Civil Rights Compliance Activities (93.001)

Program

93.001 Civil Rights Compliance Activities

Federal Agency

Agency: Department of Health and Human Services
Office: Office of the Secretary

Authorization

Civil Rights Act of 1964, Title VI, as amended; Rehabilitation Act of 1973, Sections 504 and 508, as amended; Education Amendments of 1972, Title IX, as amended; Age Discrimination Act of 1975, as amended; Nondiscrimination Provisions of the Public Health Service Act, Titles VI, VII, VIII, and XVI, as amended; Omnibus Budget Reconciliation Act of 1981, Public Law 97-35, as amended; Drug Abuse Offense and Treatment Act of 1972, Section 407; Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, Section 321, as amended; Low-Income Home Energy Assistance Act of 1981, 42 U.S.C. 8625; Community Services Block Grant Act, 42 U.S.C. 398; Family Violence Prevention and Services Act, as amended, Section 307 (a)(1) and (2), Public Law 98-457; Americans with Disabilities Act of 1990, Title II, Subtitle A, Public Law 101-336; Small Business Job Protection Act of 1996, Section 1808, Public Law 104-188; Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d-2, 45 CFR Part 160 and Subparts A and E of Part 164--Standards for Privacy of Individually Identifiable Health Information (the "Privacy Rule"); Public Health Service Act, Title IX, 42 U.S.C. 299b-22, as amended by the Patient Safety and Quality Improvement Act of 2005, Public Law 109-41; Part C of title XI of the Social Security Act, 42 U.S.C. 1320d-d-8, as amended by Section 105 of the Genetic Information Nondiscrimination Act of 2008 (GINA), Public Law 110�233; Subtitle D of the HITECH Act, Public Law 111-5, 123 Stat. 115 (2009).

Program Number

93.001

Last Known Status

Active

Objectives

The Office for Civil Rights (OCR) in the Department of Health and Human Services (HHS) promotes and ensures that people have equal access to and the opportunity to participate in and receive services from all HHS-funded programs without facing unlawful discrimination, and that the privacy of their health information is protected. OCR protects the civil rights of all individuals who are subject to discrimination in health and human services programs and protect the health information privacy rights of consumers through investigations, voluntary dispute resolution, enforcement, technical assistance, policy development and information services.

Types of Assistance

ADVISORY SERVICES AND COUNSELING; INVESTIGATION OF COMPLAINTS

Uses and Use Restrictions

The Office for Civil Rights (OCR) in the Department of Health and Human Services (HHS) is responsible for promoting and ensuring that people have equal access to and the opportunity to participate in and receive services from all HHS-funded programs without facing unlawful discrimination, and that the privacy of their health information is protected. These HHS funded programs are provided through state agencies, nursing homes, skilled nursing facilities, medical laboratories, hospitals, day care centers, social service agencies and other providers. Any person who believes that an individual has been discriminated against in the provision of these services because of race, color, national origin, disability, age, sex or religion, may file a complaint with OCR. An individual who believes that discrimination on the basis of disability has occurred in a health or social services program of a state or local government entity may file a complaint with OCR under Title II of the Americans with Disabilities Act of 1990, regardless of whether the entity receives Federal funds. Individuals may also file complaints of denials of health care for reasons other than the need and availability of services, by recipients of Hill-Burton grants and loans. In addition, a person may file a complaint under the Multiethnic Placement Act if 1994, as amended by Section 1808 of the Small Business Job Protection Act of 1996, alleging that an adoption or foster care agency or entity funded by HHS discriminatorily relied on a parent�s or child�s race, color, or national origin in making a placement decision. OCR will investigate complaints and take steps to ensure compliance with applicable civil rights laws.

OCR also enforces the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule as well as the Patient Safety and Quality Improvement Act (PSQIA) of 2005. OCR's activities under the Privacy Rule include enforcement actions, including conducting investigations, taking compliance actions, and making penalty determinations, and conducting public education, technical assistance and other outreach activities: to health care providers, health care clearinghouses and health plans, to ensure that they understand their responsibilities under the Rule; to other entities that may be impacted by the Rule, including Federal, State and local government agencies, researchers, and business associates of covered entities; and to consumers to inform them of their rights under the Privacy Rule. Anyone who believes that a person, agency or organization covered under the HIPAA Privacy Rule ("a covered entity") has violated the Privacy Rule may file a complaint with OCR. OCR's activities under PSQIA include administering an enforcement program regarding the confidentiality protections, including conducting investigations, taking compliance actions, and making penalty determinations and interpreting standards for confidentiality protections and the enforcement program for guidance and technical assistance to Patient Safety Organizations (PSOs) and providers and public information.

Eligibility Requirements

Applicant Eligibility

Anyone who believes he or she has been discriminated against in the manner outlined above or seeks information concerning civil rights, and recipients of Federal financial assistance who desire technical assistance and information for the purpose of assuring their compliance with nondiscrimination laws. Regarding the HIPAA Privacy Rule, anyone who believes that the Privacy Rule has been violated in the manner outlined above, or who seeks information about the Rule; consumers that need to know their rights under the Rule; and entities that need technical assistance and information for the purpose of assuring compliance with the Privacy Rule.

Beneficiary Eligibility

Individuals subject to discrimination and recipients who require technical assistance and information. Regarding the HIPAA Privacy Rule, individuals subject to violation of their health information privacy, covered entities, and others needing or seeking technical assistance and information concerning the Rule.

Credentials/Documentation

No Credentials or documentation are required. This program is excluded from coverage under OMB Circular No. A-87.

Application and Award Process

Preapplication Coordination

Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Complaints of discrimination and alleged violations of the HIPAA Privacy Rule may be filed, and technical assistance information and public education may be requested, at the Headquarters and Regional Office locations of the Office for Civil Rights.

Award Procedure

None.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time

A complaint must be filed not later than 180 days of the alleged discrimination, unless the time for filing is waived for good cause. Complaints under the Privacy Rule must be filed within 180 days of the date when the complainant knew, or should have known, that the act or omission complained of occurred, unless the time limit is waived for good cause.

Appeals

Individuals can appeal a civil rights discrimination complaint determination in some instances by submitting, in writing, a request for reconsideration to the Director, Office for Civil Rights. OCR imposes civil money penalties (CMPs) on a covered entity found to be in violation of the HIPAA Privacy Rule. If CMPs are imposed by OCR, the covered entity may request a hearing in which an HHS administrative law judge (ALJ) decides if the CMPs are supported by the evidence in the case. OCR is required to present the evidence to support the imposition of CMPs to the ALJ. The covered entity may also then appeal the ALJ's decision to the HHS Departmental Appeals Board (DAB) and ultimately to the U.S. Courts of Appeal.

Renewals

Not Applicable.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula.

This program has no matching requirements.

This program does not have MOE requirements.

Length and Time Phasing of Assistance

Not applicable. See the following for information on how assistance is awarded/released: Not applicable.

Post Assistance Requirements

Reports

Audits

No audits are required for this program.

Records

None.

Program Accomplishments

Fiscal Year 2008: 11,981 individual complaints were filed with OCR (3,037 civil rights discrimination cases and 8,944 Privacy Rule cases); OCR completed action on 12,418 complaint cases (3,497 discrimination and 8,921 Privacy Rule); OCR completed 2,499 compliance reviews (including 2,432 pre-grant and 67 post-grant reviews) on its traditional civil rights authorities; and OCR provided information and training to 92,603 individuals. LIMITED ENGLISH PROFICIENCY -- OCR continues to work with health care and social service providers, state and local agencies, and other HHS components to ensure that limited English proficient (LEP) persons are not discriminated against on the basis of national origin in HHS-funded programs (e.g., emergency room care, welfare to work, child protective services, senior centers, and in-home services). In FY 2008, the State of Hawaii Department of Human Services, serving a state population of more than 1.2 million, signed a statewide Settlement Agreement with OCR to ensure LEP persons receive equal access to the Department�s programs and services, including health insurance and medical programs for low-income persons. OCR also continued its technical assistance, public education and outreach activities in connection with the revised Limited English Proficiency guidance issued in August 2003. Through FY 2008, in collaboration with the American Hospital Association (AHA), OCR established partnerships with one regional and 16 state-wide hospital associations to provide technical assistance tailored to the unique needs and demographics of the member hospitals to assist them in meeting their legal obligations to effectively communicate with limited English proficient and deaf or hard of hearing patients and companions, thereby promoting patient safety and quality health care. OCR developed and provided to the hospital associations tools that have been extensively used, including surveys for data collection and a training program on how hospitals can communicate effectively with these populations, consistent with their responsibilities under the civil rights laws. In addition, OCR partnered with The Joint Commission in the development of a web-based training video that addresses legal requirements under the Federal civil rights laws pertaining to communication with deaf and hard of hearing and LEP persons in hospitals. The video has been disseminated to 300 Joint Commission surveyors to assist them in their assessment of hospitals and other types of health care providers that they evaluate for accreditation. HEALTH DISPARITIES -- In partnership with the National Consortium on Multicultural Education, OCR created and deployed a first of its kind, scenario-based curriculum on health disparities and cultural competency in medicine to educate health care providers, medical educators, and student physicians on their civil rights obligations. This curriculum ensures that medical students and other health care professionals understand that some aspects of �culturally competent� care are not only tools for effective medical practice, but also may be legally required. In May 2008, the curriculum was submitted to the Association of American Medical Colleges Med Ed Portal. MULTI-ETHNIC PLACEMENT ACT (MEPA)/SECTION 1808 - FOSTER CARE AND ADOPTION SERVICES -- OCR continues to strengthen families and create better conditions for children to live in permanent, safe environments through its work to remedy race, color, and national origin discrimination in foster care and adoption. For example, in FY 2008, OCR, in collaboration with the Administration on Children and Families, developed a comprehensive training program on the consideration of race and ethnicity in adoptions and foster care placements, which is being rolled out for training of adoptions and foster care staff nationwide. NEW FREEDOM INITIATIVE -- OCR is involved in a variety of efforts to increase the independence and quality of life of persons with disabilities, including those with long-term needs, and to promote access to home and community-based services for these individuals. Most notably, OCR has played a critical role in implementation of the Olmstead Supreme Court decision and full enforcement of Title II of the Americans with Disabilities Act through investigations, complaint resolution, and the use of alternative dispute resolution. Today, more than 1,000 individuals with disabilities institutionalized in Georgia�s seven public psychiatric and developmental disabilities facilities now have the opportunity to live in their home communities, with appropriate supports tailored to meet their individualized needs, as a result of a statewide agreement entered between the State of Georgia and OCR in July 2008. Through its website, OCR will continue to expand the information available to consumers and providers about the civil rights of persons with disabilities in order to further facilitate the community integration of individuals with disabilities. SECTION 504 � PROGRAM ACCESSIBILITY -- New York�s Schenectady County Department of Social Services, serving a county population of over 150,000 signed a voluntary resolution agreement to ensure that individuals with physical disabilities receive equal access to its services and office buildings. CIVIL RIGHTS CORPORATE AGREEMENTS �OCR negotiated and signed 8 Civil Rights Corporate Agreements in 2008, bringing to 14 the number of such Agreements. The Agreements between OCR and health care corporations promote compliance with civil rights laws in all Medicare Part A facilities owned by the corporations by ensuring that all the facilities implement policies and procedures consistent with the laws. All together, the 14 corporations own over 1,775 facilities nationwide, serving over 5.5 million patients annually. In this way, OCR maximizes its impact and voluntary civil rights compliance efforts within the Medicare provider community. EMERGENCY PREPAREDNESS -- OCR has been actively involved in many government-wide activities related to emergency planning, response, and recovery, ensuring that the needs of at-risk individuals, including persons with disabilities, LEP persons, and persons from diverse cultural origins, are addressed in all emergency preparedness activities. HIPAA PRIVACY RULE -- A major responsibility given to OCR in December 2000 is protecting the privacy of health information under the Privacy Rule, which was enacted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The Rule protects the privacy of individually identifiable health information held by health plans, covered health care providers, and health care clearinghouses. OCR promotes compliance with the Privacy Rule by investigating and resolving complaints, developing policy guidance and public education materials, and providing technical assistance directly to covered entities and members of the public. Pursuant to the recommendations in the 2007 Report to the President on Issues Raised by the Virginia Tech Tragedy, OCR in FY 2008, developed, in coordination with the Department of Education, guidance to clarify the intersection of the HIPAA Privacy Rule and the Family Educational Rights and Privacy Act, as well as the circumstances under which information may be shared under both laws in emergency circumstances. Other guidance in FY 2008 included HIPAA Privacy Guides to Communications with Family, Friends, and Others Involved in a Patient's Care: companion guidance directed at health care providers and consumers. These guides explain when a health care provider is allowed to share a patient�s health information with the patient�s family members, friends, or others identified by the patient as involved in the patient�s care. Significant enforcement actions in FY 2008 include a settlement agreement: in July 2008, OCR entered in to a resolution agreement with Seattle-based Providence Health & Services to settle potential violations of the HIPAA Privacy and Security Rules for a resolution amount of $100,000 and a 3-year corrective action plan to ensure the appropriate safeguarding of identifiable electronic patient information against theft or loss. Fiscal Year 2009: OCR projects that approximately 9,600 individual complaints will be filed in FY 2009 (2,600 civil rights discrimination cases and 7,000 Privacy Rule cases); OCR is projected to complete action on approximately 10,400 complaint cases (2,550 discrimination and 7,850 Privacy Rule). OCR is also on target to complete 2,225 compliance reviews (including 2,200 pre-grant and 25 post-grant reviews) in FY 2009 and to provide information and training to more than 95,400 individuals. HIPAA PRIVACY RULE -- In FY 2009 OCR published guidance on the limited circumstances when the Secretary of HHS may waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the HIPAA Privacy Rule following a Presidential emergency or disaster declaration or a Secretarial declaration of a public health emergency. To promote the adoption of health information technology, OCR published in December 2009 a series of fact sheets that clarify how the HIPAA Privacy Rule applies to, and can be used to help structure the privacy policies behind, electronic health information exchange in a networked environment. This guidance was developed in conjunction with the Office of the National Coordinator for the Privacy and Security Toolkit, which implements the principles in The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information. In January 2009, OCR and CVS pharmacy chain entered in to a resolution agreement to settle allegations of unsecure disposal of protected health information in dumpsters accessible to the public, for a resolution amount of $2.25 million and a 3-year corrective action plan settlement and take corrective action to ensure the safe and proper disposal of patient information. In a coordinated action, CVS also signed a consent decree with the Federal Trade Commission, (FTC) to settle potential violations of FTC law. OCR and the FTC conducted their investigations jointly. This is the first instance in which OCR has coordinated investigation and resolution of a case with the FTC. Fiscal Year 2010: OCR projects that approximately 11,400 individual complaints will be filed in FY 2010 (3,100 civil rights discrimination cases and 8,300 Privacy Rule cases); OCR is projected to complete action on approximately 13,725 complaint cases (3,600 discrimination and 10,125 Privacy Rule). OCR is also projected to complete 2,425 compliance reviews (including 2,400 pre-grant and 25 post-grant reviews) in FY 2010 and to provide information and training to more than 98,200 individuals.

Financial Information

Account Identification

75-0135-0-1-751.

Obligations

(Salaries) FY 08 $34,299,000; FY 09 est $40,099,000; FY 10 est $41,099,000

Range and Average of Financial Assistance

Not applicable.

Regulations, Guidelines and Literature

Title VI of the Civil Rights Act of 1964--the implementing regulation (45 CFR 80), "Your Rights Under Title VI of the Civil Rights Act of 1964 fact sheet, "Know Your Rights" brochure regarding national origin discrimination and limited English proficiency, a video in VHS and DVD formats entitled "Title VI Limited English Proficiency"; Section 504 of the Rehabilitation Act of 1973--the implementing regulation for HHS funded programs and activities (45 CFR 84), and fact sheets "Your Rights Under Section 504," "Your Rights as a Person with HIV Infection, AIDS, or Related Conditions," "Your Rights Under Section 504 and the Americans with Disabilities Act," and the HHS Section 504 federally conducted regulation (45 CFR 85); Age Discrimination Act of 1975--implementing regulations, HHS (45 CFR 91) and government-wide (45 CFR 90), and fact sheet "Your Rights Under the Age Discrimination Act"; Community Service Assurance of the Hill-Burton regulation (42 CFR 124) and fact sheet "Community Service Assurance Under the Hill-Burton Act"; Sex Discrimination in Health-Related Training Programs regulation (45 CFR 83); fact sheets on: Section 1808/Multiethnic Placement Act (MEPA); the Americans with Disabilities Act (ADA); "How to File a Discrimination Complaint with OCR"; "Know Your Civil Rights"; Civil Rights Frequently Asked Questions; a video presentation: OCR guidance on Temporary Assistance for Needy Families (TANF) and Disability; OCR guidance documents and questions and answers on MEPA; various technical assistance materials for Medicare providers and applicants, including a sample nondiscrimination policy, LEP policy, auxiliary aids policy, accessibility policy, and grievance procedure, and various other civil rights publications.

HIPAA regulations and standards, including the Privacy Rule, 45 CFR Part 160 and Subparts A and E of Part 164; "Your Health Information Privacy Rights"; "Privacy and Your Health Information"; fact sheets and guidance on specific aspects of the Privacy Rule, and additional compliance tools such as "Am I a Covered Entity" and Frequently Asked Questions (FAQs). A complete list of Privacy Rule publications is available. There is also a brochure titled "Protecting Your Civil Rights in Health and Social Services and Your Health Information Privacy Rights," which provides general information about the Office for Civil Rights and its services. All literature is available at no charge; however, because of budgetary constraints and availability of stock, quantities may be limited. Most publications can be downloaded from OCR's website and are available in languages other than English. All publications are available in alternative formats for individuals with disabilities.

Related Programs

Not Applicable.

Information Contacts

Regional or Local Office

See Regional Agency Offices. Region I - Boston (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
Peter Chan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Government Center
J.F. Kennedy Federal Building - Room 1875
Boston, MA 02203
Voice phone(617)565-1340
FAX (617)565-3809
TDD (617)565-1343

Region II - New York (New Jersey, New York, Puerto Rico, Virgin Islands)
Michael Carter, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278
Voice Phone (212)264-3313
FAX (212)264-3039
TDD (212)264-2355

Region III - Philadelphia (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia)
Paul Cushing, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West
Suite 372, Public Ledger Building
Philadelphia, PA 19106-9111
Main Line (215)861-4441
Hotline (800) 368-1019
FAX (215)861-4431
TDD (215)861-4440

Region IV - Atlanta (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee)
Roosevelt Freeman, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone (404)562-7886
FAX (404)562-7881
TDD (404)331-2867

Region V - Chicago (Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin)
Valerie Morgan-Alston, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Voice Phone (312)886-2359
FAX (312)886-1807
TDD (312)353-5693

Region VI - Dallas (Arkansas, Louisiana, New Mexico, Oklahoma, Texas)
Ralph Rouse, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Voice Phone (214)767-4056
FAX (214)767-0432
TDD (214)767-8940

Region VII - Kansas City (Iowa, Kansas, Missouri, Nebraska)
Frank Campbell, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
601 East 12th Street - Room 248
Kansas City, MO 64106
Voice Phone (816)426-7277
FAX (816)426-3686
TDD (816)426-7065

Region VIII - Denver (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)
Velveta Howell, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
1961 Stout Street -- Room 1426 FOB
Denver, CO 80294-3538
Voice Phone (303)844-2024
FAX (303)844-2025
TDD (303)844-3439

Region IX - San Francisco (American Samoa, Arizona, California, Guam, Hawaii, Nevada)
Michael Kruley, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
Voice Phone (415)437-8310
FAX (415)437-8329
TDD (415)437-8311

Region X - Seattle(Alaska, Idaho, Oregon, Washington)
Linda Yuu Connor, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
2201 Sixth Avenue - M/S: RX-11
Seattle, WA 98121-1831
Voice Phone (206)615-2290
FAX (206)615-2297
TDD (206)615-2296.

Headquarters Office

Director, Office for Civil Rights Hubert H. Humphrey Building - Mail Stop Room 509-F6
200 Independence Ave. S.W.
, Washington, District of Columbia 20201 Email: OCRMail@hhs.gov Phone: 202-619-0403

Web Site Address

http://www.hhs.gov/ocr.

Examples of Funded Projects

Not Applicable.

Criteria for Selecting Proposals

Not Applicable.