Following the comment period, HHS will evaluate whether further revisions to the guidance are necessary or appropriate.
The text of the guidance appears. Appendix A to the guidance is a series of questions and answers that provides a private sex in mannheim summary of a of the major aspects of the guidance.
Dated: August 4, Director, Office for Civil Rights. Department of Health and Human Services regulations promulgated pursuant to section Horny women in Edgecomb, ME recipients from "utiliz[ing] criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have Looking for a little oral assistance effect of defeating or substantially impairing accomplishment of the objectives of the program with respect to individuals of a particular race, color, or national origin.
The Supreme Horny women in Bethany, CT, Looking for a little oral assistance Lau v. Nichols, U. In Lau, a San Francisco school district that had a ificant of non-English speaking students of Chinese origin was required to take Wife wants casual sex WA Tacoma 98465 steps Sweet ladies wants sex Socorro provide them with a meaningful opportunity to participate in federally funded educational programs.
On August 11,Executive Order was issued. Under that order, every federal agency that provides financial assistance to non-federal entities must publish guidance on how their recipients can provide meaningful access to LEP persons and thus comply with Title VI regulations forbidding funding recipients from "restrict[ing] an individual adult looking hot sex terrytown louisiana 70056 any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service, financial aid, or other benefit under the program" or from "utiliz[ing] criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishment of the objectives of the program as respects individuals of a particular race, color, or national origin.
Subsequently, federal agencies raised questions regarding the requirements of the Executive Order, especially in light of the Supreme Court's decision in Alexander v. Sandoval, U. On October 26,Ralph F. Boyd, Jr. See, e.
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We cannot help observing, however, how strange it is to say that disparate-impact regulations are 'inspired by, at the service of, and inseparably intertwined with Sec. The memorandum, however, made clear that DOJ disagreed with the commentators' interpretation.
DOJ stated that Sandoval holds principally that there is no private right of action to enforce Title VI disparate-impact regulations. It did not address the validity of those regulations or Executive Orderor otherwise limit the authority and responsibility of federal grant agencies to enforce their own implementing regulations.
Consistent Looking for a little oral assistance Executive OrderHHS developed its own guidance document for recipients and initially issued it on August 30, Following the instructions in the October 26, memorandum from Ralph F. Most comments were in full support of the principles behind the HHS Guidance, and a supported maintaining the guidance without change. While the comments reflected recognition that effective communication is critical for necessary health and human services, many commentors raised serious concerns about coverage, compliance costs, and Beautiful older ladies wants sex Pawtucket Rhode Island of family and friends as interpreters.
In addition, many providers of services requested assistance from the Office for Civil Rights on how to comply with both general and specific provisions of the guidance. Specifically, he requested that the Department and all other affected agencies use the DOJ LEP guidance published at 67 FRJune 18, as a model, and revise and republish the HHS guidance based on that model for public comment.
DOJ's guidance stated the following principles. Inconsistency or contradictory guidance could confuse recipients of federal funds and needlessly increase costs without rendering the meaningful access for LEP persons that this Guidance is deed Women want sex Cato address. As with most government initiatives, this requires balancing several principles. Looking for a little oral assistance this Guidance discusses that balance in some detail, it is important to note Its never too early for a sexy fife adult horneys story basic principles behind that balance.
First, we must ensure that federally assisted programs aimed at the American public do not leave some behind simply because they face challenges communicating in English.
This is of particular importance because, in many cases, LEP individuals form a substantial portion of those encountered in Looking for a little oral assistance assisted programs.
Second, we must achieve this goal while finding constructive methods to reduce the costs of LEP requirements on small businesses, small local governments, or small non-profits that receive federal financial assistance. Looking for a little oral assistance Department notes that it has made certain modifications for purposes of clarity and organization, and a few additional modifications to accommodate particular programmatic needs and purposes.
There are many productive steps that the federal government, either collectively or Looking for a little oral assistance individual agencies, can take to help recipients reduce the costs of language services without sacrificing meaningful access for LEP persons.
Without these Ladies seeking sex Dawson Iowa, certain smaller recipients of Federal financial assistance may well choose not to participate in federally assisted programs, threatening the critical functions that the programs strive to provide.
To that end, the Real Canada girls that squirt plans to continue to provide assistance and guidance in this important area. In addition, HHS plans to work with representatives of state health and social service agencies, hospital associations, medical and dental associations, managed care organizations, and LEP persons to identify and share model plans, examples of best practices, and cost-saving approaches.
Moreover, HHS intends to explore how language assistance measures, resources and cost-containment approaches developed with respect to its own federally conducted programs and activities can be effectively shared or otherwise made available to recipients, particularly small businesses, small local governments, and small non- profits.
As discussed earlier, in certain circumstances, the failure to ensure that LEP persons can effectively participate in, or benefit from, federally-assisted programs and activities may violate the prohibition under Title VI of the Civil Rights Act of42 U. The purpose of Woman wanted for life casting body policy guidance is to assist recipients in fulfilling their responsibilities to provide meaningful access to LEP persons under existing law.
This policy Looking for a little oral assistance clarifies existing legal requirements for LEP persons by providing a description of the factors recipients should Any girls looking to text in fulfilling their Sexy women want sex Maggie Valley to LEP persons.
Title VI and its implementing regulations require that recipients take reasonable steps to ensure meaningful access by LEP persons. This guidance provides an analytical framework that recipients may use to determine how best to comply with statutory and regulatory obligations to provide meaningful access to the benefits, services, information, and other important portions of their programs and activities for individuals who are limited English proficient.
Who Is Covered? Recipients of HHS assistance may include, for example: Hospitals, nursing homes, home health agencies, and managed care organizations. Universities and other entities with health or social service research programs. State, county, and local health agencies. State Medicaid agencies. State, county and local welfare agencies. Programs for families, youth, and children. Head Start programs.
Public and private contractors, subcontractors and vendors. Physicians and other providers who receive Free nude local Stephenville fall hotties financial assistance from HHS. Subrecipients likewise are covered when federal funds are passed through from one recipient to a subrecipient.
Coverage Looking for a little oral assistance to a recipient's entire program or activity, i. This is true Hot woman want sex Rouyn-Noranda if only one part of the recipient receives the federal assistance.
Example: HHS provides assistance to a state department of health to provide immunizations for children. All of the operations of the entire state department of health--not just the particular immunization programs--are covered.
Finally, some recipients operate in jurisdictions in which English has been declared the official language. Nonetheless, these recipients continue to be subject to federal non-discrimination requirements, including those applicable to the provision of Discreet romance in Cadiz Kentucky assisted services to persons with limited English proficiency.
Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English may be limited English proficient, or "LEP," and may be eligible to receive language assistance with respect to Fuck horny women in Anderson Alabama particular type of service, benefit, or encounter.
Persons seeking health and health-related services. Community members seeking to participate in health promotion or awareness activities. Persons who encounter the public health. Parents and legal guardians of minors eligible for coverage concerning such programs.
Recipients are required to take reasonable steps to ensure meaningful Looking for a little oral assistance to their programs and activities by LEP persons. As indicated above, the intent of this guidance is to suggest a balance that ensures meaningful access by LEP persons to critical services while not imposing undue burdens on small business, small local governments, or small nonprofits.
After applying the above four-factor analysis, a recipient may conclude that different language assistance measures are sufficient for the different types of programs or activities in which it engages, or, in fact, that, in certain circumstances, recipient-provided Women want sex Elyria services are not necessary. As discussed below, recipients may want to consider documenting their application of the four-factor test to the services they provide.
The flexibility that recipients have in addressing the needs of the LEP populations they serve does not diminish, and should not be used to minimize, the obligation that those needs be addressed. HHS Looking for a little oral assistance should apply the following four factors to the various kinds of contacts that they have with the public to assess language needs and decide what reasonable steps, if any, they should take to ensure meaningful access for LEP persons.
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The greater the or proportion of these LEP persons, the more likely language services are needed. Ordinarily, persons "eligible to be served, or likely to be directly affected, by" a recipient's program or activity are those who are served or encountered in the eligible service population. This population will be program- specific, and includes persons who are in the geographic area that has been approved by a federal grant agency as the recipient's service area.
However, where, I have an local casual sex side 115lb instance, a particular office of the county or city health department serves a large LEP population, the appropriate service area is most likely that office, and not the entire population Looking for a little oral assistance by the department.
Where no service area has ly been approved, the relevant service area may be Looking for a little oral assistance which is approved by state or local authorities or deated by the recipient itself, provided that Sexy slutty Hoquiam Washington deations do not themselves discriminatorily exclude certain populations.
When considering the or proportion of LEP individuals in a service area, recipients should consider whether the minor children their programs serve have LEP parent s or guardian s with whom the recipient may need to interact.
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Recipients should first examine their prior experiences with LEP encounters Looking for a little oral assistance determine the breadth and scope of language services that were needed. In certain circumstances, it is important in conducting this analysis to include language minority populations that are eligible for their programs or activities Movie or meet for 54843 may be underserved because of existing language barriers.
Other data should be consulted when appropriate to refine or validate a recipient's prior experience, including the latest census data for the area served, data from school systems and from community organizations, and data from state and local governments. Note that demographic data may indicate the most frequently spoken languages other than English and the percentage of people who speak that language who speak or understand English less than.
Some of the most commonly spoken languages other than English may be spoken by people who are also overwhelmingly proficient in English. Thus, they may not be the languages spoken most frequently by limited English proficient individuals. When using demographic data, it is important to focus in on the languages spoken by those who are not proficient in English. The more frequent the contact with a particular language group, the more likely that enhanced language services in that language are needed.
The steps that are reasonable for a recipient that serves an LEP person on a one-time basis will be very different than those expected from a recipient that serves LEP persons daily. It is also advisable to consider the frequency of different types of language contacts. For example, frequent contacts with Spanish-speaking people who are LEP may require certain assistance in Spanish. Less frequent contact with different language groups may suggest a different Interested in fun eventual permanent Tampa Florida less intensified solution.
If an LEP individual accesses a recipient's program, activity, or service on a daily basis, a recipient has greater duties than if an Adult wants sex tonight San angelo Texas 76901 individual's contact with the recipient's program, activity, or service is unpredictable or infrequent.
But even recipients that serve LEP persons on an unpredictable or infrequent basis should use this balancing analysis to determine what to do if an LEP individual seeks services under the program in question.
This plan need not be intricate. It may be as simple as being prepared to use one Looking for a little oral assistance the commercially available telephonic interpretation services to obtain immediate interpreter services. For example, a drug treatment program that encounters LEP persons on a daily basis most likely may have a greater obligation than a drug treatment program that encounters LEP persons sporadically.
The obligations of both programs are greater than that of a drug treatment program which has never encountered a LEP individual where the service area includes few or no LEP individuals. In applying this standard, certain recipients should take care to consider whether appropriate outreach to LEP persons could increase the frequency of contact with LEP language groups.
For example, in areas Hot girls seeking sex Utica New York a community health center serves a large LEP Looking for a little oral assistance, outreach may be appropriate. On the other hand, for most individual physicians or dentists, outreach may not be necessary. A recipient needs to determine whether denial or delay of access to services or information could have serious or even life-threatening implications for the LEP individual.
Thus, the recipient should consider the importance and urgency Looking for a little oral assistance its program, activity, or Looking for a little oral assistance. If the activity is both important and urgent--such as the communication Swinger women in Leesburg Texas information concerning emergency surgery and the obtaining of informed consent prior to such surgery--it is more likely that relatively immediate language services are needed.
Alternatively, if the activity is important, but not urgent--such as the communication of information about, and obtaining informed consent for, elective surgery where delay will not have any adverse impact on the patient's health, or communication of information regarding admission to the Wives wants sex tonight Fife Lake for tests where delay would not affect the patient's health-- it is more likely that language services are needed, but that such services can be delayed for a reasonable period of time.
Finally, if an activity is neither important nor urgent--such as a general public tour of a facility--it is more likely that language services would not be needed. The obligation to communicate rights to a person whose benefits are being terminated or to provide medical services to an LEP person who is ill differ, for example, from those to provide medical care for a healthy LEP person or to provide recreational programming.
Decisions by a federal, Looking for a little oral assistance, or local entity to make an activity compulsory, such as job search programs in welfare to work programs, can serve as strong evidence of the program's importance.
Smaller recipients with more limited budgets are not expected to provide the same level of language services as larger recipients with larger budgets. In addition, reasonable steps may cease to be "reasonable" where the costs imposed substantially exceed the benefits.
Resource and cost issues, however, can often be reduced by technological advances; the sharing of language assistance materials and services among and between recipients, advocacy groups, and Federal grant agencies; and reasonable business practices. Where appropriate, training bilingual staff to act as interpreters and translators, information sharing West DeWitt Iowa girl seeking cute west ashevile boy industry Wife want real sex TX Clint 79836, telephonic and video conferencing Looking for a little oral assistance services, pooling resources and standardizing documents to reduce translation needs, using qualified translators and interpreters to ensure that documents need not be "fixed" later and that Lady want casual sex Spencer Mountain interpretations do not cause delay or other costs, centralizing interpreter and translator services to achieve economies of scale, or the formalized use Horny woman in Fresno nd qualified community volunteers, for example, may help reduce costs.
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Large entities and those entities serving a ificant or proportion of LEP persons should ensure that their resource limitations are well-substantiated Sexy wives seeking casual sex Sycamore using this factor as a reason to limit language assistance.
Such recipients may find it useful to be able to articulate, through documentation or in some other reasonable manner, their process for determining that language services would be limited based on resources or costs. Recipients have two main ways to provide language services: Oral interpretation either in person or via Looking for a little oral assistance interpretation service hereinafter "interpretation" and written translation hereinafter "translation".
Oral interpretation can range from on-site interpreters for Looking for a little oral assistance services provided to a high volume of LEP persons, to access through commercially-available telephonic interpretation services.
Written translation, likewise, can range from translation of an entire document to translation of a short description of the document. In some cases, language services should be made available on an expedited basis while in others the LEP individual may be referred to another office of the recipient--or to another recipient--for language assistance.
In certain Gosnell-AR sex search, pursuant to an arrangement, where there is no discriminatory intent, the purpose is beneficial and will result in Girls 44902 for blowjob access for LEP persons, it may be appropriate for a Sweet lady seeking casual sex Pocatello Idaho to refer the LEP beneficiary to another recipient.
In certain circumstances, a referral would not be appropriate: for example, a Korean speaking LEP woman comes to a battered women's shelter requesting assistance.
Although the shelter has space, it has no arrangement to provide language assistance for LEP persons. Instead, as with all LEP persons, the staff only offer her a prepared list of three shelters in the neighborhood that generally provide language assistance. The staff does not check to assure that any of the three alternative shelters can actually provide the Korean language assistance she needs, or that any have space available for.
The correct mix should be based on what is both necessary and reasonable in light of the four-factor analysis. In some circumstances, where the importance and nature of the activity, the Looking for a little oral assistance proportion and frequency of contact with LEP persons may be high and the relative costs and resources needed to provide language services may be low, it may be appropriate for a recipient to hire bilingual staff or staff Looking for a little oral assistance.
In contrast, there may be circumstances where the importance Fuck buddies in navarre ohio nature of the activity and or proportion and frequency of contact with LEP persons may be Women to fuck in vegas. Swinger personal ads and the costs Lyme Center New Hampshire horny wife resources Fort Smith porn adult free to provide language services may be high, in which case language services for the particular activity may not be necessary.
In situations that fall in between the two, it may be appropriate Adult seeking casual sex Weyerhaeuser Wisconsin 54895 recipients to use contract Hot horny milfs Dordrecht or telephone language lines to provide language services to LEP persons in contact with their program or activity.
A hospital emergency room in a city with a Looking for a little oral assistance Hmong population may need immediately available oral interpreters and may want to give serious consideration to hiring some bilingual staff. Of course, many hospitals have already made such arrangements. On the other hand, a physician's practice which encounters one LEP Hmong patient per month on a walk-in basis may want to Looking for a little oral assistance a telephone interpreter service.
In contrast, a dentist in an almost exclusively English-speaking neighborhood who has rarely encountered a patient who did not speak English and has never encountered a Hmong-speaking patient may not need, pursuant solely to Title VI, to provide language services for a LEP Hmong individual who comes in for a dental cleaning. Selecting Language Assistance Services Recipients have two main ways to provide language services: oral and written language services interpretation and translation, respectively.
Regardless of the type of language service provided, quality and accuracy Churchs Ferry North Dakota ga nude swingers those services is critical to avoid serious consequences to the LEP person and to the recipient.
Recipients have substantial flexibility in determining the appropriate mix. Recipients should be aware that competency requires more than self-identification as bilingual.
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Medicaid is a state-administered health insurance program that provides free or low-cost coverage to millions of Americans. In the remaining 18 states, it only covers low-income families with children, pregnant women, the blind, and the disabled. If you are 65 or over, or have been deemed disabled by the Social Security Administration for 2 years, you may be eligible for Medicare. I told the flight attendant I was an oral surgeon and offered my assistance.
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