PRH Chapter 1: Outreach & Admissions Access
Health & Disability Pat Jackson, RNLead AssessorHumanitas, Inc. Michelle DayProject Manager-Accommodation Support ContractHumanitas, Inc.
Overview • Confidentiality • Communication • Asking about Disability during Essential Admissions Requirements (EARs) Process • Reasonable Accommodation during Admissions Process • Applicant File Review at the Center Level • Scenarios • Resources
Disclosure, Storage and Transmission Confidentiality of health/disability information
HIPAA Overview • The Health Insurance Portability and Accountability Act of 1996 • The Accountability Act or Privacy Rule, a federal law, gives patients rights over their health information and sets rules and limits on who can view protected health information. • It applies to all forms of individuals' protected health information, whether electronic, written, or oral. • The Security Rule, a federal law that protects health information in electronic form, requires entities covered by HIPAA to ensure that health information is secure. • Enforced by the US Department of Health and Human Services’ Office for Civil Rights
HIPAA Authorization • Job Corps requires applicants or legal guardians to sign the HIPAA Authorization as a condition of enrollment prior to the applicant arriving on center. • Authorization informs applicants how, to whom, and why their health information will be shared. • Complete Authorization should be in the student health record.
Documentation Transmission and Storage • Any and all records that are health or disability related, or that contain any of those types of information, must be kept separate from other records about the individual. • If hard copies are transmitted, health or disability information should be placed in a separate file. That file should be placed in a sealed envelope that is clearly marked as containing such information.
Documentation Transmission and Storage • If the applicant withdraws his or her application or chooses not to enroll, all supporting documentation, including all medical, health, and disability-related documentation, must be returned to the AC.
Job Corps Applicant Eligibility Folder Inventory • Appendix 105: Health and Disability History Envelope • ETA 6-53 • Authorization for Use and Disclosure of Your Health Information Form (HIPPA) • Job Corps Informed Consent to Receive Mental Health and Wellness Treatment • Medical records • Individualized Education Program (IEP) • Reasonable Accommodation Request form • Psycho-educational reports • Other cognitive and achievement testing results • Any other protected medical/disability-related information (i.e., summaries from current and/or recent medical providers or treatment facilities, including mental health and substance abuse) • Immunization records • Chronic Care Management Plans provider form(s) • Orthodontic treatment form (if applicable) • Dental records (if applicable) • Supplemental documentation relating to health and wellness (examples) • Copy of health insurance card (front and back)
Summary • Federal law enacted by Congress to protect the privacy of patients’ medical records • Information is disclosed only to staff that have a need to know • Transmission, storage, and confidentiality of protected health information must be safeguarded • Do not share information in front of others like (elevator, water cooler, corridors)
Collection and Handling of Health-Related Documents • ACs must: • Use the ETA 6-53 Job Corps Health Questionnaire to collect health information about the applicant offered enrollment. • Forward the originals of the ETA 6-53 of the applicant offered enrollment, and all documentation that has been collected, to the center of assignment. These documents must be forwarded in envelopes or files that are sealed and kept separate from any other information about the applicant offered enrollment.
Collection and Handling of Health-Related Documents • For applicants that are not offered enrollment retain copies of the ETA 6-53, and all related documentation that has been collected, in a file that is stored separately from any other information about the applicant. • The ETA 6-53, the related documentation, and all other medical or disability-related information about the applicant must be kept confidential, and access to this information must be strictly limited to persons with a need to know, as described in Appendix 607.
Appendix 607 • Only the categories of persons identified in Appendix 607 may be permitted to review, or have access to the applicant’s medical, health, or disability-related information. • Any medical, health, or disability-related information about a particular person – whether that person is an applicant to Job Corps, an enrollee, an employee, an applicant for employment, or anyone else – must be treated with extreme care. Federal law requires that all such information be treated as strictly confidential, and that it be transmitted and stored in a way that ensures confidentiality. Confidentiality: The General Rule is Do Not Tell
Knowledge Versus Access • The categories of persons who are permitted to have access to a particular individual’s underlying medical, health, or disability-related documents are still more limited. Even among those who may be informed either about the fact that an individual has a disability, or about specific details related to a disability or medical condition. • Very few people will genuinely need to see or use those documents.
Q & A Q: Who may be informed either about the fact that a particular individual has a disability, or about specific details related to a disability or medical/health condition? A: Only people who need to know (“need to know” is interpreted narrowly)
Applicants and Others with Disabilities Communication
Communicating • Communication with applicants and others who have disabilities must be as effective as communication with others. • This obligation is separate from reasonable accommodation (Appendix 606) • Even before taking the actions described in that appendix, ACs need to know that if they receive a request for auxiliary aids and services (communication aids) for a person with a disability, they:
Communicating - Legal • Must address the request immediately; and • Must not begin, or continue with, any part of the admissions process until some sort of communication aid has been provided that is acceptable to the person for whom the auxiliary aid and/or service is being requested.
Age and Income Asking about disability during EARs process
Asking About Disability • In general AC would not ask whether applicant has disability prior to conditional enrollment in program, however, at two points in process of determining eligibility, ACs may invite applicant to disclose. • How? • Explain that disclosure is possible • Explain four principles • Explain definition of disability • Explain applicant response options
Possible Disclosure • Before EAR process begins, explain to every applicant, and his or her parent, guardian if a minor, or other representative, that two of the EAR questions (age and low-income status) may result in answers disclosing that the s/he has a disability.
Four Principles Explain the four principles that apply to all medical and disability-related questions in Job Corps. • Providing disability-related information is voluntary. • The information will be kept confidential as required by law.
Four Principles (cont’d) • Declining to disclose whether he or she has a disability will not cause the applicant to receive unfavorable treatment (except that if the applicant decides not to disclose, there is a possibility that he or she will not be found to meet the age requirements and/or qualify as low income) • The information will be used only in accordance with the law.
Definition of Disability • Explain to the applicant that under the law, he or she may be considered a “person with a disability” if: • He or she has a physical or mental impairment; • The impairment affects one or more of his or her major life activities. The term “major life activities” refers to activities that are of central importance to daily life, e.g., caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, leaning, and working; • The effect of the impairment is substantial.
Applicant Response Options • Explain to the applicant that when s/he is asked whether s/he falls into the category of an individual with a disability, the applicant should select only one of three possible answers: • Yes • No • Do not wish to answer
Age and Income • So when during EAR process may you be asking if the applicant is an individual with a disability? • If the applicant is, or will be, over 24, on the date of enrollment. • If the applicant would not meet the low-income requirement unless the applicant is considered a “family of one” because of disability.
Disability Determination • AC will not determine applicant is a person with a disability. The center will do this. • Do not review health and medical information, place in sealed envelope with applicant file that will be forwarded to center for review. • Continue EAR process
Appendices 106 and 605 Reasonable accommodation during admissions process
Reasonable Accommodation Request Forms • There are two reasonable accommodation request forms. • Appendix 106 • Accommodation(s) needed to participate in the admissions process • Appendix 605 • Accommodation(s) needed to participate in the Job Corps program
Accommodations for Admissions Process • Applicant with a disability is entitled to request and receive reasonable accommodation at any time during the admissions process. • If the applicant is requesting reasonable accommodation to participate in the admissions process, the AC: • Must address the applicant’s accommodation needs immediately; and • Must not begin, or continue with, any part of the admissions process for which the applicant has requested accommodation until the accommodation has been provided.
Accommodations for Admission Process – Do’s • The AC will inform each applicant of his or her right to request and receive reasonable accommodation at any time during the admissions process and then review the Job Corps Reasonable Accommodation Request Form (Appendix 106).
Accommodations for Admissions Process – Don’ts • Even if the applicant requests accommodation for the admissions process, the AC must not: • ask whether the applicant will need accommodation to actually participate in Job Corps. • assume that the applicant will need accommodation to participate in Job Corps. • ask for any disability-related information except at the times, and under the circumstances, that are described elsewhere in PRH 1 (e.g., age and income during EARs process, reasonable accommodation process to participate in program, 6-53). • take the applicant’s disability into consideration in determining whether he or she meets the eligibility requirements or other factors for enrollment in Job Corps (e.g., age and income during EARs process).
RA Form – Appendix 605 When? • After EAR process. • After conditional offer of enrollment and applicant assigned to center. • At same time as 6-53.
RA Form – Appendix 605 How? • Inform applicant of right to request reasonable accommodation to participate in program. • Explain four principles (voluntary, confidential, no unfavorable treatment, use in accordance with law) and that if request is not made now, it can be made at any time during rest of enrollment process or after arrival on center. • Go through form with applicant.
RA Form – Appendix 605 How (cont’d)? • Have applicant completes form if s/he wants to request accommodation; AC can assist. • Do not review health and medical information, place in sealed envelope with applicant file that will be forwarded to center for review. • Nothing has changed with this process.
Talking to an Applicant about Reasonable Accommodation • Job Corps Disability Website • JC Community
Processing Applications to the Job Corps Program Applicant File review at the center level
Applicant File Review Procedures • SOP describing center’s process for reviewing applicant files required; should describe in detail how applicant file is processed from the time it arrives on center through a final disposition.
Applicant File Review Procedures • Responsibilities of records staff: • Gatekeeper of files • Forwards the sealed medical, health, or disability-related information unopened to the appropriate staff. • Maintains records log • Responsibilities of center file review team: • Appropriate center staff conducts a review of each applicant’s file • All applicant files must be forwarded to the HWM or his or her designee for a health documentation review and initial direct threat review.
Only Potential Application Outcomes • Enrollment • Applicant withdrawal • Found ineligible based on information that was not reasonably available to the AC • Recommendation for denial • Direct threat • Cannot meet basic health care needs
Ineligible Based on New Information • Neither the center file review team nor its individual members may revisit the determination that an applicant is qualified for admission unless: • There is new information presented that the AC could not have reasonably known at the time the applicant’s qualification for admission was established, and • This new information indicates that the applicant offered enrollment may not meet one of the EARs. • Center must use same assessment/verification requirements and guidance used by AC in Exhibit 1-1 to make determination that applicant does not meet the EAR.
New Information – Center Denial • If the center determines that the applicant is no longerqualified for admission based on new information, the center will notify the AC. • ACmust contact the applicant to explain why the application has been denied. • This contact must be documented, and a written explanation of denial must be provided to the applicant (see Appendix 104), along with an explanation of the applicant’s rights to appeal and to file a discrimination complaint, as described in Section 1.2.
Direct Threat • A direct threat assessment should be completed whenever Job Corps believes that an applicant poses a direct threat to the health or safety of himself or others. • This typically will occur after the applicant has received conditional assignment to a Job Corps center and has completed the 6-53 Health Questionnaire. • Poses a significant risk of substantial harm to the health or safety of the individual or others; and • Cannot be eliminated or reduced by reasonable accommodation or modification. • See Appendix 609
Health Care Needs • Center can recommend denial if determination is made that Job Corps cannot meet the health care needs of an applicant. • Appendix 610 (future PRH release) will provide health staff with guidance on this process. • Health staff should contact regional health specialists if questions about this process.
Center Recommendation for Denial – Direct Threat or Health Care Needs • Any applicant file recommended for denial for direct threat or health care needs will be forwarded to the regional office for a final disposition. • Follow Regional Office procedures for processing these applicant files. • If denial recommendation rejected by the Regional Office, applicant must be scheduled for arrival based on the date on which the application first arrived on center.
Reasonable Accommodation • The applicant is engaged in an interactive process to determine reasonable accommodation needs prior to assigning the applicant a start date in cases where an applicant requests reasonable accommodation or information/documentation in the applicant file indicates accommodation may be necessary. • See Appendix 605.
Let’s Practice! Applicant Scenarios
Scenario #1 • AC certifies that applicant meets all admissions criteria and file is forwarded to the center for review • Applicant allegedly commits a crime after he receives a conditional offer of enrollment, and center learns of existing charges when health and wellness manager calls applicant to talk about a health care need What should happen next?