Notice Informing Individuals About Nondiscrimination and Accessibility Requirements
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1 Notice Informing Individuals About Nondiscrimination and Accessibility Requirements DISCRIMINATION IS AGAINST THE LAW Hospice Austin & Austin Palliative Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Hospice Austin & Austin Palliative Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Hospice Austin & Austin Palliative Care: Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact Christina Remus, Director of Quality at If you believe that Hospice Austin & Austin Palliative Care has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance in the following ways: Mail to Hospice Austin, Director of Quality 4107 Spicewood Springs Road, #100, Austin, TX 78759, Call , Fax to compliance@hospiceaustin.org. You can file a grievance in person or by mail, fax, or . If you need help filing a grievance our Director of Quality is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave. SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Complaint forms are available at Nondiscrimination Statement for Significant Publications and Significant Communications That Are Small-Sized Hospice Austin & Austin Palliative Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
2 Section 1557 of the Affordable Care Act Grievance Procedure It is the policy of Hospice Austin & Austin Palliative Care not to discriminate on the basis of race, color, national origin, sex, age, or disability. Hospice Austin & Austin Palliative Care has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C ) and its implementing regulations at 45 CFR Part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Human Resources, 4107 Spicewood Springs Rd, Austin, TX 78759, , , or who has been designated to coordinate the efforts of Hospice Austin & Austin Palliative Care to comply with Section Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age, or disability may file a grievance under this procedure. It is against the law for Hospice Austin & Austin Palliative Care to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. Procedure: Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action. A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Hospice Austin & Austin Palliative Care relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of his or her right to pursue further administrative or legal remedies. The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the (Administrator/Chief Executive Officer/Board of Directors/etc.) within 15 days of receiving the Section 1557 Coordinator s decision. The (Administrator/Chief Executive Officer/Board of Directors/etc.) shall issue a written decision in response to the appeal no later than 30 days after its filing. The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age, or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination
3 electronically through the Office for Civil Rights Complaint Portal, which is available at: or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave. SW., Room 509F, HHH Building, Washington, DC Complaint forms are available at: Such complaints must be filed within 180 days of the date of the alleged discrimination. Hospice Austin & Austin Palliative Care will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or ensuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.
4 Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al or compliance@hospiceaustin.org Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số or compliance@hospiceaustin.org 繁體中文 (Chinese) 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 or compliance@hospiceaustin.org. 한국어 (Korean) 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 or compliance@hospiceaustin.org. 번으로전화해주십시오. العربية (Arabic) برقم اتصل.بالمجان لك تتوافر اللغویة المساعدة خدمات فإن اللغة اذكر تتحدث كنت إذا :ملحوظة ) والبكمم الصم ھاتف:.compliance@hospiceaustin.org ا رد و (Urdu) کال ہيں دستياب ميں مفت خدمات کی مدد کی زبان کو آپ تو ہيں بولتے اردو آپ اگر :خبردار کريں.(. compliance@hospiceaustin.org or Tagalog (Tagalog Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa or compliance@hospiceaustin.org. Français (French) ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le or compliance@hospiceaustin.org. ह द (Hindi) ध य न द : यदद आप द द ब लत त आपक दलए म फ त म भ ष स यत स व ए उपलब ध or at compliance@hospiceaustin.org पर क ल कर فارسی (Farsi) توجه: اگر به زبان فارسی گفتگو می کنید تسهیالت زبانی بصورت رایگان برای شما تماس بگیرید. compliance@hospiceaustin.org فراهم or می باشد. با
5 Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: or at ગ જર ત (Gujarati) સ ચન : જ તમ ગ જર ત બ લત હ, ત ન :શ લ ક ભ ષ સહ ય સ વ ઓ તમ ર મ ટ ઉપલબ ધ છ. ફ ન કર or compliance@hospiceaustin.org. Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните or at compliance@hospiceaustin.org 日本語 (Japanese) 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます or compliance@hospiceaustin.org) まで お電話にてご連絡ください ພາສາລາວ (Lao) ໂປດຊາບ: ຖ າວ າ ທ ານເວ າພາສາ ລາວ, ການບ ລການຊ ວຍເຫອດ ານພາສາ, ໂດຍບ ເສ ຽຄ າ, ແມ ນມ ພ ອມໃຫ ທ ານ. ໂທຣ or at compliance@hospiceaustin.org
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