Fall 1999 OCR UPdate - 4
Continued from page 3 - OCR Response to Racial and Ethnic Disparities In Health Care
OCR's nationwide action plan for eliminating racial and ethnic disparities includes establishing an internal OCR task force to ensure that OCR plays an integral role in the Department's initiative to eliminate racial and ethnic disparities in health.
OCR's New York Regional Office is playing an important leadership role in the effort to eliminate racial disparities. The Region is investigating allegations of racial disparities in the provision of health care services by some health care providers in two counties in New York. A few of the allegations involved are: poor quality of care for minorities at certain hospital facilities; lack of access by minorities to the more prominent medical facilities in the counties; and barriers to health care created by language problems.
In addition, OCR director Tom Perez has spoken at a number of conferences nationwide on eliminating racial and ethnic disparities. His speeches on racial and ethnic disparities in health care can be found on OCR's website. To further inform our enforcement efforts, we are expanding our data base of publications, studies, medical articles and books. If you have any information about new studies or activities being conducted related to the subject of racial and ethnic health disparities, please contact us.
OCR is also looking at the practice of redlining as a contributing factor to racial disparities. Redlining occurs when services are limited or eliminated in specific geographic areas. Our regional offices are now identifying areas in which to focus our compliance efforts. We are starting with compliance reviews of home health care agencies nationwide to ascertain their compliance with civil rights statutes. We already have experience in our Boston region with home health agencies that were engaged in redlining, and are concerned that this may be a nationwide problem.
In addition to home health agencies, we are targeting managed care plans. Specifically, OCR is investigating how managed care plans establish their service area and how they target their marketing activities.
Every day managed care brings forward new issues of concern, many of which involve civil rights challenges. The transition to mandatory managed care in the Medicaid setting serves as one instance which has raised serious challenges for persons with disabilities, as well as for individuals who are limited English proficient (LEP).
The players in the delivery of health care are not only hospitals and physicians, but also health management organizations (HMOs) or managed care organizations (MCOs). Under health care reform, many states have moved to provide health care to Medicaid beneficiaries through HMOs. Unfortunately, both OCR and the Disability Rights Section of the Department of Justice (DOJ) have received numerous complaints concerning the accessibility of the individual providers who comprise these state Medicaid HMOs.
A cornerstone of OCR's disabilities enforcement activities is to work in close collaboration with DOJ so we can best ensure compliance with civil rights laws in the managed care setting. OCR is now developing a compliance initiative with DOJ's Disability Rights Section that would involve reviewing the accessibility of state Medicaid programs nationwide.
OCR is currently investigating a case in the State of Maryland in this area. The complainant has alleged that she has been unable to access health care services through her managed care organization due to barriers in health care provider offices, including inaccessible exam tables and building entrances. We will be working with the state agency to ensure that Medicaid managed care programs throughout the state are accessible to persons with disabilities.
OCR Regional Offices are actively addressing discrimination issues in managed care. In January 1999, our Boston Regional Office sent a letter to all MCOs that participate in the Medicaid and Medicare programs. The letter reminded the providers of their responsibilities to provide effective communication for their members and potential members who have vision and hearing impairments, or who are LEP. The Boston team is planning a training program for representatives of (continued on page 5)
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