1. Addressing Health Disparities Through Civil Rights Compliance and Enforcement September 19, Sarah Albrecht, J.D. HHS Office for Civil Rights

2. Your Role in Ensuring Civil Rights Compliance
Recipients of Federal Financial Assistance (FFA)
Agency Program Staff
Grant Management Staff

3. HHS Office for Civil Rights (OCR) What We Do & How We Do It

4. Non-Discrimination on the Basis of Race, Color, or National Origin
Title VI of the Civil Rights Act of Applies to all recipients of FFA
Multiethnic Placement Act of (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

5. 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

6. Non-Discrimination on the Basis of National Origin Ensuring Compliance with Respect to LEP Persons

7. 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

8. Number of LEP persons likely to be served or affected
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

9. Non-Discrimination on the Basis of National Origin Immigration Status Inquiries

10. Applications and processes to determine a child’s eligibility:
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

11. 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

12. Non-Discrimination on the Basis of Race, Color, or National Origin

13. 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

14. Hill-Burton Community Service Assurance
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

15. 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

16. 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

17. 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

18. 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

19. Non-Discrimination on the Basis of Disability Equal Opportunity to Receive Services

20. 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

21. Non-Discrimination on the Basis of Disability Program Accessibility

22. 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

23. Non-Discrimination on the Basis of Disability Live in the Most Integrated Setting

24. Under Section 504 and Title II of the ADA:
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

25. Non-Discrimination on the Basis of Disability Auxiliary Aids and Services

26. Under Section 504 and Title II of the ADA:
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

27. 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:
Make programs accessible
Make reasonable modifications
Provide services in the most integrated setting
Provide auxiliary aids and services

28. 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

29. 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

30. Non-Discrimination on the Basis of Age

31. Non-Discrimination on the Basis of Age

32. 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

33. Non-Discrimination on the Basis of Sex

34. 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

35. 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

36. Non-Discrimination on the Basis of Religious or Moral Objections

37. 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

38. 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)

39. Ensuring Compliance with Civil Rights Laws
Strategies for recipients of FFA:
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

40. 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

41. Technical Assistance OCR Regional Offices
Provide technical assistance
Receive reports of noncompliant programs or activities
For more information, contact us: ,
Visit

42. Resources Are Available Useful Links and Documents
HHS Office for Civil Rights information and tools,
OCR Fact Sheets,
OCR Compliance Activities,
HHS LEP Guidance (2003),
Tri-Agency Guidance,
ADA Standards for Accessible Design (2010),
DOJ Language Access Assessment and Planning Tool,
Federal Interagency Working Group on LEP,
National Standards on Culturally and Linguistically Appropriate Services (CLAS),
DOJ Guidance: Accessibility of State and Local Government Websites to People with Disabilities,
Web Content Accessibility Guidelines 2.0,