Auxiliary Aid Service Provision and Network Monitoring Plan



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Auxiliary Aid Service Provision and Network Monitoring Plan This plan delineates how Central Florida Cares Health System (CFCHS), Inc. provides auxiliary aid services, and monitors CFCHS Subcontractors performance in providing appropriate auxiliary aids and services to persons and companions who are deaf or hard-of-hearing or who have Limited English Proficiency (LEP).

I. INTRODUCTION... 1 CENTRAL FLORIDA CARES HEALTH SYSTEM (CFCHS) POLICY... 1 II. PURPOSE... 1 A. GOALS AND OBJECTIVES... 1 B. AREAS OF RESPONSIBILITY... 1 C. DEFINITIONS... 2 III. PROCEDURE:... 4 IV. MONITORING PROTOCOL... 6 A. SUBCONTRACTORS/PROVIDERS SUBJECT TO MONITORING... 6 B. APPLICABILITY, FREQUENCY, METHOD... 6 C. NON-DIRECT CARE SERVICE PROVIDERS... 6 D. SUBCONTRACTORS/PROVIDERS WITH LESS THAN 15 EMPLOYEES... 6 E. DEFICIENCIES... 7 F. Monitoring Plan Review... 7 V. GUIDELINES FOR MONITORING... 7 A. NOTICE... 7 B. AUXILIARY EQUIPMENT... 7 C. DOCUMENT REVIEW... 7 D. TOUR OF AGENCY... 9 E. INTERVIEWS... 9 VI. OUTCOMES... 9 VII. CFCHS Auxiliary Aids Monitoring Tools..11

I. INTRODUCTION CENTRAL FLORIDA CARES HEALTH SYSTEM (CFCHS) POLICY It is the policy of Central Florida Cares Health System, Inc. (CFCHS) to ensure that persons who are deaf or hard-of- hearing are afforded equal opportunity in employment and in receiving services as stipulated by Section 504 of the Rehabilitation Act of 1973 (hereinafter referred to as Section 504 ) and the Americans with Disabilities Act (ADA), as well as Department of Children and Families Operating Policy (DCF CFOP) 60-10, Chapters 1, 3 & 4. II. PURPOSE The purpose of this plan is to ensure that effective communication with deaf or hard-of-hearing persons or companions is taking place at CFCHS and at the Subcontractor level. This plan delineates how CFCHS provides services to individuals who require auxiliary aids, and reviews and monitors CFCHS Subcontractor/Provider Network s operational performance in providing appropriate auxiliary aids and compliance with: 1. Title II of the Americans with Disabilities Act (ADA); 2. Section 504 of the Rehabilitation Act of 1993; 3. Section M of the Settlement Agreement between the Department of Children and Families (DCF) and the United States Department of Health and Human Services (HHS) on January 26, 2010; 4. DCF Operating Procedures; and 5. CFCHS Auxiliary Aids Services Policies and Procedures. A. GOALS AND OBJECTIVES The goals and objectives reflected herein are designed to identify methods within CFCHS system of care and provider network programs, policies and procedures that ensure adequate provision of auxiliary aids and services to persons and companions who are deaf or hard-ofhearing. B. AREAS OF RESPONSIBILITY The CFCHS Single Point of Contact (SPOC) is responsible for the development, implementation, revision and oversight of the CFCHS auxiliary aids plan, as well as monitoring the provider network. CFCHS Auxiliary Aids Monitoring Plan - 2013 Revised 5/29/2014

C. DEFINITIONS Aid Essential Communication Situation Any circumstance in which the importance, length, and complexity of the information being conveyed is such that the exchange of information between parties should be considered as an aid essential communication situation, meaning that the requested auxiliary aid or service is always provided. Auxiliary Aids and Services Includes qualified interpreters or other effective methods of making aurally delivered materials available to individuals who are deaf or hard of hearing; qualified readers, taped texts, or other effective methods of making visually delivered materials available to individuals with visual limitations; acquisition or modification of equipment or devices; and other similar services and actions. Captioning (Real Time) This is the simultaneous conversion of spoken words to text, through computer assisted transcription or court reporting, and displaying the text on a video screen. This communication service is beneficial to individuals who are deaf or hard of hearing that do not use sign language or for whom assistive listening devices and systems are ineffective. Certified Interpreter Is a person who is certified by the national Registry of Interpreters for the Deaf (RID) or other national or state interpreter assessment and certification program. Certified Deaf Interpreter Is an individual who is deaf or hard of hearing and has been certified by the RID as an interpreter. Deaf Person A term used to describe a person whose hearing is totally impaired or whose hearing, with or without amplifications, is so seriously impaired that the primary means of receiving spoken language is through visual or other sensory input including, but not limited to, lip reading, sign language, finger spelling or reading, gestures or tactile signs. Dual Sensory A term used to describe a person having both a visual disability and a hearing disability. The term includes all ranges of loss, which would necessitate the use of auxiliary aids and services for communication. Florida Relay Service (FRS) A service offered to all persons in the state that enables a hearing person to communicate with a person who has a hearing or speech disability and must use a TDD/TTY through a specially trained operator called a communications assistant. Hard-of-Hearing - A term used to describe a person having permanent hearing limitations that are severe enough to necessitate the use of auxiliary aids or services to discern speech sounds in verbal communication. Intermediary Interpreter Is a Certified Deaf Interpreter or Deaf Interpreter also known as a relay or intermediary interpreter, can be used in tandem with a qualified sign language interpreter. Interpretation Is an oral language assistance service.

Limited English Proficiency (LEP) Is a limited ability to speak, read, write, or understand the English language at a level that permits a person to interact effectively with health and social service agencies and providers. Persons with LEP are referred to as persons who are Limited English Proficient. Non Aid Essential Communication Situation Is a situation in which DCF, CFCHS and network providers/subcontractors have flexibility in the choice of appropriate auxiliary aids or services for customers or companions to ensure effective communication. Oral Transliterates/Oral Interpreters Are individuals who have knowledge and abilities in the process of speech reading, speech production and the communication needs of speech readers. Qualified Interpreter Is an individual who is able to interpret competently, accurately, impartially and effectively, both receptively and expressively, using any specialized terminology necessary for effective communication with a customer or companion who is deaf or hard of hearing. Qualified Interpreter in Mental Health Is a qualified foreign language interpreter/translator who is also familiar with behavioral health terminology and practices. Sign Language Interpreter Is a person who engages in the practice of interpreting using sign language. Single Point of Contact (SPOC) (Risk Manager at CFCHS) Is an individual charged with coordinating auxiliary aids and communication assistance services to customers and companions with disabilities or Limited English Proficiency. Tactile or Close Vision Interpreter (for individuals who are deaf-blind) Is an individual who accurately facilitates communication between individuals who are deaf and blind. Translation Is a written communication service. Translators convert written materials from one language into another. They must have excellent writing and analytical ability, and because the translations that they produce must be accurate, they also need good editing skills. TTY/TDD TTY (Teletypewriter) or TDD (Telecommunications Device for Deaf) are devices that are used with a telephone to communicate with persons who are deaf or hard of hearing or who have speech limitations by typing and reading communications. Visual Disability Is a generic term used to describe any loss of vision.

III. PROCEDURE: 1) CFCHS and its network providers will train all staff in the provision of auxiliary aids services as required by the DCF-HHS Settlement Agreement, upon hired, and annually thereafter. Agencies that have 15 employees or more will require, during orientation period, all staff to complete the DCF mandated online training Serving Our Customers Who are Deaf or Hard of Hearing. In addition, agencies with 15 employees or more will provide monthly compliance summaries directly to HHS Compliance Report Database, and will forward the confirmation e-mail from the Regional Civil Rights Officer to their respective Contract Manager. 2) All employees shall review and sign the CFCHS Support to the Deaf or Hard-of-Hearing Attestation Form that acknowledges understanding of auxiliary aid services and procedures to properly serve customers who are deaf or hard-of-hearing. In addition, the CFCHS Support to the Deaf or Hard-of-Hearing Attestation Form will be part of the New Hire Information Packet and included in the staff personnel files. 3) CFCHS, and its network providers with more than 15 employees, shall designate the Risk Manager as the Single Point of Contact (SPOC) to ensure that the agency is equipped with the resources necessary to ensure effective communication with clients or companions who are deaf or hard-of-hearing; and to ensure that auxiliary aid services are documented properly. 4) The SPOCs will ensure that auxiliary aids are available for use by customers and companions and persons with LEP, at no cost to the client/customer or companion during all phases of the service delivery process (e.g. telephone inquiries, special accommodations requests, intake interviews, service delivery, complaints, training, access to services, meetings open to the public, etc.) SPOCs will also periodically monitor providers auxiliary aid services, and will work ensure compliance with the applicable requirements of Section 504, ADA and DCF CFOP 60-10. 5) SPOCs shall ensure that the notices which include the availability of appropriate auxiliary aids and services at no cost to the deaf or hard of hearing customers or companions and persons with Limited English Proficiency are posted in a conspicuous place accessible to visitors at all points of client entry. 6) CFCHS and Network staff will determine the customer s preferred communication method to accommodate disabilities and Limited English Proficiency. CFCHS staff shall ensure that the following forms provided by DCF are utilized to meet the actions outlined in numbers 1-6 above: a. Customer or Companion Communication Assessment and Auxiliary Aid and Service Record Form (DCF Form CF 761). b. Communication Plan for Ongoing Services (to be documented as part of DCF Form CF 761). c. Customer or Companion Request for Free Communication Assistance or Waiver of Free Communication Assistance (DCF Form CF 763)

d. Customer/Companion Feedback Form (Appendix D of DCF Auxiliary Aids Plan March 2012) 7) For scheduled appointments, the interpreter shall be available at the time of the appointment or within two hours the latest. For non-scheduled appointments, arrangements shall be made immediately and CFCHS and Network providers shall try to get an interpreter within two hours, or as soon as possible, taking in consideration the client s schedule. 8) Staff shall be aware of the difference between Aid-Essential Communication vs. Non- Essential Communication, as stipulated in the definitions section of this plan. For all Aid- Essential Communication, staff shall ensure there is always an interpreter available due to the nature of the communication being exchanged. If the client refuses the services of an interpreter, the staff should explain that they have the right to do so. However, the agency needs to make use of an interpreter due to the importance and nature of the communication being exchanged. 9) If after service provision, staff realizes that the auxiliary aid provided was ineffective, staff should reassess the situation by consulting with the client to find out what went wrong. Based on the information obtained additional auxiliary aid services will need to be rescheduled. 10) Staff shall notify any referral agency (i.e. when arranging referrals to outside agencies) the communication preferences of the client and companions and any auxiliary aids and/or LEP services that are needed. 11) Records relating to auxiliary aids and services provided shall be retained for a minimum of ten (10) years. 12) SPOCs shall ensure that all public event/meeting notices and materials designed for clients include information about provision of auxiliary aids, and special accommodations should be made for individuals with disabilities. 13) CFCHS and its network providers shall keep an Auxiliary Aids Plan, or policies and procedures, to guide employees on the steps to follow when serving clients who require auxiliary aid services. Such plan should also include information about how monitoring is implemented to ensure compliance with the stipulations of the DCF-HHS Settlement Agreement. 14) Only certified interpreters should be used, staff shall request proof of qualifications and applicable certifications upon request of each service, or by checking the Florida Registry of Interpreters for the Deaf (FRID) at http://www.fridcentral.com 15) Staff and providers should also make use of the Florida Relay Service which is the communications link for people who are Deaf, Hard of Hearing, Deaf/Blind, or Speech Disabled. Through the Florida Relay Service, people who use specialized telephone equipment can communicate with people who use standard telephone equipment. To call Florida Relay, dial 7-1-1, or use the appropriate toll free numbers

1-800-955-8771 (TTY) 1-800-955-8770 (Voice) 1-800-955-1339 (ASCII) 1-877-955-8260 (VCO-Direct) 1-877-955-5334 (STS) 1-877-955-8773 (Spanish) 16) CFCHS and all its network providers should have processes in pace to address complaints and grievances regarding auxiliary aid service provision. IV. MONITORING PROTOCOL A. SUBCONTRACTORS/PROVIDERS SUBJECT TO MONITORING All CFCHS subcontractors/providers that have direct contact with clients/consumers and companions who are deaf or hard- of- hearing will be subject to monitoring as set forth in this plan. B. APPLICABILITY, FREQUENCY, METHOD Monitoring of subcontractors/providers that have more than 15 employees will take place periodically, unless a more frequent review need is identified by the CFCHS SPOC. Monitoring method may include: 1. Desk reviews of the provider s Auxiliary Aids Policies and Procedures and Auxiliary Aids Services and Monitoring Plans. Desk reviews are employed with the goal of causing the least disruption possible in the provider s direct care service operations. 2. Onsite visits that include File Reviews (Clients, and Human Resources files for staff), Facility Inspection, and Staff Interviews. C. NON-DIRECT CARE SERVICE PROVIDERS Subcontractors/providers that do not provide direct care treatment, but information and referral, or advocacy training such as 211 United Way, 211 Brevard, and Mental Health Association of Central Florida, are exempt from this monitoring. These types of providers are still expected to assist persons who are deaf or hard-of-hearing access services provided (i.e. information and referral. D. SUBCONTRACTORS/PROVIDERS WITH LESS THAN 15 EMPLOYEES CFCHS subcontractors/providers with less than 15 employees will be subject to desk reviews of their auxiliary aid policies and procedures, but are not required to have an auxiliary aids services and monitoring plans. These providers are still expected to assist persons who are deaf or hard-of-hearing access services provided by their organization.

E. DEFICIENCIES If deficiencies are found in any area, CFCHS staff will follow the guidelines delineated by CFCHS Subcontractor Monitoring, and Performance Improvement Plan Request policies and procedures found available upon request to CFCHS contract management department. F. Monitoring Plan Review This Monitoring Plan is reviewed annually and may be revised more frequently based on previous monitoring outcomes. V. GUIDELINES FOR MONITORING A. NOTICE CFCHS will send a letter to the provider SPOC informing him/her of the Auxiliary Aids monitoring date and time. This notice will indicate that the monitoring consists of a dual process that includes a desk review and an onsite visit. The monitoring tools will be provided along with the monitoring agenda. The selection of Human Resources (HR) files and staff to be interviewed will take place randomly the day of the on-site visit. A minimum of 10 HR files will be reviewed. B. AUXILIARY EQUIPMENT The agency s auxiliary aids equipment shall be tested to ensure proper function, use and access by staff. C. DOCUMENT REVIEW The CFCHS SPOC (or designated monitoring staff) will request and review the following documents: 1. Auxiliary Aids and Services Plan a. CFCHS will review the agency s Auxiliary Aids and Services Plan ( The Plan ) prior to the onsite monitoring to ensure that it is current and compliant with the current DCF CFOP 60-10, and DCF-HHS Settlement Agreement. b. Where necessary, policies and procedures will be revised to reflect current DCF policy relative to providing auxiliary aids and services to persons or companions who are deaf or hard-of-hearing. c. The Plan should reference current auxiliary aids and services used by the deaf or hard-of-hearing community as well as the agency's process for providing these services in a timely manner. d. CFCHS will provide technical assistance if the provider relies upon outdated auxiliary aids or services, or if the agency does not utilize auxiliary aids commonly used by the deaf or hard-of- hearing community.

2. Policies and Procedures Addressing Accommodations, Auxiliary Aids, Accessibility, and Service Provision to Individuals with Disabilities CFCHS will review the agency s policies and procedures that address accommodations, auxiliary aids provision, accessibility and service provision to individuals with disabilities. The focus of this review is to determine compliance of the agency s policies and procedures with auxiliary aids service requirements, implementation and scope. 3. Auxiliary Aid Monitoring Plan CFCHS will review the agency s monitoring plan, and ensure there are provisions for the SPOC to evaluate the appropriate provision of auxiliary aids. 4. Auxiliary Aid Record Monthly Summary Reports Each subcontractor who provides direct care services and has more than 15 employees shall report monthly to the HHS Form site Data Base at: https://fs16.formsite.com/dcfuser/monthly-summary-report/form_login.html Subcontractors shall forward receipt of e-mail confirming completion to their CFCHS Contract Manager. Copies of the monthly reports shall be kept on file by the subcontractor/provider. 5. Completed Self-Assessment Every three years DCF will conduct Statewide Self-Assessments to evaluate the subcontractors/provider ability and preparedness to provide auxiliary aids and services. The DCF 504/ADA Coordinator will distribute the self-assessment tool and provide a time frame for when the assessment needs to be returned to DCF. The CFCHS SPOC will ensure that the assessment is completed by each subcontractor s/provider s SPOC. Copies of self-assessments and proof of submission shall be kept on file by the subcontractor/provider SPOC. 6. Case file review Client/consumer service records will be reviewed to ensure that the following documents have been properly completed, and that the progress notes reflect actions taken to ensure proper provision of auxiliary aids: a) Customer/Companion Communication Assessment and Auxiliary Aid Record; b) Customer/Companion Request for Free Communication Assistance or Waiver of Free Communication Assistance; c) Communication Plan for Ongoing Services; d) Customer/Companion Feedback Form (which customer/companion should mail to Tallahassee, NOT kept in client record); and e) Interpreter/auxiliary aid service provider billing documentation. The number of case files to be reviewed will depend on the amount of auxiliary aid services provided at the facility for the given period of the monitoring. If there are more than 10 case files, then at a minimum 10 records shall be reviewed. If there are less than 10, then all

records should be reviewed. 7. Personnel Files Review At a minimum, 10 employee HR files shall be reviewed to ensure: a) Proof of auxiliary aid training within 60 days of hire; b) Annual refresher training; and c) Employee Support for the Deaf and Hard-of-Hearing Attestation Form. 8. Client/Consumer Complaints or Grievances CFCHS will review the agency s process to address all discrimination complaints and grievances filed by employees and customers. The complaint and grievance process should contain a provision allowing clients/consumers or companions to file discrimination complaints with an external agency. The procedure must provide addresses and contact information for the external agencies. 9. SPOC Position Description CFCHS will review the agency s position description for its SPOC to ensure that the individual has the expertise necessary to serve in this role and also that the position fulfills the requirements of the Settlement Agreement. D. TOUR OF AGENCY a) Verify that the three required notices (Interpreter Services for the Hearing Impaired Poster, DCF Non-discrimination Poster, and Limited English Proficiency Poster) are posted in appropriate locations and are of appropriate size (11x17); b) Ensure that the fire alarms have lights along with sound; c) Confirm that the provider s Auxiliary Aid Plan is posted in the provider s website; and d) Review the agency s public notifications, handbooks, and brochures to ensure they provide information for individuals with disabilities regarding auxiliary aids, and how to request special accommodations. E. INTERVIEWS CFCHS will interview between 1 and 10 individuals, including the agency s SPOC. Staff to be interviewed will take place randomly the day of the on-site visit. VI. OUTCOMES A. Any indicators of non-compliance shall be reviewed by CFCHS to determine if further investigation is warranted. Corrective measures shall be developed in accordance with the findings. Corrective measures may include, but are not limited to, retraining of staff, programmatic system review, or other actions as appropriate. B. The report must detail all areas where a subcontractor/provider has not implemented the

terms of the Settlement Agreement and specify any area where corrective action and technical assistance may be needed. The provider will be required to submit the corrective action plan to CFCHS within (30) calendar days of receipt of the report. C. For those subcontractors/providers subject to corrective measures, CFCHS will periodically request follow-up information, at least once every six months, to ensure that the provider is complying with the remedial measures put in place. VII. CFCHS AUXILIARY AIDS MONITORING TOOLS SPACE LEFT BLANK INTENTIONALLY

AUXILIARY AID PLAN REVIEW Agency Name: Date of Site Visit: Mailing Address: Physical Location: Type of Site Visit: Annual / Special Monitoring: CFCHS Staff Conducting Site Visit: Subcontractor Staff Participating In Site Visit (Including Official Title): REQUIREMENT (Requirements of DCF CFOP 60-10 Ch 3 and 4, and the 2010 DCF-HHS Settlement Agreement) YES NO N/A 1. Does the plan include the provision of Aux Aids for customers who are deaf, hard-of-hearing, have other disabilities, or have limited English proficiency (LEP)? 2. Does the plan provide clear instructions for staff to timely request Aux Aids, on a 24/7 basis? 3. Does the plan specify that the type of auxiliary aid provided should be based on the customer s preference? 4. Does the plan instruct staff what to do if the auxiliary aid provided is found to be ineffective? 5. Does the plan instruct staff what to do if the scheduled auxiliary aid does not show or cancels (in cases of on-site interpreters)? 6. Does the plan specify what procedures should be followed in the event the agency denies a requested auxiliary aid? 7. Is the plan posted on the agency s website? 8. Is the plan available in different formats if requested by staff, customers or companions? 9. Does the plan require record retention of all documents used in the provision of auxiliary aids? If so, what is the record retention schedule? 10. Does the plan ensure accessibility at meetings, conferences, trainings, and open forums to individuals who are in need of auxiliary aids, or any other special accommodation due to a disability? 11. Does the plan instruct that all new employees receive auxiliary aid training within 60 days of hire, and that the training certificate is kept with the HR files? 12. Does the plan require that all the agency staff sign the Support to the Deaf and Hard-of-Hearing Form? 13. Does the plan require annual refresher training on the provision of auxiliary aids? 14. Does the plan require that employees receive training on how to use the auxiliary aid equipment available at the agency? 15. Does the plan require verification of the interpreter s certification? 16. Does the plan contain a list of certified sign language interpreters? 17. Does the plan contain a list of qualified foreign language interpreters?

REQUIREMENT (Requirements of DCF CFOP 60-10 Ch 3 and 4, and the 2010 DCF-HHS Settlement Agreement) YES NO N/A 18. Does the plan contain information about accessing the Florida Relay Service? Video Relay Interpreting Services Captioning in Real Time (CART) MONITORING 19. Does the plan include the timeframes for ongoing monitoring? (minimum once a year) 20. Does the plan specify what agency department, or staff, is in charge of this monitoring? (usually SPOC, or QI Dpt) 21. Does the plan instruct for the review of the Single Point of Contact job description? 22. Does the plan require review of the following in the client file? Customer/Companion Communication Assessment and Auxiliary Aid Service Record Customer/Companion Request for free Communication Assistance or Waiver of Free Communication Assistance Entry in the client file about distribution of Customer/Companion Feedback Form (the actual form is to be mailed by client to Tallahassee) File entry about the auxiliary aid services provided Verification of the interpreter s certification. 23. Does the plan require file review for the following in the employee HR file? Attestation of Support to the Deaf and Hard-of-Hearing Form Certificate of Auxiliary Aids training within 60 days of hire Annual Auxiliary aids refresher training annually. 24. Does the plan require the review of complaints/grievances regarding the provision of auxiliary aids? 25. Does the complaint/grievance procedure and form include the contact info for the DCF Office of Civil Rights, U.S Department of Health and Human Services (HHS), and United States Department of Justice (USDOJ)? 26. Does the plan ensure monitoring for the submission of Auxiliary Aid Record Monthly Summary Reports? (E-mail receipt from HHS should be kept as proof of monthly report submission). 27. Does the plan instruct for the review of policies and procedures that address auxiliary aids services? 28. Does the plan direct for the review of record retention of all documents used in the provision of auxiliary aids? (until year 2020-10 year period after the Settlement agreement signature-) 29. Does the plan ensure the review of notifications, or materials available to the public to ensure accommodations for individuals with disabilities are made? 30. Does the plan monitor the inspections and maintenance, of auxiliary aid equipment? FACILITY INSPECTION YES NO N/A 31. Interpreter Services for the Hearing Impaired Poster 32. DCF Non-discrimination Poster 33. Limited English Proficiency Poster 34. Ensure that the fire alarms have lights along with sound. 35. Confirm that the provider s Auxiliary Aid Plan is posted in the provider s website. 36. Review the agency s public notifications, handbooks, and brochures to ensure they provide information for individuals with disabilities regarding auxiliary aids, and how to request special accommodations.

Provide an explanation for any item marked NO or N/A

AUXILIARY AIDS STAFF INTERVIEW Agency Name: Date of Site Visit: Mailing Address: Physical Location: Type of Site Visit: Annual / Special Monitoring 1. CFCHS Interviewer: Staff Name and Position: Item Being Monitored (Requirements of DCF CFOP 60-10 Ch 3 and 4, and the 2010 DCF-HHS Settlement Agreement) Response 1. What is your understanding of DCF-HHS Settlement Agreement regarding provision of auxiliary aids and services to customers and companions who are deaf or hard-of- hearing? 2. Who is your agency s Single-Point-of-Contact (SPOC) for questions or issues regarding the provision of auxiliary aids? 3. Please provide the name of your region DCF ADA/504 Coordinator. 4. How do you access your Agency's Auxiliary Aids Plan? 5. What is the agency s process for assessing the communication needs of customers or companions, who are deaf, hard-ofhearing, have a disability, or have limited English proficiency (LEP)? Describe the Forms that need to be completed. 6. Describe the forms that need to be completed when providing auxiliary aids. And, where are they kept after completion? 7. Would you honor a customer/companion refusal for auxiliary aids if the information exchanged is considered to essential? 8. Would you provide the same auxiliary aids and services to a companion of a client? Any differences? 9. Have you received training on the provision of auxiliary aids? If so, how often? 10. Under what circumstances can the agency deny auxiliary aids?

Item Being Monitored (Requirements of DCF CFOP 60-10 Ch 3 and 4, and the 2010 DCF-HHS Settlement Agreement) Response 11. What are the timeframes for providing an interpreter for a scheduled appointment? 12. What are the timeframes for providing an interpreter for a nonscheduled appointments and emergency situations? 13. What would you do if after providing an auxiliary aid you find out that the communication was not effective? 14. What types of Assistive Listening Devices does your program have? Do you know how to use them? Do you find them effective? 15. Does the agency charge the customers any fees for the provision of auxiliary aids? 16. Do you make notations in the client s file regarding the services provided as it relates to auxiliary aids? 17. Do you provide clients, who are deaf or hard of hearing with the Customer Feedback Form? Where is that Form sent after completion? Do you document in the progress notes that this form was handed to the client? 18. Are there any areas related to the provision of auxiliary aids where you would like additional training? 19. Have you received any complaints regarding the agency s process for providing auxiliary aids or services? If so, what was the nature of the complaint? How were they resolved? 20. Do you know of any circumstances where the agency discriminated against or treated a customer or client unfairly when he/she requested an auxiliary aid?