Winter 2001                                                    OCR UPdate

In This Issue

OCR To Enforce New Health Care Privacy Protections

On Dec. 20, 2000, President Clinton and HHS Secretary Donna Shalala released the final regulation creating Federal privacy protections for the personal health information of all Americans. Enforcement of the rule has been assigned to OCR. The rule was mandated by Congress under the bipartisan Health Insurance Portability and Accountability Act of 1996 (HIPAA). It will give individuals more control over and access to their health information, and establish accountability for inappropriate use and release of that information.

Covered by the rule are health plans and almost all health care providers. Covered entities will have two years and two months after the rule is published in the Federal Register to come into compliance. (There is an exception for smaller health plans, which will have 38 months to come into compliance.)

The rule addresses the widespread lack of protection for the privacy of individual medical records. Studies show that over 80 percent of people surveyed agree they have "lost all control over their personal information." Individuals have suffered employment discrimination, denial of home mortgages, market research abuse, and other injustices due to the distribution of personal health information without consent for reasons unrelated to treatment. In addition, patients are often unable to access their own medical records because of barriers established by insurance companies or health care providers.

President Clinton and Secretary Shalala at the December 20th HHS event

The comprehensive regulation, "Standards for Privacy of Individually Identifiable Health Information," extends consumer control over their health information, sets boundaries on medical record use and release, ensures security of personal health information, and establishes accountability for medical record use and release. For example, the rule:

• Informs consumers how their health information is being used, by requiring such information of health plans and providers , and provides a right to a "disclosure history."
• Limits the release of private health information without written consent, even for routine purposes.
• Gives patients the right to see and copy their own health file and to request correction of potentially harmful errors.
• Restricts the amount of information used and disclosed to the "minimum necessary," to correct the practice of releasing an entire health record to an employer or other entity that needs only specific information, such as that relevant to a worker compensation claim.
• Requires the establishment of privacy-conscious business practices, such as staff training, confidentiality safeguards, and procedures for responding to privacy-related complaints.
• Creates new criminal and civil penalties for improper use or disclosure of information.
• Regulates the circumstances under which information can be disclosed to protect public health, support medical research, or investigate and prosecute criminal activity.

The regulation covers personal health information in all forms, whether electronic, paper, or oral communications.

This privacy regulation was developed by a policy team within HHS that included Louis Altarescu representing OCR. It was published as a proposed regulation on Nov. 3, 1999. HHS received approximately 52,000 comments which were analyzed by the team in developing the final rule.

The rule is available on the OCR website at www.hhs.gov/ocr/hipaa. It was published, along with the HHS Secretary's delegation of enforcement authority to OCR, in the Federal Register on Dec. 28, 2000. The rule will be codified at 45 CFR Part 160 and Part 164. OCR has established and is staffing a privacy response line to provide the public with an opportunity to ask questions related to the privacy regulation; the toll-free number is 1-866-OCR-PRIV (1-866-627-7748). The TTY number is 1-866-788-4989.

Director's Corner

Photograph of Tom Perez, OCR National Director

"An object at rest tends to stay at rest. An object in motion tends to stay in motion." This law of Physics came up recently during a meeting with Deputy Secretary Kevin Thurm. He was using this law as a metaphor to describe the perpetual motion that now characterizes OCR.

There has been a flurry of activity over the past six months. In August, President Clinton issued the Executive Order on language access, and OCR followed up shortly thereafter with the LEP Guidance. This Guidance has triggered a critical dialogue across the nation about the importance of ensuring meaningful access to health and human services for people with limited English skills.

A few weeks later, OCR, working together with our partners within HHS and at the Department of Agriculture, issued policy guidance designed to ensure that state application forms for public benefits are user-friendly for immigrant families, and do not inadvertently deter eligible people from applying for benefits. These guidance documents were designed with the same goal in mind, that is, to identify and eliminate barriers to access to health and human services for immigrants.

At the same time, we continue to make progress on other fronts. Ralph Rouse, our Regional Manager in Dallas, has been leading OCR's Olmstead efforts in Arkansas, and considerable progress has been made. In Arkansas and elsewhere, the emphasis has been on collaboration and coalition building, and it is paying dividends. Our work on eliminating racial and ethnic disparities, led by Regional Manager Michael Carter in New York, continues to grow exponentially. I have spent considerable time addressing civil rights challenges in the welfare to work context, and we are currently developing additional policy guidance to assist states and other governmental entities in addressing the unique needs of recipients with disabilities.

Perhaps the most important developments over the past six months at OCR have been on the personnel front. We are continuing to enhance our capacity to carry out our mission. The recent arrival of Robinsue Frohboese as our Deputy Director is critical, and I expect that she will be OCR's anchor for years to come (see p. 5). In addition, four senior Civil Rights Analysts joined us in October: Shelley Jackson and Lisa Evans, formerly of the Department of Justice; Dinah Wiley from the National Immigration Law Center, and Deeana Jang from the Asian Pacific Islander American Health Forum. They are playing a critical leadership role in a host of initiatives across the country.

Roosevelt Freeman and Velveta Howell have made an enormous impact as Regional Managers in Regions IV and VIII, respectively. I look forward to the opening of the Los Angeles satellite office in early 2001, to be led by Karin Wang, who joins us after a distinguished tenure at the Asian Pacific American Legal Center. New Equal Opportunity Specialists and other staff have come on board in a number of regional offices. I had the pleasure of meeting with all of them at our first national meeting in September. Their enthusiasm, skill and commitment are indeed impressive.

This combination of new talent and veteran leadership gives me great confidence that OCR will continue to be an object that remains in perpetual motion.

OCR Issues Policy Guidance on Language Access to Federally-Funded Programs and Services

On Aug. 30, 2000, the Office for Civil Rights issued written policy guidance to help providers ensure that persons with limited English skills can get critical health care and social services.

Publication of the guidance made HHS the first federal agency to comply with Executive Order 13166 issued by President Clinton on Aug. 11, 2000. The Executive Order requires each agency to have written policies on providing effective services to limited-English proficient (LEP) persons.

The release of the HHS/OCR guidance was marked by ceremonies in the Great Hall of the Hubert H. Humphrey Building in Washington, D.C. OCR's Thomas Perez and Kathryn Ellis were joined by high-ranking Administration officials. HHS Deputy Secretary Kevin Thurm, Irene Bueno, Special Assistant to the President for Policy Development, and Bill Lann Lee, Assistant Attorney General for Civil Rights, U.S. Department of Justice, discussed the importance of this Guidance to all Americans. Shamina Singh, Executive Director of the White House Initiative on Asian American and Pacific Islanders; Elena Rios, M.D., President of the National Hispanic Medical Association also spoke. A number of health and human services providers with model programs diccussed the keys to meaningful access.

In her letter to state Governors announcing publication of the guidance, HHS Secretary Donna E. Shalala wrote, "This guidance enhances our ability to reach our national goal of eliminating racial and ethnic disparities in health, and will assist in increasing opportunities for persons with limited English proficiency to improve their socioeconomic status."

Events were held across the country to mark the release of the guidance. Press conferences were held in Los Angeles and San Francisco (Region IX), Boston (Region I), and Seattle (Region X). At the Region I ceremonies in Boston's Federal Reserve Bank, about100 people from state agencies, hospitals, human service providers and advocacy groups from all six New England states attended.

The guidance emphasizes that providers have flexibility in designing effective programs, and that the design of such programs depends on a variety of factors. These include the size of the facility, the size of the eligible LEP population, the nature of the program or service, and the resources available.

"With our requirements and flexible policies now in writing," says Tom Perez, "we expect to make even greater progress in cooperation with health and social service providers in making services truly accessible to those with limited English skills. OCR will continue to provide technical assistance to ensure an effective language assistance program."

The "Policy Guidance on the Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency" was published in the Federal Register (65 Fed. Reg. 52761, Aug. 30, 2000) and is available on the internet at www.hhs.gov/ocr/lep. For more information, contact the nearest Regional Manager, or headquarters Analyst Deeana Jang at (202) 619-1795.

To help implement the guidance, the HHS Administration for Children and Families simultaneously published an information memorandum to administrators of Temporary Assistance for Needy Families (TANF) clarifying that the costs of providing language assistance may be covered with federal TANF or State Maintenance of Effort (MOE) funds. Tim Westmoreland, Director of HCFA's Center for Medicad and State Operations sent a letter to Medicaid directors reiterating that federal matching funds are available to cover the costs of providing language assistance.

Comments on the Guidance Received by OCR

The LEP guidance was published with an invitation to submit written comments on or before Oct. 30, 2000. OCR has received 275 letters, 52 telephone requests for technical assistance and briefings, and 83 E-mail messages from State Senators and private citizens, advocacy organizations, social services agencies, university medical centers, departments of public health, community health centers, community hospitals, physicians, medical associations, and medical groups.

Many writers strongly supported the guidance as a policy that has been critically needed for a long time by eligible immigrants and newly-naturalized citizens whose limited English makes it difficult if not impossible to access important health and social services. Commenters especially praised OCR for discouraging the use by HHS-funded programs of friends and family members, including children, to translate at sensitive and confidential appointments. Concerns about cost of providing services were expressed by small providers and solo practitioners. Other writers raised issues of interpreter ethics, how best to assess language access needs, monitoring mechanisms, data collection, certification of interpreters, and confidentiality. Commenters also asked about OCR's complaint process, and asked OCR to issue a guidance on cultural competence.

Although the comment period has ended, letters continue to arrive. OCR will continue to review the comments, suggestions, and recommendations.

Region II LEP Efforts with NY and NJ Hospital Associations

Region II has given high priority to its technical assistance efforts in the implementation of the new LEP Guidance. The Regional Office is working in partnership with the Greater New York Hospital Association (GNYHA) and the New Jersey Hospital Association (NJHA) to help their membership to understand and implement the new guidance. The NJHA will host an LEP conference later this Winter which will be transmitted via picture/teleconference for those unable to attend.

There are many limited English proficient immigrants who are not connected to the more traditional community based organizations. A primary objective of Region II's efforts will be to implement an outreach strategy that ensures reaching missed LEP populations. In addition, the Regional Office will be sending letters of notification regarding the LEP guidance and offering technical assistance to the myriad of public and private agencies and institutions that receive Federal assistance from HHS. We are committed to covering all of the health and human service providers in our region.

Region III Language Access Education

Region III's Philadelphia Office distributed over 500 information packets on OCR's language access guidance to a wide range of providers and community organizations, and staff have conducted in-person educational programs. Staff have addressed medical students at the Philadelphia College of Osteopathic Medicine and Hahnemann Medical College, and conducted training for grantees at the Region 3 Federally Qualified Health Centers Conference, the Northern Virginia Health Care Access Consortium, the Capitol Area Immigration Conference in Harrisburg, Pa., and the Virginia Department of Health.

Region IV Helps N.C. County Develop LEP Policy

Region IV's Atlanta Office worked with Iredall County (North Carolina) Department of Social Services (DSS) to develop programs and policies to ensure the provision of communication assistance to its LEP clients, who are primarily Hispanic and Hmong. With the technical assistance provided by OCR, DSS developed written LEP policies and procedures; hired two full-time Hispanic interpreters; provided confidentiality training; and instituted certain confidentiality safeguards. Also, DSS has provided cultural awareness training to its staff and has tapes in Spanish which address various program services and announcements, and has translated numerous vital documents into Spanish. The success of this effort exemplifies OCR's on-going commitment to work collaboratively with recipients to ensure that their LEP clients are provided the communication assistance necessary to enable them to effectively participate in their programs.

Region V Training in Six States

During her first year as Regional Manager, Lisa Simeone and the Region V staff have met with state partners and community organizations through a series of LEP outreach events held in Michigan, Wisconsin, Indiana, Minnesota, Illinois and Ohio. The training events featured speakers from immigrant communities discussing the importance of interpreter services and promising practices. Recent demographic changes in Region V have presented unprecedented challenges in the provision of linguistically and culturally competent care for communities in rural and urban areas. These LEP outreach events have attracted a broad audience of state program staff, social service and health providers and advocates who are struggling to adequately serve an increasingly diverse population of newcomers.

Region VI Provides Technical Assistance to New Mexico

The Region VI Office in Dallas, in collaboration with the U.S. Department of Agriculture, worked successfully with the New Mexico Human Services Department (HSD) to develop procedures for communication with LEP persons. The procedures comply with Title VI by appropriately addressing the needs of LEP clients seeking TANF, Medicaid, Food Stamps, and other public benefit programs and have been disseminated to the agency's 30 county offices. These offices administer the programs to over 75,000 individuals, 64 percent of whom are Hispanic/Latino.

Region IX LEP Agreement with Los Angeles County

In September, OCR's Region IX office in San Francisco signed an agreement with the Los Angeles County Department of Health Services (DHS) to resolve a complaint filed against one of the county's medical centers. DHS is one of the two largest county health departments in the country. In addition to six medical centers, DHS operates 39 outpatient clinics. As a result of the agreement, DHS is now completing a model program to ensure that LEP patients and their families can access all programs and benefits regardless of the language they speak. This agreement will be a model for other county health facilities in providing inter- preter services.

Region X Event Spotlights Washington State Best Practices

On Nov. 16, 2000, OCR's Seattle Office, led by Regional Manager Carmen Palomera Rockwell, sponsored a briefing on the LEP guidance that featured a panel discussion of best practices such as the funding for language access services that is available in Washington State. The Washington State presenter was Bonita Jacques, Chief, Office of Administrative Resources for the state Department of Social and Health Services, who described the state's Language Interpreter and Translation Services (LIST) program. She was joined by John Valencia, Language Bank Coordinator for the American Red Cross.

Greetings from Robinsue Frohboese

Robinsue Frohboese, OCR Deputy Director

I'm honored and thrilled to join OCR as the career Deputy Director. In this capacity, I will be responsible for supporting and providing leadership to the important work of OCR's ten regions and our headquarters' newly reorganized units of Program, Policy, and Training; Voluntary Compliance and Outreach; and Resources Management. As a health and human services civil rights advocate for the past 25 years, I have had a great deal of contact with OCR, so there were many familiar faces along with the welcoming new faces when I joined the office at the end of November. During my first few weeks, I was pleased to be able to greet all staff through two nationwide conference calls, to meet and discuss OCR's work with staff in each headquarters' component, and to work with the regional and headquarters leaders at the week-long OCR leadership meeting in Washington, D.C. in early December. In the coming weeks, I look forward to traveling to all of the regions to meet and spend time with regional staff.

I am inspired and impressed with the talent and commitment of staff and the impact of OCR's outreach, policy, and enforcement efforts. OCR has assumed an important leadership role in critical areas of national import, including eliminating racial and ethnic disparities, ensuring meaningful access to services by persons with limited English proficiency, implementing the ADA integration mandate, and developing the medical records privacy regulation. These and other activities are effectuating the OCR mission to serve as a gateway for millions of vulnerable people to obtain meaningful access to health and social services. I am committed to supporting OCR in this critical mission and ensuring that OCR's nationwide program continues to be a leader in ensuring that all individuals receive needed health and human services free from discrimination.

Congress Gives OCR Major Budget Boost On Dec. 15, 2000, the Labor-HHS-Education Appropriations bill for FY 2001 finally passed and OCR received a nearly 25 percent increase in funding for civil and privacy rights compliance initiatives. The budget of $28.1 million in FY 2001 is $5.6 million higher than our total appropriation of $22.5 million in FY 2000.

A substantial portion of the increase will be used to implement OCR's compliance and enforcement responsibilities under the new Health Insurance Portability and Accountability Act (HIPAA) rules on the privacy of health and medical records information. In addition, this budget contains significant increases that will enable OCR to build on current initiatives on the role of discrimination in race and ethnic health disparities; the development of state Olmstead most integrated setting plans; implementing new guidelines on language access and immigrant access, and ensuring nondiscrimination in TANF welfare-to-work program implementation.

For two decades, OCR's budget had remained relatively static within a narrow range of from just under $20 million to just over $22 million dollars. During the past several years, the Administration, and Secretary Donna Shalala and Deputy Secretary Kevin Thurm in particular, have supported increased funding for OCR to keep pace with the ongoing growth in OCR's responsibilities. This year is the third consecutive year of increased funding for OCR and reflects appreciation of the hard work of OCR's staff nationwide and the fact that stakeholders on Capitol Hill and elsewhere have stood up and taken notice of OCR's initiatives and accomplishments on a wide array of civil rights issues.

National Policy on Application Forms, Region IV Agreement Advance Immigrant Access to Health and Welfare Programs

Working collaboratively with other federal agencies, OCR issued critical national policy guidance on Sept. 21, 2000 regarding state application forms for public benefits. The guidance addresses an important barrier to health and social services faced by immigrant families. The inclusion of unnecessary questions in the application process may discourage immigrant participation. The greatest impact is on the needy immigrant families that are of "mixed" status in that they have at least one member who is a U.S. citizen; in addition, the remaining immigrant family members often have a mixture of different immigration statuses.

The current crisis in access by immigrant families to federally-funded services has been documented by organizations like the Urban Institute. Although the 1996 welfare laws rendered many legal immigrants ineligible for services, immigrants who remained eligible, as well as the citizens who live in immigrant-headed households, are avoiding vital safety net programs. The greatest impact is on children who are not getting linked to health insurance under Medicaid or the State Children's Health Insurance Program. They also are not receiving nutritional assistance they need; about three-fourths of the U.S. citizen children in immigrant-headed households dropped out of the Food Stamp Program within the first two years after passage of the welfare law.

OCR's concern with the problem led to a study of the application processes used by states. Many states have developed joint applications for programs such as Medicaid, TANF, and food stamps, to make it easier for individuals to apply for services they need. In many situations, this has resulted in the inclusion of questions regarding the immigration status and Social Security number of persons living in the applicant's household, but who are not applying for benefits or who are not eligible for benefits. Immigrant rights advocates have told OCR that these inquiries discourage some families from applying for and receiving benefits to which they or their children are entitled.

Some application form questions can violate the Privacy Act of 1974, and may raise concerns about compliance with Title VI of the Civil Rights Act of 1964 if they result in a discriminatory effect on the program participation of national origin minorities. The guidance suggests ways that states can comply with program verification requirements while also minimizing intrusiveness and fear and maximizing participation.

As reported in the last issue of OCR Update, OCR began its review of all 50 state application forms when Region IV began working with the state of Georgia to revise its joint application form for cash, food stamps and medical assistance. OCR's Region IV Manager Roosevelt Freeman led a compliance team that reached a successful agreement with Georgia on Sept. 20, 2000. The OCR nationwide review revealed problems with forms in the other states and OCR headquarters worked with other agencies to draft the national guidance.

The "Policy Guidance Regarding Inquiries into Citizenship, Immigration Status and Social Security Numbers in State Applications for Medicaid, State Children's Health Insurance Program (SCHIP), Temporary Assistance for Needy Families (TANF), and Food Stamp Benefits" is in two parts. It consists of a letter and a set of questions and answers, available at www.hhs.gov/ocr/immigration. OCR issued the guidance in conjunction with the U.S. Department of Agriculture Food and Nutrition Service, two agencies of the Department of Health and Human Services (DHHS): the Health Care Financing Administration (HCFA) and the Administration for Children and Families (ACF).

The guidance reviews for states the basic rules governing requests for information about immigration status and Social Security numbers. While states are often required to establish the immigration status of applicants, states may not require applicants to provide information about any other person's immigration status. For example, if a child is applying for Medicaid, the state may not require disclosure of the immigration status of non-applicant parents or other family members.

The guidance sets forth each program's verification requirements, and contains a list of suggestions for helpful policy and procedure options states can choose and ways states can re-design their forms. OCR staff is offering technical assistance to states as they work through the complexity of different program verification requirements and the strategies for revising forms. OCR staff will be sponsoring briefings in many states, and will be reviewing application forms and providing technical assistance in coordination with the ongoing HCFA Medicaid/TANF reviews. For more information, contact the nearest Regional Manager, or Dinah Wiley at headquarters at (202) 619-0128.

OCR's Olmstead Implementation: Spotlight on Arkansas

In the year and a half since the U.S. Supreme Court's landmark decision in Olmstead v. L.C., 119 S. Ct. 2176 (1999), OCR has been immersed in Olmstead-related implementation activities - activities now reaping real results in the states. In Arkansas, OCR has played a major role in the development of a 2000-person strong Olmstead planning coalition. The story of how this coalition grew and what it has accomplished provides a compelling model for other states seeking to comply with Olmstead and ensure that individuals with disabilities are provided with services and programs in "most integrated settings."

Background: The Olmstead Decision and OCR's Role

Olmstead v. L.C. held that unnecessary institutionalization of individuals with disabilities constitutes discrimination under the Americans with Disabilities Act (ADA). The Court suggested that states can demonstrate compliance by showing that they have effective plans for serving qualified individuals with disabilities in the most integrated setting.

OCR has received more than 200 complaints alleging that federally funded entities have failed to serve people with disabilities in most integrated settings. OCR is working to resolve the complaints by working with the parties to build comprehensive, effective working plans achieving Olmstead compliance. OCR recognizes that no one plan will work for all states, hence the focus is on working collaboratively on a state-by-state basis with state and county officials, individuals with disabilities, and other stakeholders to increase home- and community-based opportunities.

OCR has been instrumental in developing Olmstead planning coalitions, and all ten OCR regions have designated an "Olmstead Coordinator" on staff. In some states, special Governor's commissions head Olmstead coalitions, and in others, disability groups or state officials such as a Medicaid Director, have led the coalition-building. Currently, twenty states are engaged in Olmstead planning, and OCR is continuing to meet with other states to increase this number.

The Arkansas Experience

The momentum to implement Olmstead in the state of Arkansas is truly dramatic. From a few interested persons, the Arkansas Olmstead Coalition has mushroomed to a group of nearly 2,000 stakeholders. The Coalition's success in designing a collaborative process to examine and modify Arkansas' long term care delivery system is evident from a brief chronology:

• Spring 2000: Individuals with disabilities and their family members, advocates for diverse groups representing people with disabilities of all ages, and providers of supports and services met repeatedly with OCR, eventually forming a coalition and issuing a Mission Statement. One Mission Statement goal is to help the State to design, develop, and implement a comprehensive working plan that addresses the needs of the diverse stakeholders by adding more choices for accessible community-based supports and services to the existing continuum of care.
• Summer 2000: "Big Tent" meetings - half day meetings bringing together cross-disability advocates, advocates for the elderly, providers, and people with disabilities along with OCR and the state agency heads involved in the provision of state supported services to persons with disabilities, including the State Medicaid Director, were held all over the state of Arkansas, in cities and communities such as Fort Smith, Arkadelphia, Warren, El Dorado, Springdale, Jonesboro, Helena, and Mountain Home. OCR presented, at each of these meetings, the Department's view of Olmstead's requirements.
• Summer 2000: Arkansas Governor Huckabee issued a proclamation authorizing the Arkansas Department of Human Services and a DHS Steering Committee (members nominated by the Coalition and selected to serve) to write an Olmstead plan for the state. The "Working Group" ultimately consists of nine agency representatives, sixteen organizational representatives, and one state legislator. OCR's Regional Manager serves in an ex officio capacity on the Group.
• Fall 2000: Arkansas hired experts to aid plan development, obtaining input from Working Group subcommittees which, over four months' time, developed recommendations for ensuring that individuals with disabilities are provided with opportunities for services in "most integrated settings" in each component of the stated long term care system.
• Spring, 2001: the Group is to present to Arkansas Governor Mike Huckabee a comprehensive plan to serve people with disabilities in the least restrictive setting.

Achieving these milestones means in part that Arkansas advocates and agencies which have never before worked together have joined forces around Olmstead - and have discovered that the results can be powerful. As Arkansas Coalition member Jim Eakin stated, "The great thing about the proceedings in Arkansas is that many people who have not historically been known to work together have been brought together of necessity by the Olmstead decision. Grass roots advocates realize now that they must work cooperatively with the state and that the rule of fundamental alteration is an important factor. On the other hand, the state realizes that it must consider its resources in determining such a factor. Even advocates who do not ordinarily agree on issues are working remarkably well together on this most important project."

For more information, contact OCR Region VI Regional Manager Ralph Rouse, (214-767-4056), or Jim Eakin, Arkansas Olmstead Coalition Member and Executive Director, Arkansas Independent Living Council. For more information on OCR Olmstead activities generally, contact the nearest Regional Manager, or headquarters Analysts Claudia Schlosberg at (202) 619-1750 or Shelley Jackson at (202) 619-0731.

Region X Launches Washington Plan

In the state of Washington in Region X, Carmen Palomera Rockwell, Regional Manager, arranged a meeting on Nov. 15, 2000 with key stakeholders to encourage development of a state Olmstead Implementation Plan. Dennis Braddock, the newly appointed Secretary of the largest State agency in Washington State discussed Olmstead implementation with the Director and the Legal Counsel of the Washington Protection and Advocacy Service (WPAS), a federally funded program, and other disability advocacy groups. Other advocates included representatives from Columbia Legal Services, Washington Independent Living Center Coalition and private citizens. OCR's delegation included headquarters Senior Civil Rights Analyst Claudia Schlosberg.

Parties attending the meeting agreed that the dialogue should continue, and Mr. Braddock agreed to host another meeting with WPAS and other advocates. The Region X Office for Civil Rights will continue to provide the necessary support and technical assistance to help ensure that all stakeholders are brought to the planning table.

Health Disparities: Momentum Continues

National Working Group Forms On Data Collection

For the past year, OCR has fielded questions about the legality of asking patients or recipients of social services for data relating to their race, ethnicity or national origin. A nationwide working group has been convened to examine ways to let all stakeholders know that collecting racial and ethnic data is permissible, and in some instances required under Title VI. The group is meeting this challenge on several fronts. First, we are drafting a non-regulatory guidance regarding the collection of racial and ethnic data. The guidance will explain the need for the data, look at the data that is currently available, and examine the effect of disparities on health status and health outcomes. In addition, it will identify some of the benefits for recipients (improved quality and effectiveness of health care, better quality clinical trials, compliance with Title VI) and provide the Department's position on the legal issues associated with the collection of these data.

In June, 2000, OCR responded to Aetna US Healthcare's decision to begin collecting racial and ethnic data by sending it a letter affirming the legality of their efforts, and applauding the critically important decision. This letter went to only one entity, but could be a useful mechanism of providing similar information to other managed care providers. The Disparities Group is working to develop a broader letter to be sent to all managed care providers by HCFA, or from OCR directly. The Group is also working within HHS to assist agencies in developing appropriate policies on data collection.

For more information, contact the nearest Regional Manager, or headquarters Analyst Lisa Evans at (202) 260-7645.

Region II Continues Disparities Activities

Region II, which has taken a leadership role within OCR in working with the headquarters office to highlight civil rights concerns inherent in racial and ethnic disparities in health care, participated in several recent events. The Arthur Ashe Institute for Urban Health, the Associated Medical Schools of New York, the New York State Council on Graduate Medical Education, and the Biomedical Sciences Careers Program convened a day long conference on Increasing the Representation of Minorities in Medicine and The Health Professions. The conference examined many of the conditions and barriers contributing to minority under- representation in the health professions, as well as the range of potential solutions including policy changes. Surgeon General Dr. David Satcher was the Keynote Speaker and OCR Region II Manager Michael Carter participated as a guest panelist.

In New Jersey, the OCR Region II Manager was the guest speaker at the Healthy Black People Project talk show, sponsored by the Hostess Guild and Men's Club of the Mt. Zion A.M.E. Church of New Brunswick. The talk show focused on The Health Divide: Racial Discrimination and Disparities. The project drew over 300 participants. Robert L. Tarver Jr., trial attorney and nationally recognized legal news commentator, served as the host/facilitator.

Region II applauds the work of Bronx Borough President, Fernando Ferrer, and Dr. Neil Calman, President of the Institute for Urban Family Health, who convened a joint press conference in which the Borough President issued a report discussing racial and ethnic health disparities in New York City. In addition to highlighting barriers that exist in the health care delivery system, the report offers a number of policy recommendations to eliminate racial and ethnic health disparities. We applaud Fernando Ferrer for being the first New York City elected official to address this critical issue. For more information, contact the Borough President's office at (718) 590-6001.

The New York Academy of Medicine under the leadership of Alan R. Fleischman, M.D. produced a comprehensive report entitled "Addressing Racial Disparities in Health Care Delivery: A Regional Response to the Problem," that features the accomplishments of the last two years of OCR's Region II Office. The report is an excellent descriptive guide for other regions to use as they coordinate their efforts to eliminate racial and ethnic health disparities. For more information, contact the Academy at (212) 822-7200 or via the internet at www.nyam.org.

Regions II and III Hold Major Conference on Women, Diversity and Health Disparities

A major conference on "Women, Diversity and Health Disparities" was held in Philadelphia on Sept. 21-22, 2000 to address the six areas of health disparities proposed by Surgeon General David Satcher: HIV/AIDS, diabetes, cancer, cardiovascular disease, immunization, and infant mortality.

One hundred and forty participants, representing African American, Hispanic/Latina, Asian/Pacific Islander, Native American, and Caribbean women, as well as women with disabilities, rural, and lesbian women, participated in roundtable discussions focusing on the elimination of health care disparities for women. Every state in Regions II and III, the District of Columbia, and the territories were represented by staff from community based health and human service providers.

Access to health services and differential treatment in health care were recurrent themes. The recommendations of the conference participants will be presented in a written report to the Secretary of the Department of Health and Human Services (DHHS), the Surgeon General, the Director of the Office on Women's Health, the HHS Office of Women's Health Steering Committee, the ten Regional Health Administrators, the Regional Women's Health Coordinators, the Health Commissioners of the participating states and territories and the conference participants themselves. The report will be posted in late January, 2001, on the website of the Office on Women's Health of the National Women's Health Information Center (NWHIC): www.4woman.gov.

Sandra Estepa and Rosa Myers, the Regional Women's Health Coordinators from Regions II and III, initiated the planning of this bi-regional conference co-sponsored by the Office for Civil Rights Regions II and III, Office of Women's Health, Office of the Regional Director, Office of the Regional Health Administrator, Office of Minority Health, Office of Population Affairs, Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Health Care Financing Administration (HCFA), Administration on Aging, and Administration for Children and Families (ACF).

Congress Creates National Center on Minority Health and Health Disparities

On Nov. 22, 2000, the President signed into law S. 1880, the "Minority Health and Health Disparities Research and Education Act of 2000." The centerpiece of the legislation is the creation of a new National Center on Minority Health and Health Disparities. The Center, to be located at the National Institutes of Health, will fund research on minority health and health disparities. It also will support training of members of health disparity populations as researchers, provide education loan relief for health professionals who commit themselves to perform health disparities research, and improve the study and collection of data regarding minorities and other populations. The Center also will coordinate NIH research efforts in the area of health disparities.

The legislation requires the National Academy of Sciences (NAS) to conduct a comprehensive study of HHS data collection systems and practices. The report by the NAS must identify the data needed for evaluating the effects of socioeconomic status, race and ethnicity on access to health care and other services and on disparities in health and other social outcomes. It must also identify the data needed to enforce existing protections for equal access to health care. The Act provides for consultation with the Director of the Office for Civil Rights and other HHS officials in matters related to recommendations for carrying out activities regarding proficiency in speaking English.

In signing the legislation into law, President Clinton stated, "This legislation provides long overdue attention to the dramatic disparities in the incidence of disease and health care outcomes in minorities as compared to the overall population. It is unacceptable that African American men have a higher overall cancer incidence and infant mortality rates than any other racial or ethnic group; Hispanic and Native Americans suffer much greater rates of diabetes, and Asian American and Pacific Islanders are afflicted with extraordinarily high levels of cancer of the liver. [The legislation] will make a major contribution toward eliminating these disparities by 2010 - a nationwide goal we established over two years ago, and one which must be pursued with the same rigor with which we have worked towards eliminating barriers to basic civil rights."

Region IX Enforcing Rights of Persons Living With HIV/AIDS

Region IX's San Francisco Office is working with providers serving persons with HIV and AIDS to increase education about civil rights, and has investigated and resolved complaints brought by an advocacy organization in Los Angeles, California. The Region IX outreach initiative includes presentations on HIV-related discrimination with Asian-Pacific Islander AIDS Intervention Teams at symposiums in Los Angeles and Santa Ana, California, for health and social service providers working with HIV-positive Asian-Pacific Islanders. Other organizations sponsoring recent Region IX presentations are: the HIV/AIDS Legal Services Alliance (HALSA) in Los Angeles County, the AIDS Service Center in Pasadena, the Inland AIDS Project in Ontario (serving western San Bernardino and Riverside Counties in California), the National HIV/AIDS Update Conference in San Francisco, the Las Vegas Ryan White CARE Act Title I Planning Council, the National Minority AIDS Conference in Los Angeles.

Staff also is working with the Pacific AIDS Education and Training Center, Western Region, in San Francisco. AIDS Education and Training Centers (AETC) are funded by HHS's Health Resources and Services Administration (HRSA), and are located throughout the U.S. The Pacific AETC has 14 sites in Region IX. Most other regions also have multiple sites, usually connected to universities. They provide training at no charge on HIV in the workplace for any occupation, and particularly for health care workers.

Region IX refers to the AETCs as one source for education and training required as corrective actions. HALSA has successfully settled complaints with corrective actions against local dentists who agree to attend training at an AETC site, in lieu of filing a complaint with OCR. Site locations or additional information about AETCs are available on HRSA's web site, or contact Region IX Equal Opportunity Specialist Brock Evans at (415) 437-8321.

Region IX Resolves HIV Complaints from Los Angeles

OCR's Region IX Office in San Francisco recently completed investigations of complaints from the HIV/AIDS Legal Services Alliance (HALSA) in Los Angeles County.

In the first case, the Regional Office signed Resolution Agreements with three skilled nursing facilities in Pasadena and one in South Pasadena to resolve HALSA complaints alleging denial of admission to a 65-year-old woman with HIV. The facilities have taken corrective action, including notice in writing to referral sources, community groups, and media of nondiscrimination policies now in place. In addition, the nursing homes will maintain an admissions log for up to two years, and conduct staff training and education. Region IX facilitated interaction between the Pasadena providers and a Los Angeles provider that offers inpatient skilled nursing care in an integrated setting in which HIV patients represent 20 percent of the total. Staff from the Pasadena facilities attended training at the Los Angeles facility.

In another case filed by HALSA, Region IX verified completion of corrective actions required after OCR found that the L.A. County-USC Medical Center Employee Health Services Director delayed and threatened to deny a health clearance needed by an HIV-positive R.N. nursing student at the county's College of Nursing. DHS provided a full clearance to the nursing student and conducted training of all Employee Health Services staff at all of its facilities. The training included nondiscriminatory treatment of disabled employees, prospective employees, and trainees, use and notice of grievance procedures, and identification and responsibility of the Coordinator of Compliance with Section 504 of the Rehabilitation Act and the Americans with Disabilities Act.

Region V Addressing Kidney Transplant Disparities

Region V's Chicago Office has embarked on an initiative to address the disparity in the receipt of kidney transplants between African-Americans and whites. Kidney failure leads to end-stage renal disease (ESRD), a chronic, life threatening condition. To survive, patients must receive dialysis, a blood cleansing treatment taken usually three days per week for four hours per day, or receive a kidney transplant. These services are funded mainly through Medicare's ESRD Program.

Kidney failure is four times more common among African-Americans than whites. The most common causes are hypertension and diabetes. Yet African-Americans constitute about one-third of those on the waiting list for a transplant. Studies show that African-Americans are less likely to complete the process necessary to receive placement on the transplant waiting list; once on the list, they wait longer than do whites for a transplant. Region V is working with local and national organizations to fashion possible solutions to be implemented locally.

Staff have visited dialysis and transplant centers, compiled and studied articles, and interviewed patients to learn reasons for the disparity. The number of donors is far short of the need. The selection process is governed to a great extent by rules established by UNOS, the United Network for Organ Sharing, under contract with the HHS Health Care Financing Administration (HCFA), which oversees Medicare. Some of the factors considered include whether an available organ is a perfect match for any waiting patient, the extent to which an available organ matches a waiting patient, the region from which the organ came, and the length of time a patient has been on the waiting list.

Although disparities in kidney transplantation are multifaceted, Clive Callender, MD, of the Minority Organ and Tissue Transplant Education Program, believes that tissue matching, specifically the matching of certain "antigens" between the donor and the recipient, constitutes one of the primary barriers to organ access by minorities. Most donors are white and their organs are more likely to match with white patients than black patients. Although recent improvements in immunosuppressant drug therapy have lessened the need for a close match in order for the transplant to succeed, antigen matching is still a factor given weight by UNOS.

To be considered for a transplant, the patient must decide with certainty that this is what he or she wants. Studies show that this decision poses a barrier to minorities, due to factors such as lack of education about transplants, fear of a bad outcome, religious and cultural beliefs, distrust of the medical profession or, conversely, passive reliance on medical staff for decision making.

Other factors may affect a patient's decision. The patient may lose the status of a disabled person as a result of a successful transplant, leading to the cutoff of disability benefits. Expensive immunosuppressant drugs, required for life, are covered by Medicare for a period of only three years, leaving patients to rely on Medicaid if they are eligible, or on private insurance if they have coverage. Many patients must pay out of pocket with the result that some stop taking medications, become ill, lose the organ, and return to dialysis or seek another transplant.

Dialysis centers are not required to refer patients for a transplant evaluation. There are no standardized criteria for "eligibility" for a transplant; transplant hospitals develop their own criteria for patient acceptance as well as for the quality of the organs they accept for use in transplants. There are needs for increased educational efforts for ESRD patients, for more donors (especially African-American donors), and for more scientific research to determine factors that affect the success of transplants involving African-American ESRD patients.

This Spring, Region V will bring interested parties together to develop a plan for future action to lessen the disparity in the Chicago area. We are hopeful that what we learn in Chicago will be of value to others across the country interested in similar problems. For more information, contact Sylvia Philpot at (312) 886-5887 or Patricia Lucas at (312) 353-5999.

Immigrants' Rights Focus of Bi-Regional Training and Regional Conference

Regions II and III, Advocates, Educators Train on Health Care Access for Immigrants

Staff from the Region II and Region III Offices conducted training for health care providers and com- munity groups at a series of four conferences in New Jersey that were sponsored by the New Jersey Immigration Policy Network. The project, funded by Brandeis University, is designed to inform community leaders and providers of current state and federal law related to issues of health care access for immigrant populations. Programs were held in Camden and Princeton and reached over 200 recipients and community groups. OCR staff were joined by representatives from the N.J. Medicaid Agency and the U.S. Immigration and Naturalization Service.

Region I Sponsors Immigrant Rights Conference

On Dec. 11-12, 2000, OCR's Boston Regional Office co-sponsored a regional Immigrant Rights Conference in Marlborough, Mass., in cooperation with U.S. Department of Justice, Community Relations Service and the U.S. Department of Education, Office for Civil Rights. Immigrant advocates, community based organizations, health and human service providers, legal services providers, state and federal agency staff from Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont attended the two-day conference. The conference focus was to increase knowledge of federal civil rights laws, identify problems in the communities we serve and provide information about best practices. The substantive areas covered in workshops and plenary sessions were Immigrant Rights in Employment, Education, Health and Community Services, Public Safety and Public Benefits. Attendees recommended the conference be held again next year.

From the Docket...

Region I LEP Agreement with Maine Medical Center

On July 17, 2000 OCR and the Maine Medical Center in Portland signed an agreement to ensure that limited English speaking patients and their families have access to interpreters and other language assistance. This action follows a lawsuit filed by the American Civil Liberties Union (ACLU) alleging that the hospital had failed to live up to a previous voluntary compliance agreement OCR had reached with the hospital in 1991. That agreement covered only the Khmer and Vietnamese languages. This agreement covers data collection for outpatients, training of interpreters and assessing whether signs and documents should be translated into additional languages.

Background: In January 1998, OCR received a complaint alleging that Maine Medical Center (MMC) violated Title VI and a previous 1991 voluntary compliance agreement with OCR by failing to provide the Khmer- and Vietnamese-speaking limited English proficient patients with needed translation and interpreter services. OCR met with MMC representatives to discuss the allegations and the possibility of revising the compliance agreement. It was apparent during the review process that MMC had not completed monitoring actions such as recording of racial and ethnic data for outpatients, training interpreters and assessing whether signs and documents should be translated into additional languages.

In December 1998, the Maine ACLU filed a lawsuit against the hospital raising the same issues OCR was investigating. OCR engaged in settlement negotiations with the parties but they were unable to reach agreement; however, MMC expressed a desire to reach a resolution with OCR. The successful, new agreement reached on July 17, 2000 will be effective until Dec. 31, 2005.

The OCR/Office of General Counsel Region I team responsible for the successful resolution of this case included Regional Manager Caroline Chang, and Stuart Graham, Donna Gartelman, and Peter Chan.

Region VI Resolves Title VI Complaint in Arkansas

OCR Region VI thanks the civil rights employees of the Arkansas Department of Human Services (ADHS) in Little Rock, for their assistance in resolving Woods v. Arkansas Department of Human Services. The complaint alleged disparate treatment of an African-American case manager who provided Medicaid services to developmentally disabled clients. The complaint, filed under Title VI of the Civil Rights Act, alleged that the conduct of ADHS' Medicaid audits of African-American case managers was based on the race of the provider. OCR and ADHS civil rights staff engaged in cooperative discussions to settle the matter by exchanging information about OCR's complaint and a separate lawsuit that had been filed against the state agency by a group of African-American case managers. Once a settlement agreement was reached in the lawsuit, OCR relayed to ADHS that the complainant would withdraw her complaint if the benefits of the settlement agreement were extended to the complainant. The ADHS agreed and notified the complainant that her audit reports were expunged, and that restitution would not be sought on claims resulting from the audit reports. As a result, the complaint was withdrawn in November.

Region VII Successfully Resolves LEP Juvenile Justice Confidentiality Case in Kansas

The complaint against the Kaw Valley Center, which contracts with the Kansas Department of Social and Rehabilitation Services to provide juvenile justice services for Wyandotte County, Kansas, alleged that the large County population of Hispanic residents who are limited English proficient are not provided interpreter services. The recipient contended that persons often bring family members to interpret because of the confidentiality concerns in juvenile justice matters. The complaint filed with OCR noted that family members may not be appropriate interpreters.

Using Alternate Dispute Resolution techniques, OCR brokered a meeting between the complainant and the recipient. Kaw Valley Center agreed to furnish proof that it hires interpreters who are qualified to provide confidential services to troubled youth; and the recipient trained staff on the new interpreter policies. OCR determined that the recipient complied with Title VI, and closed the case.

Region IX Helps Autistic Child to Obtain Day Care and a Patient With Depression to Obtain Kidney Transplant

Region IX's San Francisco Office successfully negotiated a resolution with a child development center after finding that the center was discriminating against a child with low-functioning autism because of her disability. The Center was requiring the child's family to pay for an attendant for their daughter and prohibited the child from attending day care at a program site with her peers. OCR negotiated a resolution in which the center agreed to provide services to the child with the same terms, conditions, and costs as non-disabled children. The center also agreed to evaluate the child's ability to integrate with her peers at the program site in consultation with an expert in autism. Based on the evaluation, the center will either admit the child to the day care center or fully explain in writing to the family the factual basis for denying her admission based on legitimate, nondiscriminatory criteria. OCR informed both parties that the complainant may appeal a denial of admission to OCR.

In another case, Region IX found that the University of California Davis Medical Center denied a kidney transplant to the complainant based on his disability, depression. The OCR investigation showed that the facility had denied the transplant twice over two years based on the patient's disability, and had failed to follow its own criteria. As a result of OCR's finding, the facility successfully completed a kidney transplant for the complainant.

Headquarters Conducts "Internal Outreach" Civil Rights Forum

Why conduct a civil rights forum for only HHS components? The Department provides millions of dollars of Federal financial assistance for thousands of health and human services programs throughout our nation. Each of these programs is obligated by statute to be accessible to all persons without regard to race, color, national origin, disability, age, and under certain limited conditions, gender. The recent Civil Rights Forum, conducted by OCR's Voluntary Compliance and Outreach Division, will help participants recognize and address civil rights issues as they plan and implement departmental programs. As stated by HHS Deputy Secretary Kevin Thurm in a recent memorandum, "Although OCR plays the lead role in civil rights enforcement, the Secretary and I both want to emphasize that all agencies within the Department share this responsibility."

The highly-successful Forum, held Oct. 18, 2000, promises to be the first of many more to come. Over fifty persons representing all HHS operating divisions and several staff divisions attended. Participants had a chance to hear first hand from the OCR Director, Tom Perez, and engaged in interactive learning activities covering civil rights laws and regulations and interdepartmental partnering ventures and best practices. The Forum's highlight was the opportunity to work in small groups with OCR staff to discuss and resolve hypothetical cases based on actual OCR investigations involving HHS operating division components. The Forum concluded with an informative "open mike" discussion. One topic raised was the upcoming requirement for HHS to enforce section 508 of the Rehabilitation Act Amendments of 1998. This Act requires Federal agencies' electronic and information technology to be accessible to people with disabilities. OCR quickly searched the internet and provided information related to section 508 to participants before the Forum ended.

For more information, contact Johnny Nelson at (202) 619-2742.

HHS Reduces Immigrant Access Barriers With Two Policy Clarifications

OCR and its Director, Thomas Perez, have encour- aged and participated in a number of policy initiatives designed to break down barriers to participation in health and human services programs by eligible members of immigrant families. Most immigrants in the U.S. live in mixed-status families that consist of U.S. citizens and immigrants, some of whom may be eligible for benefits and some of whom may not. In many cases eligible members do not participate in programs when there are ineligible members in the same family. Disproportionate drops in enrollment and participation of immigrant families in the Medicaid and Temporary Assistance for Needy Families (TANF) programs have been documented.

In 1999, the Department of Justice began addressing the reluctance of eligible immigrants to access federal safety net programs, by issuing a clarification that use of Medicaid and other non-cash benefits would not in an of itself be used to deny immigration applications on "public charge" grounds. This year, OCR has issued two key policy clarifications addressing immigrant access barriers, the guidance on providing services to persons with limited English skills, and the guidance on state application processes for public benefits (see articles elsewhere in this issue). Recently other DHHS offices have chipped away at other reasons why eligible members of immigrant families do not participate in government programs, with guidance on INS reporting and on Social Security number requirements in the child care program.

Notice Regarding INS Reporting

DHHS, along with the Departments of Justice, Labor, Housing and Urban Development, and the Social Security Administration, issued a notice in the Federal Register interpreting the mandatory reporting provision found in the 1996 welfare law, section 404 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). See 65 Fed. Reg. 58301 (Sept. 28, 2000).

Section 404 requires certain governmental entities to notify the INS quarterly of any alien the entity "knows" is not lawfully present in the U.S. This provision has been widely misinterpreted as imposing a general duty on benefits agency personnel to report to the INS persons suspected of being undocumented immigrants. As the notice explains, nothing could be farther from the truth: the duty to report is extremely narrow.

As a threshold matter, the welfare law imposes a duty on only three program areas: (1) Temporary Assistance for Needy Families (TANF); (2) Supplemental Security Income (SSI); or (3) Public and Assisted Housing. Under a longstanding provision of the Food Stamp Act, the Food Stamp Program also imposes an INS reporting duty that is as narrowly interpreted as that of the welfare law. Unless a person is applying for food stamps or one of the three programs covered by section 404, there is no agency duty to report under any circumstances.

As to an applicant for one of these four programs, federal agencies have set a very high standard for an entity's "knowledge" of that applicant's immigration status. To "know" that a person is not lawfully present in the U.S. such that there would be a duty to report, the agency must have a formal government determination such as a Final Order of Deportation issued by the Department of Justice. Anything less is mere suspicion.

Immigration status is highly fluid and technical. Even immigrants themselves sometimes make mistakes when asked to identify their status or that of family members. The welfare law does not deputize benefits agency personnel as immigration enforcers. The Notice reminds agencies that inquiries into immigration status should be confined to information needed to determine whether an applicant is eligible for the benefit. There is no authority for asking immigration status questions about family members who are not applying for anything.

Guidance on Social Security Number Requests in Child Care Applications

On October 27, 2000 the HHS Administration for Children and Families (ACF) issued an important clarification that, like the State Application Form Guidance, helps to protect against overbroad requirements for Social Security numbers (SSNs) that can implicate privacy interests. The Guidance, "Clarifying Policy Regarding Limits on the Use of Social Security Numbers under the Child Care Development Fund and the Privacy Act of 1974" is Program Instruction ACYF-PI-CC-00-44 available at www.acf. dhhs.gov/programs/ccb.

SSN requirements are an administrative barrier to participation in child care programs by eligible children in immigrant families. The Guidance reminds States that there is no statutory authority for requiring disclosure of the SSN of the family head as part of the eligibility process for child care, and that States must comply with the Privacy Act of 1974. The Act prohibits making disclosure of SSNs a condition of eligibility unless required by federal law. The Act permits requests for SSNs, but only if the requestor informs the individual that (1) provision of an SSN is voluntary; (2) what the statutory authority is for the request; and (3) what uses will be made of the SSN. The ACF does require States to report to the Child Care Bureau any SSNs collected voluntarily, solely for the purpose of assembling data sets.

The Guidance makes an important clarification about SSN requirements if Temporary Assistance for Needy Families (TANF) monies are being used to fund child care; the TANF statute does require an SSN as a condition of eligibility. However, families who are receiving child care assistance through either the Social Services Block Grant (SSBG) or the Child Care Development Fund (CCDF) are not affected by the TANF SSN requirement even when the SSBG or CCDF funding stream includes transferred TANF funds. In such a case, the TANF funds are governed by CCDF rules.

For more information, contact Dinah Wiley at headquarters, (202) 619-0128.

HCFA's 2002 National Quality Project To Be Health Care Disparities and Culturally and Linguistically Appropriate Services

Each year the Health Care Financing Administration (HCFA) requires that Medicare+Choice (M+C) managed care organizations (MCOs) initiate two quality improvement projects under the Quality Improvement System for Managed Care (QISMC) program. One project is HCFA-directed, selected because of its potential national significance to Medicare enrollees. The other is chosen by the managed care organization based on specific enrollee needs. For the year 2002, HCFA has selected "Health Care Disparities and Culturally and Linguistically Appropriate Services" as the focus of its national project.

The focus on disparities and on cultural and linguistic access will help managed care organizations to use quality assessment and performance improvement (QAPI) projects to meet the statutory and regulatory requirements of the Balanced Budget Act and Title VI of the Civil Rights Act. These laws mandate the assurance of equal access and the provision of culturally appropriate services to all Medicare+Choice enrollees. Under the QISMC 2002 Project, over time M+C organizations will be required to demonstrate improved quality of care in one of several clinical or non-clinical subject areas. MCOs may focus their efforts on a project which either reduces clinical health care disparities for a given minority population or on improving provision of culturally and linguistically appropriate services (CLAS).

A team of HCFA staff has begun to plan for the development of tools to help M + C organizations conduct the project. The agency intends to provide a minimum of three clinical options and one non-clinical option for M+C organization consideration. For example, a managed care entity may choose to focus their efforts on interpretive services, outreach to the community and/or training health care professionals and staff in the unique needs of special populations. Alternatively, they may choose to stratify a current national QAPI project in areas such as care of patients with diabetes or pneumonia, to determine if disparities in health care outcomes exist as a result of race and ethnicity. The specific intervention to improve care will be selected by the M+C organizations. However, technical assistance and other tools developed by HCFA and partners such as the Office of Minority Health and the Office for Civil Rights will be part of the project development strategy. HCFA's focus on assuring provision of interpreter services will contribute to the implementation of OCR's Guidance on providing language access for persons with limited English.

Further information regarding this project will be released in the Spring of 2001 through a HCFA Operational Policy Letter (OPL). For more information, contact Judith L. Bragdon, MS, RN in HCFA's Center for Health Plans and Providers at (410) 786-1037.

OCR Holds First National Staff Retreat

OCR convened its 230 employees in Hunt Valley, Maryland, from September 11-15 of this year for the first national business and training meeting. This was an historic occasion for OCR because it was the first time all of OCR's employees had come together in person. Feedback from advocates, Departmental components and others indicate that OCR's efforts are having an impact in a variety of important areas, such as racial and ethnic disparities, welfare to work, Olmstead implementation, managed care, and language access and other issues affecting immigrant populations. However, OCR leadership recognizes that we can increase our impact in these very important areas through enhanced commitment and energy of all staff and a common understanding of our programmatic goals and directions. OCR has come a long way in a short time but we can always do more to serve vulnerable populations and the national meeting was a key step in the on-going process of continuous improvement of our organization.

At the time of the meeting, significant changes had taken place in the OCR's programmatic direction and infrastructure that had engendered some apprehension and stress among staff. The meeting provided an opportunity for OCR Leadership to focus on organizational development and coping with change as a positive tool not only to move OCR forward to accomplish the ambitious agenda we have for the coming years but to empower staff to derive new fulfillment from their jobs.

By all accounts, the meeting was a huge success. In addition to providing a welcome opportunity for all staff to meet each other face to face, it strengthened and renewed staff commitment to the organization, its mission, and vision, providing an opportunity to explore what staff collectively and individually can do to advance the mission. At the meeting OCR heard from staff directly on ideas for improving the organization and the tools that are needed in a growing organization to improve staff efficiency, productivity and morale. And staff shared much expertise in the substantive program issue areas. As a result of the meeting, OCR is working better together as one national team with a shared vision.

After the national meeting, OCR staff conducted follow up activities throughout the country, forming national work groups to draft action plans for moving certain priorities forward. For example, one group formed to revamp outreach materials and another group formed to increase efforts in the area of racial and ethnic health disparities. Teams are working on strategies for meeting technology needs, and on initiatives to improve communication and collaboration at all levels of the organization.

Each employee in the organization reviewed the draft action plans, and voted for the most promising action steps. The results of the national vote were compiled and formed the basis for the agenda at a Leadership Meeting that OCR convened December 5-8 at the headquarters office in Washington, D.C. The results from that meeting were shared with all staff, and will guide our work in the upcoming year.

OCR leaders at December meeting in Washington, l. to r., top row, Henry Barbour, Deputy Regeional Manager (Reg. IV, Atlanta); Al Sanchez, Deputy Reg Manager (Reg. V, Chicago); Ira Pollock, Region IX Manager (San Francisco); Fred Laing, Deputy Reg. Manager (Reg. VII, Kansas City); Roosvelt Freeman, Region IV Manager (Atlanta); Michael Carter, Region II Manager (New York); second row, Lisa Simeone, Region V Manager (Chicago); Peter Chan, Deputy Reg. Manager (Reg. I, Boston); Caroline Chang, Region I Manager (Boston); Velveta Howell, Region VII Manager (Denver); Kathleen O'Brien, Special Asst. to the Director (HQ); seated, George Bennet, Deputy Regional manager (Reg. VI, Dallas); Carmen Rockwell, region X Manager (Seattle); Johnny Nelson, Dir., Voluntary Compliance & Outreach (HQ); John Halverson, Region VII Manager (Kansas City).

Staff Notes

New Employees

Headquarters
Robinsue Frohboese, Deputy Director
Lisa Evans, Senior Civil Rights Analyst
Shelley Jackson, Senior Civil Rights Analyst
Deeana Jang, Senior Civil Rights Analyst
Dinah Wiley, Senior Civil Rights Analyst
Norman Oslik, Senior Computer Specialist
Patricia Middleton, Office Automation Clerk

Boston
Evelyn Aponte McCarthy, Equal Opportunity Specialist
Lisa Otero, Regional Attorney
Keisha Edwards, Secretary

New York
Lisa Anderson, Equal Opportunity Specialist
Elizabeth Russell, Equal Opportunity Specialist

Atlanta
Lisa Stokes, Office Automation Clerk

Kansas City
Sandra Villarreal, Secretary/Reader

Denver
Luis Corchado, Deputy Regional Manager
Kelly Lewis, Equal Opportunity Specialist
Leo Murphy, Administrative Officer
Stephanie Thomas, Equal Opportunity Specialist
Valerie Morgan-Alston, Regional Attorney

San Francisco
Raymond Lo, Student Clerk
Karin Wang, Supervisory Equal Opportunity Specialist
Lynn Neely-Edmonds, Equal Opportunity Specialist

Seattle
Marcos Zuniga, Regional Attorney
Jennifer Yoakum, Secretary

Retirements

Gloria Baggs, Equal Opportunity Specialist, Seattle
Eddie Castillo, Equal Opportunity Specialist, San Francisco
Stuart Graham, Regional Attorney Boston
Frank E G Weil, Supervisory Equal Opportunity Specialist HQ

Other Departures

Margaret Cordova, Equal Opportunity Specialist, Denver
Marcella Haynes, Director, Policy and Special Projects, HQ
Patricia Mackey, Deputy to the Associate Deputy Director, Office of Program Operations, HQ
Valerie Villaraza, Equal Opportunity Specialist, San Francisco

Welcome to Leadership

Velveta Howell, Regional Manager Denver
Roosevelt Freeman, Regional Manager Atlanta

For More Information ...

National Headquarters
Director
Office for Civil Rights
U.S. Department of Health & Human Services (U.S. DHHS)
200 Independence Avenue, SW - Room 506-F
Washington, DC 20201
(202) 619-0403, (202) 619-3257 (TDD)
Toll Free Numbers: 1-800-368-1019, 1-800-537-7679 (TDD)
E-Mail: ocrmail@hhs.gov
Website: http://www.hhs.gov/ocr

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Last revised: November 23, 2001