Transcript Addressing Health Disparities

Addressing Health Disparities
Through Civil Rights
Compliance and
Enforcement
September 19, 2012
Sarah Albrecht, J.D.
HHS Office for Civil Rights
U.S. Department of Health and Human Services – Office for Civil Rights
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Your Role in Ensuring
Civil Rights Compliance
• Recipients of Federal Financial Assistance
(FFA)
• Agency Program Staff
• Grant Management Staff
U.S. Department of Health and Human Services – Office for Civil Rights
2
HHS Office for Civil Rights (OCR)
What We Do & How We Do It
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Race, Color, or National Origin
• Title VI of the Civil Rights Act of 1964
Applies to all recipients of FFA
• Multiethnic Placement Act of 1994
(MEPA)
Applies to recipients of FFA who administer foster
care and adoption programs
• Hill-Burton Community Service
Assurance
Applies to recipients of Hill-Burton funds
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Race, Color, or National Origin
Avoiding National Origin Discrimination
Under Title VI
• Must take reasonable steps to provide meaningful
access to individuals who are limited English
proficient (LEP)
• Failure to provide meaningful access to individuals
who are LEP, such as through oral interpretation
and written translation, may constitute national
origin discrimination
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of National Origin
Ensuring Compliance with Respect to LEP Persons
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of National Origin
Ensuring Compliance with Respect to LEP Persons
Strategies to ensure compliance:
• Maintain written policies and procedures on providing language
assistance services
• Assess language needs of the service area
• Maintain data on the primary language of each LEP person served
and the type of language assistance provided
• Notify LEP persons in the service area in their native languages of
the right to language assistance at no cost
• Ensure competency, quality and accuracy of language services
• Offer language services even if a person brings a family member,
friend, or child to interpret
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of National Origin
Ensuring Compliance with Respect to LEP Persons
Four factors to consider to determine the
reasonable steps needed for meaningful access:
• Number of LEP persons likely to be served or
affected
• Frequency of contact
• Nature and importance of the program
• Costs and resources
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of National Origin
Immigration Status Inquiries
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of National Origin
Ensuring Equal Access for All Children
Applications and processes to determine
a child’s eligibility:
• Should focus exclusively on the criteria to determine
the child’s eligibility
• Should identify and differentiate between “applicants”
and “non-applicants” early in the process to clarify
which questions pertain to the applicant child
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Race, Color, or National Origin
MEPA Prohibits:
Recipients of federal financial assistance (FFA)
from using race, color, or national origin as a
basis:
• to deny any person the opportunity to
become an adoptive or foster parent, or
• to delay or deny any child’s adoptive or foster
home placement
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Race, Color, or National Origin
U.S. Department of Health and Human Services – Office for Civil Rights
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Race, Color, or National Origin
Ensuring Compliance
• Develop and implement policies and procedures prohibiting:
– The use of race, color, or national origin in making adoption
decisions
– The use of culture as a proxy for race or national origin
– The different treatment of families who are willing to adopt or
foster a child of a different race, color, or national origin
• Do not collect and act on birth parents’ preferences
concerning the race, color, or national origin of adoptive
parents
• Document the reasons a family was considered more
appropriate to adopt a child
U.S. Department of Health and Human Services – Office for Civil Rights
13
Non-Discrimination on the Basis of Race, Color,
National Origin, Creed, and Other Bases
Hill-Burton Community Service Assurance
Prohibits facilities receiving federal financial assistance under
Title VI or Title XVI of the Public Health Service Act from
discriminating on the basis of:
• race, color, national origin,
• creed, or
• any basis unrelated to the need for the service or the
facility’s ability to provide the service
Distinct from the Hill-Burton uncompensated care provision
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Race, Color, or National Origin
Key Take Away Points:
Race, Color, or National Origin
• Title VI
– Reasonable steps to provide meaningful access
– Discriminatory effects of questions about immigration
status of non-applicants
• MEPA
– Applies to foster care and adoption
• Hill-Burton Community Service Assurance
– Applies to recipients of Hill-Burton funding
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Disability
• Section 504 of the Rehabilitation Act of 1973
– Applies to recipients of FFA
• Title II of the Americans with Disabilities Act
(ADA)
– Applies to public entities, including those that do not
receive FFA
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Disability
Discriminatory Prohibitions:
• Exclude or deny benefits based on an individual’s
disability
• Provide separate or different benefits to individuals
with disabilities, unless it is necessary to ensure that
the benefits and services are equally effective
• Establish eligibility criteria that screen out, or tend to
screen out, individuals with disabilities, unless the
criteria are necessary to meet the program objectives
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Disability
Obligations:
• Ensure that programs are accessible
• Make reasonable modifications, unless it would result in
a fundamental alteration in their program or activity
• Provide services and programs in the most integrated
setting
• Provide auxiliary aids and services, at no cost, where
necessary to ensure effective communication
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Equal Opportunity to Receive Services
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Equal Opportunity to Receive Services
• Definition of disability is broad and includes
HIV status
• Prohibited actions include excluding
participation in a program and denying
services to an individual with a disability
based on the disability
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Program Accessibility
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Program Accessibility
Under Section 504 and Title II of the ADA:
• Must make programs accessible
2010 ADA Standards for Accessible Design
• Set minimum requirements for newly
designed and constructed or altered state and
local government facilities
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Live in the Most Integrated Setting
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Live in the Most Integrated Setting
Under Section 504 and Title II of the ADA:
• Make reasonable modifications unless it would
result in a fundamental alteration
• Must provide services in the most integrated
setting
–Enables interaction with nondisabled persons to
the fullest extent possible
–Prevents unnecessary institutionalization
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Auxiliary Aids and Services
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Disability
Auxiliary Aids and Services
Under Section 504 and Title II of the ADA:
• Must provide auxiliary aids and services unless it
would fundamentally alter the program or result
in undue financial and administrative burden
Considerations for Auxiliary Aids and Services:
• Make an individualized determination based on
needs, circumstances, and preferences
• Provide at no cost
• Refrain from asking a family member, friend, or
child to interpret
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Disability
Key Take Away Points:
• Section 504 and Title II of the ADA
• Definition of disability is broad
Must not:
• Exclude or deny
• Provide different or separate programs
• Use eligibility criteria that screen out persons with disabilities
Must:
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Make programs accessible
Make reasonable modifications
Provide services in the most integrated setting
Provide auxiliary aids and services
U.S. Department of Health and Human Services – Office for Civil Rights
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Lack of Effective Communication
Impacts Outcomes
Effective communication is critical for safe, quality
services.
• Consequences for Individuals:
– Denial of needed benefits
– Delay in delivery
– Wrong benefits or services
– Ineffective or less effective services
• Consequences for Providers:
– Inferior Quality
– Potential Liability
– Increased Costs and Inefficiencies
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Age
The Age Discrimination Act of 1975
• Prohibits recipients of FFA from discriminating
on the basis of age in their programs and
activities
• Use of age must be necessary to normal
program operations or to achieve a statutory
objective
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Age
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Age
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Sex
Title IX of the Education Amendments of 1972
• Prohibits recipients of FFA from discriminating on
the basis of sex in education programs and
activities
Comprehensive Health Manpower Training
Act and the Nurse Training Act
• Program-specific laws administered by HRSA
• Prohibit sex discrimination in health training
schools and centers that receive FFA and operate
academic or other training programs or activities
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the
Basis of Sex
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of Sex
Ensuring Compliance
Strategies to ensure compliance:
• Use gender-neutral language in eligibility
criteria
• Include a nondiscrimination policy in program
materials
• Conduct outreach and recruitment in a
manner that is accessible to all persons
regardless of gender
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Religious or Moral Objections
Federal Health Care Provider Conscience
Protection Statutes
• Church Amendments
• Section 245 of the Public Health Service Act
• Weldon Amendment
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on the Basis of
Religious or Moral Objections
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination Provisions
In the Affordable Care Act (ACA)
Section 1553 of the Affordable Care Act
Prohibits discrimination against individuals or
institutional health care entities that do not provide
assisted suicide services
Section 1557 of the Affordable Care Act
Prohibits discrimination in federally assisted and
some federally conducted health programs and
activities and program and activities administered
by entities created under Title I of the ACA
U.S. Department of Health and Human Services – Office for Civil Rights
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Non-Discrimination on Multiple Bases in
Program-Specific Laws
Some program laws prohibit discrimination on the basis of
age, race, color, national origin, disability, sex, or religion
•Maternal and Child Health Services Block Grant (HRSA)
•Projects for Assistance in Transition from Homelessness (SAMHSA)
•Substance Abuse Prevention and Treatment Block Grant (SAMHSA)
•Community Mental Health Services Block Grant (SAMHSA)
•Preventive Health and Health Services Block Grant (CDC)
•Community Services Block Grant (ACF)
•Low-Income Home Energy Assistance Program (ACF)
•Family Violence Prevention and Services Act (ACF)
U.S. Department of Health and Human Services – Office for Civil Rights
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Ensuring Compliance with Civil Rights Laws
Strategies for recipients of FFA:
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Maintain written policies and procedures on ensuring
nondiscrimination and responding to complaints
Identify a coordinator of the recipient’s compliance
efforts
Develop and post nondiscrimination policy.
Ensure effective communication with persons who are
LEP or have disabilities
Notify LEP persons in the service area of the right to
language assistance at no cost.
Train supervisors and staff
U.S. Department of Health and Human Services – Office for Civil Rights
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Opportunities to Promote
Civil Rights Compliance
Agency Program Staff
• Incorporate civil rights in program oversight
materials
• Identify when recipients need technical
assistance
Grant Management Staff
Include civil rights information in:
• Funding announcements
• Materials on grant requirements
• Outreach materials on HHS grant opportunities
U.S. Department of Health and Human Services – Office for Civil Rights
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Technical Assistance
OCR Regional Offices
• Provide technical
assistance
• Receive reports of
noncompliant programs
or activities
For more information, contact us: 1-800-368-1019, [email protected]
Visit http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html
U.S. Department of Health and Human Services – Office for Civil Rights
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Resources Are Available
Useful Links and Documents
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HHS Office for Civil Rights information and tools, http://www.hhs.gov/ocr/
OCR Fact Sheets, http://www.hhs.gov/ocr/civilrights/resources/factsheets/index.html
OCR Compliance Activities,
http://www.hhs.gov/ocr/civilrights/resources/specialtopics/hospitalcommunication/heccomplianceacti
vities.html
HHS LEP Guidance (2003),
http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/hhslepguidancepdf.pdf
Tri-Agency Guidance,
http://www.hhs.gov/ocr/civilrights/resources/specialtopics/origin/policyguidanceregardinginquiriesinto
citizenshipimmigrationstatus.html
ADA Standards for Accessible Design (2010),
http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#designconstruction
DOJ Language Access Assessment and Planning Tool,
http://www.lep.gov/resources/2011_Language_Access_Assessment_and_Planning_Tool.pdf
Federal Interagency Working Group on LEP, http://www.lep.gov
National Standards on Culturally and Linguistically Appropriate Services (CLAS),
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15
DOJ Guidance: Accessibility of State and Local Government Websites
to People with Disabilities, http://www.ada.gov/websites2.htm
Web Content Accessibility Guidelines 2.0, http://www.w3.org/TR/WCAG/
U.S. Department of Health and Human Services – Office for Civil Rights
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