Civil Rights Contract Compliance

GUIDANCE ON COMPLETION OF THE

CIVIL RIGHTS CONTRACT COMPLIANCE

SELF ASSESSMENT FORM

Missouri Medicaid funding is obtained through federal grant programs and the Missouri Department of Social Services is, therefore, required to make sure all recipients of monies originating from those funds are complying with all requisite civil rights legislation in the delivery of services. The Department of Social Services, Office for Civil Rights is responsible for monitoring provider compliance with applicable civil rights laws.

Federal regulations regarding disability discrimination generally require two types of compliance –facility accessibility and program accessibility. Facility accessibility means that there should be no obstacles to your facility that would prohibit on-site participation by a disabled individual (handicap accessibility). Program accessibility means that your services are available to anyone regardless of whether or not they are disabled. A language barrier can be considered a disability.

The Civil Rights Contract Compliance Self Assessment Form is designed to assist providers in retaining information relevant to their compliance with civil rights laws and making that information easily accessible for review by compliance monitors. If, at any time, the Department of Social Services, Office for Civil Rights determines that a provider is NOT in compliance with federal and/or state regulations, notification may be sent to the Department of Social Services, Division of Medical Services to SANCTION the provider and reimbursement for services may be affected.

NOTE: The numbered paragraphs below provide additional information which should assist you in the completion of the Self Assessment Form. The paragraphs are numbered to correspond to the numbered questions (1-25) on the Self Assessment Form.

1. Providers have to be in compliance at every location where they provide services. Audits may be conducted by the US Department of Health and Human Services or by the Missouri Department of Social Services at any time to monitor a provider’s compliance with federal/state regulations. If your service site has been previously reviewed by one of these entities, you should have received a letter notifying you that you are/are not in compliance. If you were in compliance, you should retain a copy of that letter for simplification in future reviews. If you were not in compliance, you should retain all documentation of actions taken to remedy any problem areas and what the final outcome was of the reviewing entity.

2. Providers sometimes operate with a business entity (doctors group, hospital, etc.). We will need your business name as it is documented with the Secretary of State’s office.

3. Service Locations are those sites where you actually provide your service to the clients. You must meet compliance guidelines at any location where you provide services. If you provide services in the clients’ homes, you do not have to list the clients’ individual addresses. Rather, you should list your business address. You must provide a physical street address for your Service Location site, not the mailing or post office address.

4. If your business is actually government-owned (not subcontracted) you are considered to be a public organization. Otherwise, your business is a private organization.

5. As a recipient of federal funds, the State of Missouri is required to keep statistical information about the providers themselves. If a facility is minority owned, the business owner is someone who falls under one of the federally protected categories (i.e., race, color, national origin, gender/female, age, disability).

6. If your business has a planning or advisory board/panel, positions on those boards/panels should be available to individuals with disabilities. It is your responsibility to ensure that those individuals are not being excluded from consideration as a board/panel member. You should be familiar with guidelines involving your planning or advisory boards to ensure that qualified disabled persons are not being denied the opportunity to serve on those boards/panels.

7. You must designate a ‘Civil Rights Coordinator’ or contact person for your facility. If you are self-employed, you will serve as your own coordinator. A Civil Rights Coordinator would be the individual with your business that handles civil rights matters for the business. That individual should be the person who oversees the non-discrimination policy, the grievance/complaint process and staff training. The Coordinator should also ensure that documents and statistics are being kept as required under the contractual agreement. Ultimately, the business owner/Medicaid provider is responsible for conforming to Civil Rights laws/regulations.

8. You must have a non-discrimination policy for your business at each location where you provide services. That policy has to reflect certain information and must be specific to providing services in a non-discriminatory manner in order to be acceptable under federal regulations. For your convenience, the Department of Social Services, Office for Civil Rights has drafted a Sample Nondiscrimination Policy Statement that you can convert to your business letterhead and a Nondiscrimination Poster that can be displayed in an area accessible to all clientele. The policy should also be incorporated in your admissions or informational packet provided to each client.

9. It is mandatory that individuals receiving federal monies have a mechanism in place that allows clients to file a complaint or grievance if they feel they have been denied services based on their membership in a federally protected category. Language for a Sample Complaint-Grievance Procedure is available on this website. Any complaint-grievance procedure should provide specific instruction as to who the client should contact and how, how long the client should expect before receiving a response to their complaint and that the client will not be retaliated against for making such complaint. Your Civil Rights ‘Coordinator’ should be responsible for ensuring that the grievance investigation is handled timely and appropriately. Documentation of the investigation and subsequent findings needs to be retained for audit or review purposes.

10. Your facility should have a procedure in place to provide reasonable accommodations to individuals with disabilities that allows them equal access to your services. That means that your office needs to be physically accessible and that you must provide assistive devices/interpreters as needed. There are several organizations that can help you provide those types of service. For your convenience, we have developed a listing of some of those [Resources].

11. If you conduct your business from your home, the physical site must be accessible. If a facility employs less than 15 employees, the provider may refer disabled individuals to another agency that is accessible or may conduct home visits. If you conduct business in the client’s home, you have no responsibility for accessibility. If you provide services at multiple locations, you are responsible for ensuring that your clients are not excluded from those locations due to their membership in a protected class.

12. Explain how you handle situations when you have a client with a disability requesting services. If you cannot provide services to the client, you need to explain to them why and make sure they understand that you are not denying services based on their disability.

13. Intake procedures would include initial assessment forms or admissions records. You need to ensure that none of the questions asked on those forms excludes individuals from your services based on their membership of a protected class.

14. Alcohol and drug abuse can fall under the federal guidelines as a disability issue. You need to ensure that you do not exclude individuals with an alcohol or drug abuse problem from your services because of their condition.

15 & 16. As a recipient of Medicaid benefits, you must make your services available to all clients, regardless of their disabilities or limited conditions. Being able to communicate with those clients is essential in providing services for them. Limited English Proficiency (LEP) regulations require that you be able to communicate and offer services to individuals who are limited in their English-speaking abilities. You must make provisions to ensure that you are able to provide services to those individuals if necessary.

17. Auxiliary aids or assistive devices are types of equipment used to assist in communication or mobility with individuals that have disabilities. That would include (but is not limited to) telephone lines for the hearing impaired, Braille documents or extra large print for the visually impaired, language interpreters, ramps, and wheelchair accessibility inside the facility. Those [Resources] can be developed at little or no cost through various entities.

18. All of your employees should receive training on service delivery in relation to non-discriminatory practices. This training should be given during initial employee orientation and given as follow-up training as necessary. Employees need to be trained specifically on your non-discrimination policy and your complaint procedure.

19. If you provide transportation for your clients, you must ensure that the transportation is accessible for individuals with disabilities. This includes any company you may sub-contract with.

20. Providers are responsible for ensuring that all facilities where their services are provided are in compliance with federal and state anti-discrimination laws (with the exception of individuals providing services in clients homes). If you sub-contract services, you should retain a copy of any sub-contractor’s non-discrimination policy.

21. If you employ more than 15 people, you also have an obligation to ensure that your staffing practices are non-discriminatory. This includes (but is not limited to) job announcements, hiring, promoting, layoffs, and terminations. You need to collect and maintain information regarding the racial/ethnic makeup of your workforce if you employ more than 50 people. That information should be kept in your business records.

22. If you fail to hire or promote an individual because of a disability, you will have to be able to show why that action would have caused an undue hardship. Make sure that your interview process is devoid of questions regarding disability. If you sub-contract your hiring process, you need to ensure that the subcontractor does not discriminate.

23. Facility accessibility means that there should be no obstacles to your facility that would prohibit on-site participation by a disabled individual (handicap accessibility). If your facility is not accessible to individuals with a physical disability, you need to make provisions to ensure that those individuals can receive your services. If you employ less than 15 people, you may refer disabled individuals to another agency that is accessible for services or may conduct home visits.

24. If your office/facility is undergoing (or planning to undergo) structural changes, you must ensure that those changes are within guidelines as outlined for ADA accessibility. You may contact the US Department of Health and Human Services at (800) 514-0301 or the Missouri Department of Labor and Industrial Relations, Division of Labor Standards at (800) 475-2130.

25. As part of your contractual agreement with the Missouri Department of Social Services, Division of Medical Services you have agreed to maintain fiscal and medical records for a period of five years and those records are to be made available upon request by an authorized representative of the Missouri Department of Social Services or the US Department of Health and Human Services. For purposes of Civil Rights regulations, those records should include (but are not limited to):

a. The type and number of discrimination complaints filed against you or your facility. Your records should include documentation of the action taken to resolve the complaint and any subsequent actions resulting from the complaint.

b. Documentation of any previous audits or reviews conducted by the federal or state entities charged with determining compliance with Civil Rights issues and any correspondence regarding the outcome of that audit/review.

c. Statistical information regarding the ethnic make-up or minority status of your business/facility clientele. That information can be obtained by voluntary submission from the client (via initial assessment forms) or by visual notation from employees. That information should be kept for statistical purposes only and should not be kept in affiliation with a particular client’s name.

d. A listing of all Service Locations that includes the physical location of the site and a copy of all applicable discrimination policies/complaint procedures (if different) for each site.

e. Employee training records (as applicable to non-discrimination training) and statistical information regarding the minority make-up of your employees.

f. A copy of your Non-Discrimination in the Provision of Services policy and a copy of your Discrimination Complaint/Grievance policy.

g. A copy of the Non-Discrimination in the Provision of Services poster which is displayed in your various facilities.