The Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) has issued guidance to hospital and long-term care facility administrators. According to the OCR press release, the purpose of the guidance is to remind them of their independent obligations under Centers for Medicare and Medicaid Services (CMS) regulations to ensure that facility visitation policies, including during a public health emergency, do not unlawfully discriminate against patients or other individuals receiving care on the basis of religion or other protected bases under federal civil rights laws.
The guidance is titled FAQs on Patient Visitation at Certain Federally Funded Entities and Facilities. It provides examples demonstrating the importance of considering the religious needs of patients and other individuals when implementing visitation policies and procedures. For instance, the guidance discusses examples such as:
- Hospitals prevented family members from bringing patients Kosher food or halal food that met the patient’s religious dietary restrictions while allowing other visitors to bring patients food items.
- Members of certain religious groups were subjected to more rigorous screening processes and/or denied opportunities for visitation based on the patient’s and/or visitor’s religious affiliation.
- Hospitals adopted policies during the COVID-19 pandemic that allowed patients to visit with family members or friends but prohibited them from visiting with clergy.
- The guidance also contains information to help covered facilities and entities effectively communicate with patients and others regarding their visitation policies, procedures, and practices.
Compliance Perspective
Issue
Under CMS regulations, hospitals, long-term care facilities, and critical access hospitals are required to have written visitation policies, procedures, and practices that prohibit restricting, limiting, or otherwise denying visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. OCR enforces the bar on religious discrimination in these regulations. In addition, civil rights laws prohibit discrimination on the basis of race, color, national origin, sex (including sexual orientation and gender identity), age, and disability in certain federally funded programs and activities. These laws may also prohibit restrictions on visitation in some circumstances.
Discussion Points
- Review policies and procedures to ensure prevention of any type of discrimination, including religious discrimination. Revise policies and procedures if needed. Review visitation policies and procedures to ensure they include the most up-to-date information from OCR and CMS.
- Train staff about their right to be free from discrimination in the workplace. Teach staff to report any concerns of discrimination against themselves, their co-workers, or other individuals to their immediate supervisor, the compliance officer, or through the facility’s hotline. Also train staff on visitation policies and procedures. Document that the trainings occurred and keep a signed copy in each employee’s education file. Provide resident- andThe Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) has issued guidance to hospital and long-term care facility administrators family member-related education through presentations at Resident or Family Council Meetings and document within those meetings’ minutes.
- Periodically audit to ensure that visitation guidelines are being followed and that discrimination is not occurring. In addition, ensure that staff are aware of how to report any concerns of discrimination or retaliation.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
