SETTLEMENT AGREEMENT BETWEEN THE UNITED STATES OF AMERICA AND MOUNTAIN STATES HEALTH ALLIANCE UNDER THE ADA

B. Effective Communication

32. Appropriate Auxiliary Aids and Services. Pursuant to 42 U.S.C. § 12182(b)(2)(A)(iii), MSHA will provide to Patients and Companions who are deaf or hard of hearing any appropriate Auxiliary Aids and Services that are necessary for effective communication after making the assessment mandated in this Agreement.  Appropriate Auxiliary Aids and Services will be provided as soon as practicable (without compromising Patient care), except that the provision of on-site interpreters must be within the time frame described in Paragraph 38 of this Agreement.  MSHA will advise Patients and Companions who require Auxiliary Aids or Services that these are available throughout the Patient’s time at the MSHA hospital as requested by the Patient.

33. General Assessment Criteria. The determination of appropriate Auxiliary Aids or Services, and the timing, duration, and frequency with which they will be provided, will be made by the MSHA hospital personnel in consultation with the person with a disability whenever possible. The assessment made by MSHA hospital personnel will take into account all relevant facts and circumstances, including, for example, the individual’s communication skills and knowledge, and the nature, length, complexity of the communication at issue, and the context in which the communication is taking place (see Paragraph 36 for guidance).  A Model Communication Assessment Form is attached to this Agreement as Exhibit A, and will be used by the MSHA hospital upon the effective date of this Agreement.  MSHA may develop a more comprehensive form similar to Exhibit A within 60 days of the effective date of this Agreement to be used at MSHA hospital facilities.  This new form will be subject to approval by counsel for the United States prior to implementation.

34. Time for Assessment. The determination of which appropriate Auxiliary Aids and Services are necessary must be made to the extent possible at the time an appointment is scheduled for the Patient who is deaf or hard of hearing or on the arrival of the Patient or Companion who is deaf or hard of hearing at a MSHA hospital, whichever is earlier.  Then, if determined that Auxiliary Aids and Services are necessary, MSHA hospital personnel will perform an assessment using the appropriate Auxiliary Aids and Services (see Paragraphs 25 and 26) as part of each initial inpatient assessment when the patient is first seen to fully determine which appropriate Auxiliary Aids and Services are necessary, and the timing, duration, and frequency with which they will be provided. The results of this assessment will then be documented in the Patient’s medical chart.  In the event that communication is not effective, MSHA hospital personnel will reassess which appropriate Auxiliary Aids and Services are necessary, in consultation with the person with a disability, where possible, and provide such aid or service based on the reassessment.

35. ADA Administrators. MSHA hereby designates the House Supervisor, for the designated shift, at each MSHA facility as the ADA Administrator.  In the event a facility does not have a House Supervisor on duty, the Shift Leader for that facility, during that shift, will act as the ADA Administrator.  The House Supervisors, or their designee(s) in their absence, will be available 24 hours a day, seven days a week, to answer questions and provide appropriate assistance regarding immediate access to, and proper use of, the Auxiliary Aids and Services, including Qualified Interpreters.  The ADA Administrator(s) will know where the Auxiliary Aids are stored and how to operate them.  The MSHA hospital hereby designates its Compliance Officer, or his/her designee, as being responsible for their maintenance, repair, replacement, and distribution.  The MSHA hospital will circulate and post broadly within each MSHA facility the name, telephone number, function, and office location of the ADA Administrator(s), including a TTY telephone number, through which the ADA Administrator(s) on duty can be contacted 24 hours a day seven days a week by Patients and Companions who are deaf or hard of hearing.  The ADA Administrators will be responsible for the complaint resolution mechanism described in Paragraph 32 of this Agreement during the periods that they are on duty.  Complaints incapable of immediate resolution will be processed using the established grievance resolution mechanism under Paragraph 32.

36. Auxiliary Aid and Service Log. Each MSHA hospital will maintain a log, or a master log shall be maintained at a central location in MSHA Administration, which shall identify specific facilities in which requests for Qualified Interpreters on site or through video remote services will be documented.  The log will indicate the time and date the request was made, the name of the Patient or Companion who is deaf or hard of hearing, the time and date of the scheduled appointment (if a scheduled appointment was made), the nature of the auxiliary aid or service provided, and the time and date the auxiliary aid or service was provided.  If no auxiliary aid or service was provided, the log shall contain a statement explaining why the auxiliary aid and service was not provided and the MSHA hospital staff who made the decision.  Such logs will be maintained at each hospital or at a central location in MSHA Administration which shall identify specific facilities, for the entire duration of the Agreement, and will be incorporated into the semi-annual Compliance Reports as described in Paragraph 51 of this Agreement.

37. Successive Patient Visits. MSHA shall, to the extent it has not already done so, implement policies and procedures to expedite arrangements for the provision of auxiliary aids and interpretive services when a Patient or Companion requests appropriate auxiliary aids or services for successive visits to MSHA hospitals. MSHA personnel shall keep appropriate records that reflect the provision of auxiliary aids and services to Patients and Companions, such as notations in Patients’ medical charts.  During a Patient or Companion’s successive visit, MSHA hospital personnel shall reference the individual’s prior medical records, where available, as part of the Communications Assessment.

38. Medical Equipment. Nothing in this Settlement Agreement shall require that an electronic device or equipment constituting an appropriate auxiliary aid be used when or where its use may interfere with medical or monitoring equipment or may otherwise constitute a threat to the patient’s medical condition.  This provision in no way lessens MSHA’s obligation to provide appropriate Auxiliary Aids and Services as required under this Settlement Agreement.

39. Complaint Resolution. MSHA will utilize its established grievance resolution mechanism for the investigation of disputes regarding effective communication with Patients and Companions who are deaf and hard of hearing.  MSHA will maintain records of all grievances regarding effective communication, whether oral or written, made to MSHA and actions taken with respect thereto.  At the time MSHA personnel complete the assessment described in Paragraph 26 and in Paragraph 27 and advise Patient and/or Companion of the determination of which appropriate Auxiliary Aids and Services are necessary, MSHA will notify Patients and/or Companions who are deaf or hard of hearing of its grievance resolution mechanism, to whom complaints should be made, and of the right to receive a written response to the grievance.  This notification will be provided verbally during the assessment and shall appear in writing on the Communication Assessment Form.  A written response to any grievance filed shall be completed within the same time frames under the established grievance process.  Copies of all grievances related to provision of services for Patients and/or Companions who are deaf or hard of hearing and the responses thereto will be maintained by the ADA Administrators for the entire duration of the Agreement.

40. Prohibition of Surcharges. All appropriate Auxiliary Aids and Services required by this Agreement will be provided free of charge to the Patient and/or Companion who is deaf or hard of hearing.

41. Record of Need for Auxiliary Aid or Service. MSHA will take appropriate steps to ensure that all MSHA hospital personnel are made aware of a Patient or Companion’s disability and auxiliary aid and services needed by specifying those needs in the patient’s chart (electronic or otherwise) so that effective communication with such person will be achieved.  When such a record is made, it should also note that responses to call lights should be automatically made in person and that intercoms or other similar systems of non-visual communication should not be used.