Civil Rights and Privacy Rule Compliance Activities

The Office for Civil Rights (OCR) in the Department of Health and Human Services (HHS) promotes and ensures that people have equal access to and the opportunity to participate in and receive services from all HHS-funded programs without facing unlawful discrimination, and that the privacy of their health
information is protected.

OCR protects the civil rights of all individuals who are subject to discrimination in health and human services programs and protect the health information privacy rights of consumers through investigations, voluntary dispute resolution, enforcement, technical assistance, policy development and information services.

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - Regional Manager, Office for Civil Rights, HHS Regional Offices.

(See Appendix IV of the Catalog for listing.)
Website Address

Program Accomplishments

OCR enforces nondiscrimination and privacy requirements by processing and resolving complaints, conducting compliance reviews, and carrying out voluntary compliance, public education, outreach and technical assistance activities. OCR continues to achieve significant accomplishments in all of these areas. In Fiscal Year (FY) 2007: 11,290 individual complaints were filed with OCR (3,371 civil rights discrimination cases and 7,919 Privacy Rule cases); OCR completed action on 10,053 complaint cases (3,131 discrimination and 6,922 Privacy Rule); OCR completed 2,352 compliance reviews (including 2,306 pre-grant and 46 post-grant reviews) on its traditional civil rights authorities; and OCR provided information and training to 75,632 individuals. OCR projects that approximately 11,700 individual complaints will be filed in FY 2008 (3,300 civil rights discrimination cases and 8,400 Privacy Rule cases); OCR is projected to complete action on approximately 10,700 complaint cases (3,500 discrimination and 7,200 Privacy Rule). OCR is also on target to complete 1,800 compliance reviews (including 1,750 pre-grant and 50 post-grant reviews) in FY 2008 and to provide information and training to more than 75,000 individuals. Highlights of OCR's major accomplishments in FY 2007 and FY 2008 in some of our priority areas are as follows. LIMITED ENGLISH PROFICIENCY -- OCR continues to work with health care and social service providers, state and local agencies, and other HHS components to ensure that limited English proficient (LEP) persons are not discriminated against on the basis of national origin in HHS-funded programs (e.g., emergency room care, welfare to work, child protective services, senior centers, and in-home services). OCR continued its technical assistance, public education and outreach activities in connection with the revised Limited English Proficiency guidance issued in August 2003. In FY 2007, in collaboration with the American Hospital Association (AHA), OCR established partnerships with 13 state-wide hospital associations to provide technical assistance tailored to the unique needs and demographics of the AHA member hospitals to assist them in meeting their legal obligations to engage in effective communication, consistent with the HIPAA Privacy Rule, with limited English proficient and deaf or hard of hearing patients and their companions, thereby promoting patient safety and quality health care. MULTI-ETHNIC PLACEMENT ACT (MEPA)/SECTION 1808 - FOSTER CARE AND ADOPTION SERVICES -- OCR continues to strengthen families and create better conditions for children to live in permanent, safe environments through its work to remedy race, color, and national origin discrimination in foster care and adoption. For example, in FY 2007, OCR successfully negotiated a comprehensive compliance agreement with the South Carolina Department of Social Services, which ensures that the 53 state offices serving over 5,000 children in foster care and all prospective adoptive and foster parents will not delay or deny the placement of children into foster or adoptive homes, or deny parents the opportunity to foster or adopt children, due to race, color or national origin. NEW FREEDOM INITIATIVE -- OCR is involved in a variety of efforts to increase the independence and quality of life of persons with disabilities, including those with long-term needs. Most notably, OCR has played a critical role in implementation of the Administration's New Freedom Initiative that was announced in February 2001, and implemented through Executive Order (E.O.) 13217 issued on June 19, 2001. The E.O. calls for swift implementation of the Olmstead Supreme Court decision and full enforcement of Title II of the Americans with Disabilities Act through investigations, complaint resolution, and the use of alternative dispute resolution. OCR maintains a New Freedom Initiative web page, on which it published "Delivering on thePromise: OCR'sCompliance Activities Promote Community Integration." This report provides accounts of satisfactorily resolved complaints affecting over 250 individuals. In FY 2007, OCR entered into a resolution agreement with the Massachusetts Department of Transitional Assistance that achieved statewide reform by requiring all 28 offices serving more than 400,000 individuals across the state to implement effective screening and assessment programs that will allow TANF beneficiaries with learning disabilities to acquire the education and support services needed to find and retain jobs. Through its website, OCR will continue to expand the information available to consumers and providers about the civil rights of persons with disabilities in order to further facilitate the community integration of individuals with disabilities. EMERGENCY PREPEAREDNESS PLANNING AND RESPONSE -- OCR has been actively involved in many government-wide activities related to emergency planning, response, and recovery. In FY 2007, OCR provided technical assistance to ten states examining privacy issues in pandemic flu planning and response. In a workshop convened in May 2007, by the Association of State and Territorial Health Officials, OCR guided state public health agency and privacy officials through important decision points, using the OCR decision tool for emergency preparedness. HIPAA PRIVACY RULE -- A major responsibility given to OCR in December 2000 is protecting the privacy of health information under the Privacy Rule, which was enacted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The Rule protects the privacy of individually identifiable health information held by health plans, covered health care providers, and health care clearinghouses. OCR promotes compliance with the Privacy Rule by investigating and resolving complaints, developing policy guidance and public education materials, and providing technical assistance directly to covered entities and members of the public. To promote the well-being of individuals at risk of violence and mental illness, OCR is carrying out Presidential mandates to improve understanding of appropriate information-sharing under the HIPAA Privacy Rule and to share best practices with states about mental health services pursuant to the June 13, 2007 Report to the President on Issues Raised by the Virginia Tech Tragedy. OCR participated with the Departments of Education and Justice on panels about understanding federal privacy rules at the Department of Justice's annual national conference on Project Safe Neighborhoods. Pursuant to the President's directive, in FY 2008 OCR has developed, in coordination with the Department of Education, guidance to clarify the intersection of the HIPAA Privacy Rule and the Family Educational Rights and Privacy Act, as well as the circumstances under which information may be shared under both laws in emergency circumstances.

Uses and Use Restrictions

The Office for Civil Rights (OCR) in the Department of Health and Human Services (HHS) is responsible for promoting and ensuring that people have equal access to and the opportunity to participate in and receive services from all HHS-funded programs without facing unlawful discrimination, and that privacy of their health information is protected.

These HHS funded programs are provided through state agencies, nursing homes, skilled nursing facilities, medical laboratories, hospitals, day care centers, social service agencies and other providers.

Any person who believes that he or she has been discriminated against in the provision of these services because of race, color, national origin, disability, age, sex or religion, may file a complaint with OCR.

Individuals may also file complaints of sex discrimination in health training programs receiving Federal financial assistance, and complaints of denials of health care for reasons other than the need and availability of services, by recipients of Hill-Burton grants and loans.

OCR also has enforcement responsibilities under the Americans with Disabilities Act (ADA) of 1990, and Section 1808 of the Small Business Job Protection Act (SBJPA) of 1996.

Regarding the ADA, any person who believes that he or she has been denied benefits in health and human services programs and activities conducted by state or local government entities, because of his/her disability, may file a complaint with OCR.

Regarding Section 1808 of the SBJPA, any individual may file a complaint with OCR alleging that an adoption or foster care organization funded by HHS makes placement decisions in violation of Section 1808 of the SBJPA and Title VI of the Civil Rights Act of 1964.

The Office will investigate complaints and take steps to ensure compliance with applicable civil rights laws.

OCR also enforces the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule as well as the Patient Safety and Quality Improvement Act (PSQIA) of 2005.

OCR's activities under the Privacy Rule include: investigating complaints and conducting public education, technical assistance and other outreach activities to health care providers, health care clearinghouses and health plans, to ensure that they understand their responsibilities under the Rule; to other entities that may be impacted by the Rule, including Federal, State and local government agencies, researchers, and business associates of covered entities; and to consumers to inform them of their rights under the Privacy Rule.

Anyone who believes that a person, agency or organization covered under the HIPAA Privacy Rule ("a covered entity") has violated the Privacy Rule may file a complaint with OCR.

OCR's activities under PSQIA include: administering an enforcement program regarding the confidentiality protections, including conducting investigations, taking compliance actions, and making penalty determinations; developing, for issuance by the Secretary, regulations regarding such compliance and enforcement program; Imposing Civil Monetary Penalties (CMPs) for confidentiality violations; Interpreting standards for enforcement and for guidance to Patient Safety Organizations (PSOs) and providers; and Providing technical assistance and public information in the administration of the enforcement program.

Eligibility Requirements

Applicant Eligibility

Anyone who believes he or she has been discriminated against in the manner outlined above or seeks information concerning civil rights, and recipients of Federal financial assistance who desire technical assistance and information for the purpose of assuring their compliance with nondiscrimination laws.

Regarding the HIPAA Privacy Rule, anyone who believes that the Privacy Rule has been violated in the manner outlined above, or who seeks information about the Rule; consumers that need to know their rights under the Rule; and entities that need technical assistance and information for the purpose of assuring compliance with the Privacy Rule.

Beneficiary Eligibility

Individuals subject to discrimination and recipients who require technical assistance and information. Regarding the HIPAA Privacy Rule, individuals subject to violation of their health information privacy, covered entities, and others needing or seeking technical assistance and information concerning the Rule.



Aplication and Award Process

Preapplication Coordination

Contact the Director, Office for Civil Rights.

This program is excluded from coverage under E.O.


Application Procedures

Complaints of discrimination and alleged violations of the HIPAA Privacy Rule may be filed, and technical assistance information and public education requested, at the Headquarters and Regional Office locations of the Office for Civil Rights.

Award Procedures



A complaint must be filed not later than 180 days from the last act of the alleged discrimination, unless the time for filing is waived for good cause. Complaints under the Privacy Rule must be filed within 180 days of the date when the complainant knew, or should have known, that the act or omission complained of occurred, unless the time limit is waived for good cause.


Civil Rights Act of 1964, Title VI, as amended; Rehabilitation Act of 1973, Sections 504 and 508, as amended; Education Amendments of 1972, Title IX, as amended; Age Discrimination Act of 1975, as amended; Education Amendments of 1972, Title IX, as amended; Nondiscrimination Provisions of the Public Health Service Act, Titles VI, VII, VIII, and XVI, as amended; Omnibus Budget Reconciliation Act of 1981, Public Law 97-35, as amended; Drug Abuse Offense and Treatment Act of 1972, Section 407; Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, Section 321, as amended; Low-Income Home Energy Assistance Act of 1981, 42 U.S.C. 8625; Community Services Block Grant Act, 42 U.S.C. 398; Family Violence Prevention and Services Act, as amended, Section 307 (a)(1) and (2), Public Law 98-457; Americans with Disabilities Act of 1990, Title II, Subtitle A, Public Law 101-336; Small Business Job Protection Act of 1996, Section 1808, Public Law 104-188; Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d-2, 45 CFR Part 160 and Subparts A and E of Part 164--Standards for Privacy of Individually Identifiable Health Information (the "Privacy Rule"); Public Health Service Act, Title IX, 42 U.S.C. 299b-22, as amended by the Patient Safety and Quality Improvement Act of 2005, Public Law 109-41.

Range of Approval/Disapproval Time



Individuals can appeal a civil rights discrimination complaint determination by submitting, in writing, a request for reconsideration to the Director, Office for Civil Rights. OCR imposes civil money penalties (CMPs) on a covered entity found to be in violation of the HIPAA Privacy Rule. If CMPs are imposed by OCR, the covered entity may request a hearing in which an HHS administrative law judge (ALJ) decides if the CMPs are supported by the evidence in the case. OCR is required to present the evidence to support the imposition of CMPs to the ALJ. The covered entity may also then appeal the ALJ's decision to the HHS Departmental Appeals Board (DAB) and ultimately to the U.S. Courts of Appeal.



Assistance Considerations

Formula and Matching Requirements


Length and Time Phasing of Assistance


Post Assistance Requirements







Financial Information

Account Identification



(Salaries and Expenses) FY 07 $34,909,000; FY 08 est $37,062,000; and FY 09 est not available.

Range and Average of Financial Assistance


Regulations, Guidelines, and Literature

Title VI of the Civil Rights Act of 1964--the implementing regulation (45 CFR 80), "Your Rights Under Title VI of the Civil Rights Act of 1964 fact sheet, "Know Your Rights" brochure regarding national origin discrimination and limited English proficiency, a video in VHS and DVD formats entitled "Title VI Limited English Proficiency"; Section 504 of the Rehabilitation Act of 1973--the implementing regulation for HHS funded programs and activities (45 CFR 84), and fact sheets "Your Rights Under Section 504," "Your Rights as a Person with HIV Infection, AIDS, or Related Conditions," "Your Rights Under Section 504 and the Americans with Disabilities Act," and the HHS Section 504 federally conducted regulation (45 CFR 85); Age Discrimination Act of 1975--implementing regulations, HHS (45 CFR 91) and government-wide (45 CFR 90), and fact sheet "Your Rights Under the Age Discrimination Act"; Community Service Assurance of the Hill-Burton regulation (42 CFR 124) and fact sheet "Community Service Assurance Under the Hill-Burton Act"; Sex Discrimination in Health-Related Training Programs regulation (45 CFR 83); fact sheets on: Section 1808/Multiethnic Placement Act (MEPA); the Americans with Disabilities Act (ADA); "How to File a Discrimination Complaint with OCR"; "Know Your Civil Rights"; a video presentation: OCR guidance on Temporary Assistance for Needy Families (TANF) and Disability; and various other civil rights publications. HIPAA regulations and standards, including the Privacy Rule, 45 CFR Part 160 and Subparts A and E of Part 164; "Your Health Information Privacy Rights"; "Privacy and Your Health Information"; fact sheets and guidance on specific aspects of the Privacy Rule, and additional compliance tools such as "Am I a Covered Entity" and Frequently Asked Questions (FAQs). A complete list of Privacy Rule publications is available. There is also a brochure titled "Protecting Your Civil Rights in Health and Social Services and Your Health Information Privacy Rights," which provides general information about the Office for Civil Rights and its services. All literature is available at no charge; however, because of budgetary constraints and availability of stock, quantities may be limited. Most publications can be downloaded from OCR's website and are available in languages other than English. All publications are available in alternative formats for individuals with disabilities.

Information Contacts

Regional or Local Office

Regional Manager, Office for Civil Rights, HHS Regional Offices. (See Appendix IV of the Catalog for listing.)

Headquarters Office

Director, Office for Civil Rights, Office of the Secretary, Department of Health and Human Services, Hubert H. Humphrey Building - Mail Stop Room 509-F6, 200 Independence Ave. S.W., Washington, DC 20201; Telephone: (202) 619-0403. Toll free numbers: 1(800) 368-1019 (voice); 1(800) 537-7697 (TDD). Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule information toll free number: 1(866) 627-7748.

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