Civil Rights

For LTSS, as for all covered services, providers are required by law to ensure access to equally effective services regardless of the individual’s disability (broadly defined under the Americans with Disabilities Act of 1990 [ADA]), age, sexual orientation or gender identity, and linguistic, cultural or racial background.  With regard to disability, this means pro-active planning to ensure that the MCO, as well as its provider network and subcontractors, can meet requests from individuals for reasonable accommodations and policy or procedural modifications that are needed for quality health care.  Moreover, the civil rights mandate to act without discrimination extends to the needs and preference of HCBS consumers.  For example, an individual who has multiple chronic conditions and is Deaf may choose to hire a Deaf personal assistance worker.  The MCO should be prepared to provide American Sign Language interpretation or other effective communication aids to both the individual and the personal assistance worker in where it is reasonable to provide such assistance.  For LTSS to be truly person-centered, MCOs must go beyond minimum civil rights requirements.

  • CMS and the state must have an affirmative plan, with data requirements, periodic monitoring obligations, and enforcement measures, to ensure that MCOs are in compliance with all relevant civil right laws.
  • MCOs must be required to conduct a staff review of their provider networks, using available facility site review tools, to ensure that  the provider network is physically accessible, and providers make reasonable modifications of policies, practices, and procedures (programmatic accessibility) to meet the array of disability-related needs of all beneficiaries, such as height-adjustable examination tables, assistance with filling forms or undressing, or extended appointment times or diagnostic equipment and other accommodations.  Providers must be advised of their accessibility obligations under the Americans with Disabilities Act and other applicable Federal and state statutes and rules.  Beneficiaries and MCO employees must be able to find information about the accessibility of individual providers and provider sites in order to be able to choose physically and programmatically accessible providers.
  • Plans must survey, identify and commit to preserving providers that deliver unique or specialized LTSS for people with disabilities or high-needs senior populations, including those that have uncommon linguistic or cultural abilities (e.g., Spanish sign language).
  • All levels of the MCO must demonstrate a clear commitment to and understanding of the unique importance of LTSS, including the integration mandate of the Americans with Disabilities Act as interpreted by the Supreme Court in the Olmstead decision.
  • MCOs must be part of the state’s Olmstead plan, participate in any Olmstead  committee, and have their own plan for delivering services consistent with the Americans with Disabilities Act and the integration mandate.
  • As recipients of federal funds, the MCOs must develop language access plans to address the needs of Limited English Proficient (LEP) individuals in every aspect of the organization’s interaction, from enrollment to initial assessment to grievance and appeal procedures.  The communication needs of LEP individuals and people with visual, hearing, or other communication impairments must be especially accounted for when giving notices related to, assessing for, or providing home and community-based services.
  • MCOs must incorporate HHS Office of Minority Health cultural competency standards(CLAS) into all levels of the organization and services delivery system.
  • MCOs and providers should gather data about, and take into account, the needs and preferences of lesbian, gay, bisexual and transgender beneficiaries.
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