Dear Yale Medicine Faculty and Staff,

As part of our ongoing commitment to provide inclusive, high-quality care to all patients, we are reaching out with a special edition of The Compliance Compass to help educate you on Section 1557 of the Affordable Care Act (ACA) and our Section 1557 program and resources at Yale Medicine.

To help everyone understand the Section 1557, all Yale Medicine new hires (faculty and staff) are now required to complete a Workday training module as part of their new hire curriculum. Starting this fall, we will also incorporate key elements of the program’s policies and procedures into the annual Yale Medicine Compliance training for our existing workforce population.

The articles below highlight key points in the newly developed policies and procedures related to Section 1557. If you have any questions or concerns about a policy below, please contact your respective Regional Site Director or the Senior Director for Clinical Operations, Richard Ahern, via email or phone (203-737-3964).

Thank you for your unwavering commitment to fostering an inclusive health care environment. If you have any questions or need further clarification on Section 1557, please reach out to our Compliance team.

Sincerely,

Andrea Bradley, MHA, CHC, CHPC

Chief Compliance Officer, Yale Medicine and Aligned Clinician Enterprise

Senior Director, Compliance, Yale School of Medicine

Section 1557 prohibits discrimination toward patients and their companions in health programs and activities on the basis of race, color, national origin, sex, age, or disability. This section aims to ensure that all individuals have equal access to health care services and that no one is subjected to discrimination.

While this newsletter addresses Section 1557 of the ACA and Yale Medicine’s commitment to prevent discrimination towards patients or their companions, it is also important for you to be aware of the Office of Institutional Equity and Accessibility (OIEA). OIEA plays a leadership role in the university’s efforts to provide equitable treatment and accessibility within Yale’s programs and activities. Any student, faculty member, staff member, or applicant for employment or programs at Yale who is concerned about discrimination, harassment, or retaliation can report their concern to OIEA.

Yale Medicine complies with applicable federal civil rights laws and does not discriminate against patients or their companions on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). Yale Medicine does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.

This statement can be found on Yale Medicine’s website, at all Yale Medicine clinic locations near patient registration areas, and in the Yale Medicine Nondiscrimination Policy.

To ensure effective communication with patients* and their companions**, Yale Medicine offers a range of services at no cost.

As a member of the Yale Medicine workforce, in addition to responding to requests for services, it is your responsibility to recognize if patients or their companions have disabilities or limited English proficiency (LEP). You can do this by observing them, asking them directly, or checking their existing medical records. This helps ensure they receive the necessary aids and services to communicate effectively.

It is important to document agreed upon and provided accommodations in the patient’s medical record. This ensures Yale Medicine can consistently meet the individual’s needs for each visit and the individual doesn’t need to make duplicative requests.

Instructions on how to document these elements in Epic and where to locate them after entry are provided here.

Learn more about the available language and auxiliary aids below.

For patients and their companions who have limited English proficiency, we provide language assistance (e.g., qualified interpreters, translation services, and vital documents that are pre-translated in the most commonly spoken languages) at no cost.

• Qualified interpreters must be certified in clinical language translation, be accurate and timely, and protect the privacy and independent decision-making of the individual. The following interpreters are not acceptable under Section 1557:
  • Translation applications, such as Google Translate
  • A companion or child of the patient (the only exception is an emergency)
• The following Vital Documents are readily available upon request in the most commonly spoken languages, representing more than one percent of the patient population (currently, Spanish, Portuguese, Arabic, Pashto, Italian, Haitian Creole, and Chinese Mandarin).
  • Nondiscrimination Statement
  • Advance Beneficiary Notice of Noncoverage
  • Notice of Privacy Practices
  • Patient Acknowledgement and Financial Authorization
  • Consent for Operation or Special Procedure
  • Authorization for Access or Release of Information
  • Summary of Financial Assistance Policy and Application
  • Financial Assistance Policy

Yale Medicine provides appropriate free auxiliary aids and services to individuals with disabilities, including sign language interpreters, braille, and more.

On-site personnel can also assist patients and companions with access to auxiliary aids, including:

• Wheelchairs, canes, walkers, or crutches
• Sit-to-stand lifts
• Adaptive devices, such as screen reading software.

If a patient needs language interpreter services, a vital document in another language, or auxiliary aid services, please call the Yale Medicine Communication Services department that is most closely associated with your location on their behalf (see the contact information below). To ensure quality patient care and advocacy, do not ask the patient to call for these services themselves.

1. Yale New Haven Hospital York Street and Saint Raphael Campuses: 203-688-9104, Monday through Friday, 7 a.m. to 5:30 p.m.
2. Bridgeport Hospital, including Milford Campus: 203-384-3704, Monday through Friday, 8 a.m. to 4:30 p.m.
3. Greenwich Hospital: 203-863-4746, Monday through Friday, 8 a.m. to 4 p.m.
4. Lawrence + Memorial and Westerly Hospital: 860-442-0711 extension 5026, Monday through Friday, 8 a.m. to 5 p.m.

If a patient or companion requests a modification that is not readily available or is outside routine accommodation, do not confirm or deny the request. Instead, contact your respective site manager or director or the Yale Medicine Senior Director for Clinical Operations Richard Ahern via email or 203-737-3964 in a timely manner. They will determine, in collaboration with the Section 1557 Coordinator and OIEA, whether Yale Medicine can provide the requested modification.

See the Yale Medicine Language Access and Effective Communication Procedure and Yale Medicine Reasonable Modifications Procedure for more information.

It is Yale Medicine's policy to accommodate qualified individuals with disabilities using service animals and qualified miniature horses.

Service animals and qualified miniature horses may accompany a qualified individual with a disability in all areas within our facilities that are open to the public and where the individual is normally allowed except those that employ greater than general infection-control measures and have rooms with a patient who is immunosuppressed or in isolation.

When it is not obvious what service an animal provides, only limited inquiries are permitted. Yale Medicine clinicians and staff may only ask:

1. Is a service animal required because of a disability; and
2. What work or task the service animal has been trained to perform.
3. If the animal is a miniature horse, clinicians and staff may also inquire about the horse’s type, weight and size and confirm that it is housebroken.

Yale Medicine clinicians and staff cannot ask about:

1. The individual’s disability
2. Require medical documentation
3. Require a special identification card or training documentation for the service animal or qualified miniature horse, or
4. Ask that the service animal or qualified miniature horse demonstrate its ability to perform the work or task.

If a clinician or staff member believes that the service animal or qualified miniature horse is out of control or if the animal is not housebroken, they should take immediate action. These animals also are not allowed when their presence or behavior creates a fundamental alteration in the nature of the facility’s services or poses a direct threat to other individuals in a particular area.

A qualified individual with a disability can only be asked to remove their service animal or qualified miniature horse from the premises if:

1. The animal is out of control (behavior that could include persistent barking, jumping, running away, or aggressive behavior that raises concerns about an immediate risk of harm to others) and the handler does not take effective action to control it, or;
2. The animal is not housebroken.

The individual must be given an opportunity to take prompt and effective action to control the animal before asking the individual to leave and must offer the individual the opportunity to obtain services without the animal’s presence.

If a clinician or staff member believes that they may need to exclude a service animal or qualified miniature horse from an area that is open to the public for other reasons or on an ongoing basis, they should contact Yale Medicine Compliance using the team intake form or by email, who will further review the situation with the Office of Institutional Equity and Accessibility

Any Yale University employee who requests to bring a service animal to work as a reasonable accommodation should be referred to Yale Human Resources if they are a staff member, or the Office of Institutional Equity and Accessibility if they are a faculty member, psychiatry resident, postdoctoral or postgraduate associate, or fellow.

Patients have the right to escalate discrimination-related concerns. Yale Medicine is committed to receiving, reviewing, and resolving such incidents. It’s important for all Yale Medicine workforce members to know the established procedures for individuals to file complaints regarding discrimination in the provision of health care services. They are outlined below:

Patients who wish to file a grievance may do so by emailing ym1557coordinator@yale.edu or calling 203-785-2140. All grievance investigations are overseen by the Yale Medicine Section 1557 Coordinator. See the Yale Medicine Section 1557 Grievance Procedure for further information.

* Patient: A patient includes patients, participants, beneficiaries, enrollees, and applicants of Yale Medicine's services, health programs and activities, including clinical research participants and prospective patients and participants.

** Companion: A family member, friend, or associate of a patient seeking access to a service, program, or activity of Yale Medicine, who along with such patient, is an appropriate person with whom YM should communicate.