Department of Health & Human Services Updates
Department of Health & Human Services Updates
Fall 2016 Newsletter
- Department of Health and Human Services and Department of Justice Issue Joint Guidance on Child Welfare and Title VI
- Departments of Justice, Homeland Security, Health and Human Services, Housing and Urban Development and Transportation Issue Guidance on Title VI Protections in Emergency Preparedness, Response and Recovery
- Department of Health and Human Services’ Office for Civil Rights Issues National HIV/AIDS Compliance Review Report to Strengthen Civil Rights and Health Information Privacy for People Living with HIV/AIDS
On October 19, DOJ and HHS issued joint guidance (go.usa.gov/xkGD3) to state and local child welfare agencies and courts on the requirements of Title VI and its implementing regulations. Data shows that particular racial and ethnic groups are overrepresented in the child welfare system compared to their numbers in the general population. The guidance provides an overview of Title VI and Frequently Asked Questions on how Title VI applies to child welfare programs and activities, including investigations, assessments, guardianship, removal of children from their homes, reunification, case planning, adoption, and foster care and family court hearings.
The guidance addresses race and language access complaints that the Departments have received. These complaints have alleged unnecessary removal of children from their biological families; biological parents being denied equal access to culturally competent reunification services; denial of relative or kinship placements; unnecessarily long stays in foster care; and family members being denied full and informed participation in family courts and social services because of limited English proficiency. The guidance highlights the clear need for frank and productive discussion about how child welfare laws, policies, practices and implicit bias affect communities of color. The guidance is part of an ongoing partnership between the Departments to help child welfare agencies protect the well-being of children and ensure compliance with federal nondiscrimination laws. The press release can be found here (go.usa.gov/xkGjY).
Departments of Justice, Homeland Security, Health and Human Services, Housing and Urban Development and Transportation Issue Guidance on Title VI Protections in Emergency Preparedness, Response and Recovery:
On August 16, the Departments of Justice, Homeland Security, Health and Human Services, Housing and Urban Development, and Transportation issued joint agency guidance, Guidance to State and Local Governments and Other Federally Assisted Recipients Engaged in Emergency Preparedness, Response, Mitigation, and Recovery Activities on Compliance with Title VI of the Civil Rights Act of 1964 (go.usa.gov/xkGW5) (en Español - go.usa.gov/xkGZ3, Tiếng Việt - go.usa.gov/xkGZw, Kreyòl Ayisyen - go.usa.gov/xkGZS), to recipients of federal financial assistance on the nondiscrimination protections of Title VI in emergency and disaster preparedness, response, and recovery.
The guidance provides an overview of the application of Title VI in emergency and disaster management and examples of promising practices that recipients of federal financial assistance can take now, in advance of emergencies and disasters, to ensure Title VI compliance. Notably, the guidance emphasizes that Title VI obligations and protections cannot be waived during emergencies and disasters. Although every emergency or disaster situation will be different and pose its own set of unique challenges, effective planning can help avoid Title VI violations. The guidance highlights that preparation for exigent circumstances, including addressing meaningful access to services and benefits by limited English proficient communities can often make all the difference in preserving the lives of first-responders and the people they help.
Two new resources to assist recipients of federal financial assistance also accompany the guidance: the Department of Justice’s Tips and Tools for Reaching Limited English Proficient Communities in Emergency Preparedness, Response and Recovery (go.usa.gov/xkGBs) and the Department of Health and Human Services’ Checklist for Recipients of Federal Financial Assistance (go.usa.gov/xkGBJ), which facilitates the integration of the whole community into emergency-related activities. The press release announcing the guidance and accompanying materials can be found here (go.usa.gov/xkGKj).
Department of Health and Human Services’ Office for Civil Rights Issues National HIV/AIDS Compliance Review Report to Strengthen Civil Rights and Health Information Privacy for People Living with HIV/AIDS:
On July 12, the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) issued a report on its National HIV/AIDS Compliance Review Initiative. The Initiative began in 2014, when HHS OCR conducted coordinated compliance reviews at twelve hospitals – one hospital in each of the twelve cities most impacted by HIV/AIDS: Atlanta, GA; Baltimore, MD; Chicago, IL; Dallas, TX; Houston, TX; Los Angeles, CA; Miami, FL; New York City, NY; Philadelphia, PA; San Francisco, CA; San Juan, PR; and Washington, D.C. The compliance reviews examined the ways in which each hospital ensures: (1) equal access for HIV-positive individuals to programs and services, in compliance with Section 504 of the Rehabilitation Act of 1973; (2) meaningful access for limited English proficient (LEP) individuals in compliance with Title VI of the Civil Rights Act of 1964; and (3) the privacy and security of individuals’ health information and their rights with regard to that information, in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The report emphasizes that, pursuant to Title VI and Section 1557 of the Affordable Care Act, hospitals and other health care providers (“covered entities”) must:
- Adopt and post Notices and Nondiscrimination Statements which explain that the covered entity does not discriminate on the basis of race, color, national origin, sex, age, or disability, including HIV status;
- Designate Civil Rights Coordinators to establish and implement grievance procedures for patients and consumers;
- Provide auxiliary aids and services to ensure effective communication for individuals with disabilities;
- Take reasonable steps to provide meaningful access to each LEP individual eligible to be served or likely to be encountered in the covered entity’s health programs or activities. Reasonable steps may include: (1) the provision of qualified interpreters to LEP individuals when oral interpretation is required to provide meaningful access; and (2) the provision of qualified translators to translate written documents or web content.
- Ensure that such language assistance services are provided free of charge, are accurate and timely, and protect the privacy and independence of LEP individuals. Covered entities, with limited exceptions, are prohibited from allowing children, family members or friends of the patient to serve as interpreters.
Spring 2016 Newsletter updates
- HHS Office for Civil Rights Publishes Blog Post on Language Access in Health Care
- HHS Health Resources and Services Administration Completes Milestone Training Initiative
- HHS Office for Civil Rights Issues Notice of Proposed Rulemaking to Implement Civil Rights Regulations for the Affordable Care Act
- HHS OCR Launches Redesigned Website
HHS Office for Civil Rights Publishes Blog Post on Language Access in Health Care:
In December, the Department of Health and Human Services Office for Civil Rights (HHS OCR) published a blog post highlighting ways in which the agency is helping to improve access to health care coverage and services for LEP individuals (go.usa.gov/cub4m). As part of the 2015 Open Enrollment period of the Health Insurance Marketplaces, HHS participated in the “LEP Week of Action,” a weeklong HHS campaign to promote language access across the Department and to share in-language resources with community partners who work closely with LEP populations.
In September 2015, HHS Health Resources and Services Administration (HRSA), Office of Equal Opportunity, Civil Rights, and Diversity Management in partnership with HHS OCR concluded a three-year English and Spanish training initiative entitled “Addressing Health Disparities through Civil Rights Compliance and Enforcement.” This training initiative offered guidance to more than 1,750 federal and non-federal entities of their crucial role in addressing discriminatory effects that create serious inequities in health and access to care. Trainees collectively spent more than 4,500 hours learning about their civil rights obligations through web-based trainings. HRSA is in the process of developing additional non-discrimination technical assistance for its 3,000 grantees, many of whom provide direct health services to the public.
In September 2015, HHS OCR issued a Notice of Proposed Rulemaking to implement Section 1557. Section 1557 is the civil rights provision of the Affordable Care Act and prohibits discrimination on the grounds of race, color, national origin, sex, age, or disability in certain health programs and activities, including all health programs and activities that receive federal financial assistance from any Executive agency. The comment period ended November 9. HHS OCR is currently reviewing comments and drafting the final rule, which will be published in 2016. Section 1557 extends nondiscrimination protections to individuals enrolled in coverage plans through the Health Insurance Marketplaces andcertain other health coverage plans, and provides that HHS’s health programs are covered by the rule. The proposed rule would enhance language assistance for LEP individuals and require covered entities to provide notice of the availability of language assistance services in 15 languages.
For more information, see go.usa.gov/cnRqF.
HHS OCR has launched a redesign of its website (www.hhs.gov/ocr). The new site boasts improved search functionality, improved content layout, mobile platform optimization, and a streamlined process for online complaint submission.
Summer 2015 Newsletter updates
- HHS Resolves Complaints of National Origin Discrimination Against Arizona State Agencies Responsible for Distributing Federal Benefits
- HHS Office of Minority Health (OMH) Releases The Guide to Providing Effective Communication and Language Assistance Services
- HHS Office of Minority Health (OMH) Releases an Updated E-Learning Course, Entitled Culturally Competent Nursing Care: A Cornerstone of Caring
HHS Resolves Complaints of National Origin Discrimination Against Arizona State Agencies Responsible for Distributing Federal Benefits:
The Department of Health and Human Services Office for Civil Rights has entered into a voluntary resolution agreement with two Arizona State agencies: the Arizona Health Care Cost Containment System (AHCCCS) and the Arizona Department of Economic Security (DES), which are responsible for administration of Medicaid, CHIP, and TANF. The agreement resolves national origin discrimination issues under Title VI resulting from the way AHCCCS and DES implemented an Arizona law requiring State employees to report persons discovered to be unlawfully present in the United States to the U.S. Immigration and Customs Enforcement. This agreement specifically addresses circumstances where immigrants seek public benefits for themselves, on behalf of an eligible child, or on behalf of other eligible persons living in a mixed U.S. citizen/immigrant family or household. AHCCCS and DES have agreed to do the following: adopt and implement OCR-approved policies and procedures providing nondiscriminatory access to public benefits; utilize public benefits applications that reduce obstacles to those seeking public benefits; provide outreach on available public benefits; and conduct staff training. The agreement and press bulletin is on the OCR website at go.usa.gov/3629C.
HHS Office of Minority Health (OMH) Releases The Guide to Providing Effective Communication and Language Assistance Services:
On June 30, OMH released a tool to help health and health care organizations facilitate communication with culturally and linguistically diverse populations, including limited English proficient individuals. The Guide covers strategies for communicating in a way that considers the cultural, health literacy, and language needs of patients and their families. It is designed for health care providers, administrators, and executives who work across a broad spectrum of health care organizations. The Guide consists of two parts:
- Information on planning, implementing, and evaluating effective communication and language assistance services for health care administrators.
- Information on cross-cultural communication skills, working with an interpreter, and more for health care providers (or those providing direct care and services).
Updated with guidance on health and health care organizations’ responsibilities under Title VI and Section 1557 of the Affordable Care Act, this Guide is a revision and replacement of HHS OMH’s previous communication-related e-resource, A Patient-Centered Guide to Implementing Language Access Services. For more information or to access the Guide, please visit go.usa.gov/36284.
HHS Office of Minority Health (OMH) Releases an Updated E-Learning Course, Entitled:
Culturally Competent Nursing Care: A Cornerstone of Caring: Culturally Competent Nursing Care is designed to help nurses and social workers provide culturally and linguistically competent care and services. HHS OMH initially launched Culturally Competent Nursing Care in 2007 and has now updated it to reflect the changes in health policy and health care practices. The e-learning program now includes current information and resources on Title VI, Section 1557 of the Affordable Care Act, and HHS OMH’s enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. The e-learning program also has a re-designed website with updated graphics and interactivity. Culturally Competent Nursing Care is still accredited for up to nine continuing education credits for nurses and social workers.
For more information or to access the e-learning program, please visit go.usa.gov/3628G.
HHS Combats Discrimination in Patient Placement:
The Department of Health and Human Services’ Office for Civil Rights (OCR) entered into a Voluntary Resolution Agreement with Shiawassee County Medical Care Facility in Corunna, Michigan. The Agreement resolves Title VI compliance issues identified during OCR’s review of Shiawassee, a 136-bed skilled nursing facility that is Medicare and Medicaid certified. OCR initiated a review to examine a report that hospital nursing staff were assigned based on patients’ racial preferences. The Resolution Agreement with OCR calls for the appointment of a Title VI Coordinator who will be charged with overseeing Shiawassee’s overall compliance with Title VI and will have special responsibilities for the investigation and adjudication of any Title VI complaints filed internally with Shiawassee. In addition, Shiawassee will train its workforce on relevant aspects of Title VI. The Agreement will remain in effect for two years and requires Shiawassee to submit reports to OCR regarding compliance.
HHS-OCR Reaches Agreement with Hurley Medical Center over Discrimination in the Reassignment of Medical Professionals Based on Patient Preference:
The HHS Office for Civil Rights reached an agreement with Hurley Medical Center, a public safety net hospital, to resolve allegations that Hurley assigned a nurse based on the racial preference of a patient. The agreement establishes that the assignment of hospital staff on the basis of discriminatory preferences by patients violates Title VI.
In 2013, the Department of Health and Human Services released its report on the “Advancing Effective Communication in Critical Access Hospitals” initiative, which was a national compliance review of critical access hospitals (CAHs) to ensure that they provided comprehensive language access services to LEP populations in rural and isolated areas. HHS’s Office for Civil Rights (OCR) reviewed CAHs by examining the demographic data they collected for their service areas; conducting onsite visits; evaluating their language access services policies and procedures; interviewing hospital staff and community stakeholders; and securing corrective action at the discovery of compliance issues with the hospital’s language access program. The press release, which details this initiative, is here, and a report on the initiative is here.
The Department of Health and Human Services recently reached an agreement with the Mississippi Department of Human Services, Division of Family and Children's Services (MDHS-DFCS) to provide LEP individuals timely and competent language assistance at no charge to ensure meaningful access to MDHS-DFCS programs, including foster care and adoption programs. The agreement resolves an OCR compliance review and complaint investigation, conducted to determine whether MDHS-DFCS provided persons with LEP meaningful access to their programs in accordance with Title VI, which arose after it was involved in the removal of a baby from an LEP mother who was not provided any language assistance. The press release, which details the efforts MDHS-DFCS is undertaking to ensure language assistance, is here, and the full agreement is here.
The HHS Office for Civil Rights reached an agreement with Mee Memorial Hospital to expand and improve access to LEP individuals, including indigenous language speakers. The agreement sets forth remedial steps that Mee Memorial Hospital will take to ensure meaningful access to its programs, services and activities for LEP individuals.