offered by the recipient, subject to:
o Issues of competence, appropriateness, conflicts of interests, and confidentiality. o Heightened caution when a LEP person asks a minor child to serve as an interpreter. 15
Other Considerations When Title VI of the Civil Rights Act and its implementing regulations recommends that language services be provided, recipients should: – Inform the LEP person that interpreter can be provided at no cost cost. –
Not require LEP persons to provide own interpreter.
–
Not plan to rely on family members or friends as interpreters.
–
Evaluate whether, because of special concerns, interpreter should be provided in any case.
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Laws Protecting Persons with Disabilities • Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by recipients of Federal financial assistance. • The Americans with Disabilities Act of 1990 prohibits discrimination on the basis of disability by covered entities. • Title II applies to public entities entities. • Title III applies to places of public accommodation. 17
Definitions • Handicap/disability • Physical or mental impairment to a body system that substantially limits one or more major life activities activities.
• Individual with a Disability
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Definitions (continued) ( ) • A person who has an impairment. • person using a wheelchair • A person who has a history of an impairment. • person who has had cancer • A person who is viewed by the recipient to have an impairment. • person with a facial disfigurement • Person who is associated with an individual who has a disability . 19
Obligations Under Both Statutes • Ensure persons with disabilities are not segregated . • Ensure they have equal opportunity to benefit from services. • Provide accommodations or modifications to afford equal access through the use of auxiliary aids. aids • Facilities where services are located must be accessible. 20
For Persons with Sensory Impairments •
These laws prohibit discrimination on the basis of disability and require grantees to ensure effective communication with individuals who are deaf or hard of hearing.
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Grantees G t mustt provide id auxiliary ili aids id and d services i where necessary to avoid discrimination and may not charge for the auxiliary aid or service.
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Grantees do not need to provide an auxiliary aid or service if to do so would fundamentally alter the nature of the program or result in an undue financial and administrative burden.
Auxiliaryy Aids • Effective Communication: • assessing the communication needs of deaf and hard of hearing individuals; • range g of auxiliary y aids: • writing notes, • Communication Access Real-Time Translation (CART), (CART) • lip reading for hard of hearing individuals, • Interpreters, • video interpreting, • NOT family members.
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Other Auxiliaryy Aids • For Visually y Impaired p Individuals: • Note takers, Readers, • Readers • Printed materials in alternative media: ed a • Braille and • Large print.
Rx for Prospective Applicants:
Take HRSA’s Unified Health Communication Web Course!
First Training Program to Integrate Health Literacy Literacy, Limited English Proficiency and Cultural Competency 30
www.hrsa.gov/health literacy 31
AHRQ Health Literacy Universal Precautions Toolkit • • • • •
Offers primary care practices a way to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific areas. Universal precautions refers to taking specific actions that minimize risk for everyone when it is unclear which patients may be affected. Research suggests that clear communication practices and removing literacyrelated barriers will improve care for all patients, regardless of their level of h lth literacy. health lit Toolkit is designed to help providers ensure that systems are in place to promote better understanding by all patients, Toolkit contains: • • • •
Quick Start Guide. Path to Improvement (6 steps to take to implement the toolkit). 20 Tools (2-5 pages each). Over 25 resources such as sample forms, PowerPoint presentations, and worksheets. k h t
http://www.ahrq.gov/qual/literacy/
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New Free CDC Web Course:
Health Literacy for Public Health Professionals (Continuing Education Credits) • Why take this training? As a health professional professional, you want to • Communicate clearly with the populations you serve. • Communicate in a way that is easy to understand and is culturally appropriate. • Help others understand vital health information. • This training will … • Teach essential information about health literacy to improve your effectiveness in communicating with and educating others. • Give you practical strategies, tools, and resources that you can pp y in yyour p public health p practice. apply www.cdc.gov/healthmarketing/healthliteracy/training
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How to File a Complaint If you feel a health care provider, or state or local government agency, has discriminated against you (or someone else) based on race, national origin, disability, or age, you may file a civil rights complaint. OCR can investigate disability-based discrimination complaints against programs operated by HHS. Under certain statutes and regulations, OCR also has limited authority to investigate complaints of discrimination based on sex and religion. Anyone can file a complaint and the complaint requirements must be followed: 1) Be filed in writing, either on paper or electronically, by mail, fax, or e-mail; 2)) Name the healthcare or social service provider involved,, and describe the acts or omissions, you believed violated the civil rights laws or regulations; and 3) Be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show "good cause."
Submitting a Complaint To submit a complaint to OCR, please use one of the following methods. •
•
•
If you mail or fax the complaint, be sure to send it to the appropriate OCR regional office based on where the alleged violation o at o too took p place. ace OCR has ten regional offices, and each regional office covers specific states. Send your complaint to the attention of the OCR Regional g Manager. g
You do not need to sign the complaint and consent forms when you submit them by email because submission by email p yyour signature. g represents
Peter Chan
Michael Carter
Regional Manager, Region I
Regional Manager, Region II
Department of Health and Human Services Office for Civil Rights J.F. Kennedy Federal Building – Room 1875 Boston, MA 02203 Kansas City, MO 64106
Department of Health and Human Services Office for Civil Rights Jacob Javits Federal Building 26 Federal Plaza – Suite 3312 New York, NY 10278
Main Line 617-565-1340 FAX 617-565-3809 TDD 617-565-1343 www.hhs.gov/ocr
Main Line 212-264-3313 FAX 212-264-3039 TDD 212-264-2355 www.hhs.gov/ocr
Paul Cushing
Roosevelt Freeman
Regional Manager, Region III
Regional Manager, Region IV
Department of Health and Human Services Office for Civil Rights 601 East 12th Street – Room 248 Kansas City, MO 64106
Department of Health and Human Services Office for Civil Rights Atlanta Federal Center, Suite 3B70 61 Forsyth Street, S.W. Atlanta, GA 30303-8909
Main Line 215-861-4441 FAX 215-861-4431 TDD 215-861-4440 www.hhs.gov/ocr
Main Line 404-562-7886 FAX 404-562-7881 TDD 404-331-2867 www.hhs.gov/ocr
Valerie Morgan-alston
Ralph Rouse
Regional Manager, Region V
Regional Manager, Region VI
Department of Health and Human Services Office for Civil Rights 233 N. Michigan Ave., Suite 240 Chicago, IL 60601
Department of Health and Human Services Office for Civil Rights 1301 Young Street, Suite 1169 Dallas, TX 75202
Main Line 312-886-2359 FAX 312-886-1807 TDD 312-353-5693
Main Line 214-767-4056 FAX 214-767-0432 TDD 214-767-8940
www.hhs.gov/ocr
www.hhs.gov/ocr
Frank Campbell
Velveta Howell
Regional Manager, Region VII
Regional Manager, Region VIII
Department of Health and Human Services Office for Civil Rights 601 East 12th Street – Room 248 Kansas City, MO 64106
Department of Health and Human Services Office for Civil Rights 1961 Stout Street, Suite 1426 Denver, Colorado 80294
Main Line 816-426-7277 FAX 816-426-3686 TDD 816-426-7065
Main Line 303-844-2024 FAX 303-844-2025 TDD 303-844-3439
www.hhs.gov/ocr
www.hhs.gov/ocr
Michael Kruley
Linda Yuu Connor
Regional Manager, Region IX
Regional Manager, Region VIII
Department of Health and Human Services Office for Civil Rights 90 7th Street, Suite 4-100 San Francisco, CA 94103
Department of Health and Human Services Office for Civil Rights 2201 Sixth Avenue – M/S: RX-11 Seattle, WA 98121-1831
Main Line 415-437-8310 FAX 415-437-8329 TDD 415-437-8311
Main Line 206-615-2290 FAX 206-615-2297 TDD 206-615-2296
www.hhs.gov/ocr
www.hhs.gov/ocr
Helpful Federal Websites Cultural Competence Effective health communication is as important to health care as clinical skill. To improve individual health and build healthy communities, health care providers need to recognize and address the unique culture, language and health literacy of diverse consumers and communities. http://www.hrsa.gov/culturalcompetence Civil Rights Civil Rights help to protect you from unfair treatment or discrimination, because of your race, color, national origin, disability, age, sex (gender), or religion www hhs gov/ocr religion.www.hhs.gov/ocr Disability Information Disability.gov is an award-winning federal government website that provides an interactive, community-driven information network of disability-related programs, services, laws and benefits. Through the site, Americans with disabilities, their families, Veterans, educators, employers and many others are connected to thousands of resources from federal, state and local government agencies, educational institutions and non-profit organizations. www.disability.gov
Helpful Federal Websites Health Literacy Unified Health Communication (UHC): Addressing Health Literacy, Cultural Competency, and Limited English Proficiency is free, on-line, go-at-your-ownpace training that has helped more than 4,000 health care professionals and students improve patient-provider communication. http://www.hrsa.gov/healthliteracy Limited English Proficiency LEP.gov promotes a positive and cooperative understanding of the importance of language access to federally conducted and federally assisted programs. This site also acts as a clearinghouse, providing and linking to information, tools, and technical assistance regarding limited English proficiency and language services for federal agencies, recipients of federal funds, users of federal programs and federally assisted programs, and other stakeholders. http://www.lEP.GOV Social Security S S Administration A General Information in multiple languages for use. http://www.ssa.gov/multilanguage/
Helpful NonNon-Federal Websites CommonWEALTH FUnD aims to promote a high performing health care system that achieves better access, access improved quality quality, and greater efficiency efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. http://www.CMWF.ORG Cross Cultural Health Care Program helps ensure underserved communities RECEIVE full access to quality health care that is culturally and linguistically appropriate. http://www.xculture.org/ Cultured MED Provides Cultural Awareness Information About HealthCare for Refugees and Immigrants. http://culturedmed.binghamton.edu/
Helpful NonNon-Federal Websites DIVERSITY RX Improves the accessibility and quality of health care for minority, immigrant and indigenous communities immigrant, communities. http://www.diversityrx.org/ http //www diversityrx org/ Grantmakers Concerned with Immigrants and Refugees addresses the needs of the country's country s growing and increasingly diverse immigrant and Refugee populations. http://www.gcir.org/ Hablamos Juntos Develops affordable models for health care organization to offer language services by funding ten demonstration sites in regions with new and fast-growing Latino populations. http://www.hablamosjuntos.org/
Helpful NonNon-Federal Websites JoinT Commission The Joint Commission, with funding from The Commonwealth Fund, developed the Roadmap for Hospitals in collaboration with the National Health Law Program. The Roadmap for Hospitals provides recommendations to inspire hospitals to address unique patient needs and comply with new standards for patient-centered communication and existing Joint C Commission requirements. Example E practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools are also included. http://www.jointcommission.org/joint_commission_publishes_new_guide_for_ad vancing_patient-centered_care/
Additional Information Maria E. White, MA Senior Civil Rights Analyst Department of Health and Human Services Health Resources and Services Administration O Office OF Equal E Opportunity, O t t Civil C R Rights t & Diversity D t M Management t
5600 Fishers Lane, 6-105 Rockville, Maryland 20857 Main Line 301-443-5636 FAX 301-443-7898 TDD 1-800-552-7724 www.hrsa.gov
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