Notice Informing Individuals About Nondiscrimination and Accessibility Requirements
DISCRIMINATION IS AGAINST THE LAW
Hospice of Wichita Falls complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Hospice of Wichita Falls does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Hospice of Wichita Falls:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- 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:
- Qualified interpreters
- Information written in other languages
If you need these services, contact us at (940) 691-0982.
If you believe that Hospice of Wichita Falls 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 of Wichita Falls, Chief Operating Officer, 4909 Johnson Road, Wichita Falls, TX 76310
- Call (940) 691-0982
- Email to firstname.lastname@example.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance our Director of Clinical Services 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 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, 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, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.
- Section 1557 of the Affordable Care Act Grievance Procedure
It is the policy of Hospice of Wichita Falls not to discriminate on the basis of race, color, national origin, sex, age, or disability. Hospice of Wichita Falls 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. 18116) 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, Hospice of Wichita Falls, Chief Operating Officer, 4909 Johnson Road, Wichita Falls, TX 76310, (940) 691-0982, or email@example.com@howf.org, who has been designated to coordinate the efforts of Hospice of Wichita Falls to comply with Section 1557.
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 of Wichita Falls to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
- 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 of Wichita Falls 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
electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, 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.
Complaint forms are available at: www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination.
Hospice of Wichita Falls 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.
Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (940) 691-0982 or email firstname.lastname@example.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 (940) 691-0982 or email email@example.com
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(940) 691-0982 or email firstname.lastname@example.org.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (940) 691-0982 or email email@example.com번으로 전화해 주십시오.
برقم اتصل .بالمجان لك تتوافر اللغویة المساعدة خدمات فإن ،اللغة اذكر تتحدث كنت إذا :ملحوظة
( (940) 691-0982 ) والبكمم الصم ھاتف: firstname.lastname@example.org.
اُر ُدو )Urdu
( کال ۔ ہيں دستياب ميں مفت خدمات کی مدد کی زبان کو آپ تو ،ہيں بولتے اردو آپ اگر :خبردار کريں.).or email email@example.com (940) 691-0982
Tagalog (Tagalog – Filipino)
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (940) 691-0982 or email firstname.lastname@example.org.
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le (940) 691-0982 or email email@example.com.
ान द : यदद आप द दी बोलते तो आपके दलए मु म भाषा स ायता सेवाए उपल । (940) 691-0982 or email at firstname.lastname@example.org पर कॉल कर ।
توجه: اگر به زبان فارسی گفتگو می کنید، تسهی ت زبانی بصورت رایگان برای شما تماس بگیرید.or email email@example.com (940) 691-0982فراهم می باشد. با
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (940) 691-0982 or email at firstname.lastname@example.org.
સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો (940) 691-0982 or email email@example.com.
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (940) 691-0982 or email at firstname.lastname@example.org.
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。(940) 691-0982 or email@example.com) まで、お電話にてご連絡ください。
ໂປດຊາບ:ຖ້ າວ່ າທ່ ານເວ້ າພາສາລາວ,ການໍບິລການຊ່ ວຍເຫ ອດ້ ານພາສາ,ໂດຍ່ໍບເສັ ຽຄ່ າ, ແມ່ ນມີ ພ້ ອມໃຫ້ ທ່ ານ. ໂທຣ (940) 691-0982 or email at firstname.lastname@example.org.