Keystone Nursing Care Center Inc. Grievance Procedure that Incorporates Due Process Standards

Appendix C to Part 92—Sample Section 1557 of the Affordable Care Act Grievance Procedure

It is the policy of Keystone Nursing Care Center Inc. not to discriminate on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age or disability. Keystone Nursing Care Center 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 C.F.R. pt. 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 (including pregnancy, sexual orientation, and gender identity), age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office Tracy Bruns, 250 5 th St Keystone, Iowa 52249, 319-449-6827, Tbruns@keystonecare.org who has been designated to coordinate the efforts of Keystone Nursing Care Center Inc. to comply with Section 1557.

Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age or disability may file a grievance under this procedure. It is against the law for Keystone Nursing Care Center 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 [Keystone Nursing Care Center Inc. ] 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 (including pregnancy, sexual orientation, and gender identity), 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 Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201

Complaint forms are available at: https://www.hhs.gov/ocr/complaints/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination.

[Keystone Nursing Care Center 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.

Tracy Bruns
Administrator

Nondiscrimination Policy

As a recipient of Federal financial assistance, Keystone Nursing Care Center Inc. does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of race, color, national origin, disability, age, sex, sexual orientation, gender identity, religion, or creed in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, and in staff and employee assignments to patients, whether carried out by Keystone Nursing Care Center Inc. directly or through a contractor or any other entity with which Keystone Nursing Care Center Inc. arranges to carry out its programs and activities.

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (nondiscrimination on the basis of race, color, national origin), Section 504 of the Rehabilitation Act of 197 3 (nondiscrimination on the basis of disability), the Age Discrimination Act of 197 5 (nondiscrimination on the basis of age), regulations of the U.S. Department of Health and Human Services issued pursuant to these three statutes at Title 45 Code of Federal Regulations Parts 80, 84, and 91, (and state laws or corporate policies, etc.).

Additionally, in accordance with Section 1557 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 18116, Keystone Nursing Care Center Inc. does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of sex (including gender identity) in admission to, participation in, or receipt of the services and benefits under any of its health programs and activities, and in staff and employee assignments, whether carried out by Keystone Nursing Care Center Inc. directly or though a contractor or any other entity with which Keystone Nursing Care Center Inc arranges to carry out it’s programs and activities.

Inc case of questions, please contact:
Keystone Nursing Care Center Inc.
Contact Person/Section 503 Coordinator: Tracy Bruns
(319) 449-6827, EXT 113