NOTICE OF NONDISCRIMINATION
Virginia Eye Institute Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Virginia Eye Institute Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Virginia Eye Institute Surgery Center:
• Will provide free aids and services to people with disabilities to communicate effectively with us, such as:
o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Will provide free language services to people whose primary language is not English, such as:
o Qualified interpreters
o Information written in other languages
If these services are required, please contact: 804-287-4244 or info@vaeye.com
If you believe that Virginia Eye Institute Surgery Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the ACA Grievance Coordinator. If you need help filing a grievance, a qualified interpreter can be assigned to help you. You can file a grievance in person by appointment or by mail, fax or email at:
Lisa Sizemore, Director of Surgical Services
402 Westhampton Station
Richmond, VA 23226
Office: 804-287-4240
Fax: 804-287-4207
sizemorel@vaeye.com
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
Section 1557 of the Affordable Care Act Grievance Procedure
It is the policy of Virginia Eye Institute Surgery Center not to discriminate on the basis of race, color, national origin, sex, age or disability. Virginia Eye Institute Surgery Center has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services.
Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of :
Lisa Sizemore, Director of Surgical Services
402 Westhampton Station
Richmond, VA 23226
804-287-4240
Fax: 804-287-4207
Email: sizemorel@vaeye.com
who has been designated to coordinate the efforts of Virginia Eye Institute Surgery Center to comply with Section 1557.
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Virginia Eye Institute Surgery Center to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
Procedure:
- Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action. • A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
- The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Virginia Eye Institute Surgery Center relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
- The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies. • The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the Chief Executive Officer of Virginia Eye Institute within 15 days of receiving the Section 1557 Coordinator’s decision. The Chief Executive Officer or Board of Directors shall issue a written decision in response to the appeal no later than 30 days after its filing.
The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Virginia Eye Institute Surgery Center will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.
Dated: November 2016
