Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law

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Appendix A to Part 92—Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement: Discrimination is Against the Law

Wright State Physicians, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Wright State Physicians does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Wright State Physicians, Inc.:

  • 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 is available as requested.
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters – Provided by patients insurance carrier as available or by Global to Local Interpreter Services. (513) 526-5011.
    • Information written in other languages – Available as Requested through Interpreter Services.

If you need these services, contact Peggy Whisman, Patient Relations Coordinator at (937) 245-7233.

If you believe that Wright State Physicians, Inc. 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 with:

Peggy Whisman, Patient Relations Coordinator

  • By phone: (937) 245-7233,
  • By mail: Wright State Physicians Inc., 725 University Blvd., Fairborn, Ohio 45324
  • By email: peggy.whisman@wrightstatephysicians.org

If you need help filing a grievance, Peggy Whisman 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

By mail:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building
Washington, D.C. 20201

By phone:

1-800-868-1019, 800-537-7697 (TDD).

Complaint forms are available at www.hhs.gov/ocr/office/file/index.html

Nondiscrimination statement for significant publications and signification communications that are small-size:
Wright State Physicians, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Appendix B to Part 92—Limited English Proficiency of Language Assistance Services

ATTENTION: If you speak:

  • Arabic
  • Korean
  • Chinese
  • Pennsylvania Dutch
  • Cushite
  • Romanian
  • Dutch
  • Russian
  • French
  • Spanish
  • German
  • Ukrainian
  • Italian
  • Vietnamese
  • Japanese

Language assistance services, free of charge, are available to you.  Call Global to Local Interpreter Services. (513) 526-5011.

Appendix C to Part 92—the Affordable Care Act Grievance

Procedure

It is the policy of Wright State Physicians, Inc. not to discriminate on the basis of race, color, national origin, sex, age or disability. Wright State Physicians, Inc. 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

Peggy Whisman, Patient Relations Coordinator

  • By phone: (937) 245-7233
  • By mail: Wright State Physicians Inc., 725 University Blvd., Fairborn, Ohio 45324
  • By email: peggy.whisman@wrightstatephysicians.org

If you need help filing a grievance, Peggy Whisman is available to help you.

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 Wright State Physicians, Inc. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

Procedure:

  • Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.
  • A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
  • The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Wright State Physicians 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 their 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, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

By mail:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building
Washington, D.C. 20201

By phone:

1-800-868-1019, 800-537-7697 (TDD).

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 allegeddiscrimination. Wright State Physicians, Inc. 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 assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.