PRH Chapter 1:

Outreach &

Admissions

Access

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Health & Disability

Pat Jackson, RNLead Assessor

Humanitas, Inc.

Michelle DayProject Manager-Accommodation Support Contract

Humanitas, Inc.

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Overview

• Confidentiality• Communication• Asking about Disability during Essential Admissions

Requirements (EARs) Process• Reasonable Accommodation during Admissions

Process• Applicant File Review at the Center Level• Scenarios• Resources

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CONFIDENTIALITY OF HEALTH/DISABILITY INFORMATION

Disclosure, Storage and Transmission

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HIPAA Overview

• The Health Insurance Portability and Accountability Act of 1996– The Accountability Act or Privacy Rule, a federal law,

gives patients rights over their health information and sets rules and limits on who can view protected health information.• It applies to all forms of individuals' protected health information,

whether electronic, written, or oral.– The Security Rule, a federal law that protects health

information in electronic form, requires entities covered by HIPAA to ensure that health information is secure.

• Enforced by the US Department of Health and Human Services’ Office for Civil Rights

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HIPAA Authorization• Job Corps requires

applicants or legal guardians to sign the HIPAA Authorization as a condition of enrollment prior to the applicant arriving on center.– Authorization informs

applicants how, to whom, and why their health information will be shared.

– Complete Authorization should be in the student health record.

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Documentation Transmission and Storage

• Any and all records that are health or disability related, or that contain any of those types of information, must be kept separate from other records about the individual.

• If hard copies are transmitted, health or disability information should be placed in a separate file. That file should be placed in a sealed envelope that is clearly marked as containing such information.

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Documentation Transmission and Storage

• If the applicant withdraws his or her application or chooses not to enroll, all supporting documentation, including all medical, health, and disability-related documentation, must be returned to the AC.

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Job Corps Applicant Eligibility Folder Inventory

• Appendix 105: Health and Disability History Envelope

• ETA 6-53• Authorization for Use and Disclosure of

Your Health Information Form (HIPPA)• Job Corps Informed Consent to Receive

Mental Health and Wellness Treatment • Medical records• Individualized Education Program (IEP)• Reasonable Accommodation Request

form • Psycho-educational reports• Other cognitive and achievement

testing results

• Any other protected medical/disability-related information (i.e., summaries from current and/or recent medical providers or treatment facilities, including mental health and substance abuse)

• Immunization records

• Chronic Care Management Plans provider form(s)

• Orthodontic treatment form (if applicable)

• Dental records (if applicable)

• Supplemental documentation relating to health and wellness (examples)

• Copy of health insurance card (front and back)

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Summary

• Federal law enacted by Congress to protect the privacy of patients’ medical records

• Information is disclosed only to staff that have a need to know

• Transmission, storage, and confidentiality of protected health information must be safeguarded

• Do not share information in front of others like (elevator, water cooler, corridors)

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Collection and Handling of Health-Related Documents

• ACs must:– Use the ETA 6-53 Job Corps Health Questionnaire to collect

health information about the applicant offered enrollment.– Forward the originals of the ETA 6-53 of the applicant

offered enrollment, and all documentation that has been collected, to the center of assignment. These documents must be forwarded in envelopes or files that are sealed and kept separate from any other information about the applicant offered enrollment.

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Collection and Handling of Health-Related Documents

• For applicants that are not offered enrollment retain copies of the ETA 6-53, and all related documentation that has been collected, in a file that is stored separately from any other information about the applicant.

• The ETA 6-53, the related documentation, and all other medical or disability-related information about the applicant must be kept confidential, and access to this information must be strictly limited to persons with a need to know, as described in Appendix 607.

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Appendix 607

• Only the categories of persons identified in Appendix 607 may be permitted to review, or have access to the applicant’s medical, health, or disability-related information.

• Any medical, health, or disability-related information about a particular person – whether that person is an applicant to Job Corps, an enrollee, an employee, an applicant for employment, or anyone else – must be treated with extreme care. Federal law requires that all such information be treated as strictly confidential, and that it be transmitted and stored in a way that ensures confidentiality.

Confidentiality: The General Rule is Do Not Tell

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Knowledge Versus Access

• The categories of persons who are permitted to have access to a particular individual’s underlying medical, health, or disability-related documents are still more limited. Even among those who may be informed either about the fact that an individual has a disability, or about specific details related to a disability or medical condition.– Very few people will genuinely need to see or use those

documents.

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Q & A

Q: Who may be informed either about the fact that a particular individual has a disability, or about specific details related to a disability or medical/health condition?

A: Only people who need to know (“need to know” is interpreted narrowly)

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COMMUNICATIONApplicants and Others with Disabilities

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Communicating• Communication with applicants and

others who have disabilities must be as effective as communication with others. – This obligation is separate from

reasonable accommodation (Appendix 606)

• Even before taking the actions described in that appendix, ACs need to know that if they receive a request for auxiliary aids and services (communication aids) for a person with a disability, they:

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Communicating - Legal

– Must address the request immediately; and

– Must not begin, or continue with, any part of the admissions process until some sort of communication aid has been provided that is acceptable to the person for whom the auxiliary aid and/or service is being requested.

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ASKING ABOUT DISABILITY DURING EARS PROCESS

Age and Income

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Asking About Disability

• In general AC would not ask whether applicant has disability prior to conditional enrollment in program, however, at two points in process of determining eligibility, ACs may invite applicant to disclose.

• How?– Explain that disclosure is possible– Explain four principles– Explain definition of disability– Explain applicant response options

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Possible Disclosure

• Before EAR process begins, explain to every applicant, and his or her parent, guardian if a minor, or other representative, that two of the EAR questions (age and low-income status) may result in answers disclosing that the s/he has a disability.

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Four Principles

Explain the four principles that apply to all medical and disability-related questions in Job Corps.

1. Providing disability-related information is voluntary.

2. The information will be kept confidential as required by law.

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Four Principles (cont’d)

3. Declining to disclose whether he or she has a disability will not cause the applicant to receive unfavorable treatment (except that if the applicant decides not to disclose, there is a possibility that he or she will not be found to meet the age requirements and/or qualify as low income)

4. The information will be used only in accordance with the law.

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Definition of Disability

• Explain to the applicant that under the law, he or she may be considered a “person with a disability” if:a) He or she has a physical or mental impairment;b) The impairment affects one or more of his or

her major life activities. The term “major life activities” refers to activities that are of central importance to daily life, e.g., caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, leaning, and working;

c) The effect of the impairment is substantial.

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Applicant Response Options

• Explain to the applicant that when s/he is asked whether s/he falls into the category of an individual with a disability, the applicant should select only one of three possible answers: 1. Yes2. No3. Do not wish to answer

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Age and Income

• So when during EAR process may you be asking if the applicant is an individual with a disability?– If the applicant is, or will be, over 24, on the date of

enrollment. – If the applicant would not meet the low-income

requirement unless the applicant is considered a “family of one” because of disability.

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Disability Determination

• AC will not determine applicant is a person with a disability. The center will do this.– Do not review health and medical information, place in

sealed envelope with applicant file that will be forwarded to center for review.

• Continue EAR process

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REASONABLE ACCOMMODATION DURING ADMISSIONS PROCESS

Appendices 106 and 605

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Reasonable Accommodation Request Forms

• There are two reasonable accommodation request forms.– Appendix 106

• Accommodation(s) needed to participate in the admissions process

– Appendix 605• Accommodation(s) needed to participate in the Job Corps

program

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RA Form – Appendix 106 Accommodations to Participate in Program

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Accommodations for Admissions Process

• Applicant with a disability is entitled to request and receive reasonable accommodation at any time during the admissions process.

• If the applicant is requesting reasonable accommodation to participate in the admissions process, the AC:a) Must address the applicant’s accommodation needs

immediately; andb) Must not begin, or continue with, any part of the admissions

process for which the applicant has requested accommodation until the accommodation has been provided.

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Accommodations for Admission Process – Do’s

• The AC will inform each applicant of his or her right to request and receive reasonable accommodation at any time during the admissions process and then review the Job Corps Reasonable Accommodation Request Form (Appendix 106).

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Accommodations for Admissions Process – Don’ts

• Even if the applicant requests accommodation for the admissions process, the AC must not:– ask whether the applicant will need accommodation to actually

participate in Job Corps.– assume that the applicant will need accommodation to participate in

Job Corps.– ask for any disability-related information except at the times, and

under the circumstances, that are described elsewhere in PRH 1 (e.g., age and income during EARs process, reasonable accommodation process to participate in program, 6-53).

– take the applicant’s disability into consideration in determining whether he or she meets the eligibility requirements or other factors for enrollment in Job Corps (e.g., age and income during EARs process).

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RA Form – Appendix 605Accommodations to Participate in Program

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RA Form – Appendix 605

When?• After EAR process.• After conditional offer of enrollment and applicant

assigned to center.• At same time as 6-53.

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RA Form – Appendix 605

How?• Inform applicant of right to request reasonable

accommodation to participate in program.• Explain four principles (voluntary, confidential,

no unfavorable treatment, use in accordance with law) and that if request is not made now, it can be made at any time during rest of enrollment process or after arrival on center.

• Go through form with applicant.

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RA Form – Appendix 605

How (cont’d)?• Have applicant completes form if s/he wants

to request accommodation; AC can assist.• Do not review health and medical

information, place in sealed envelope with applicant file that will be forwarded to center for review.

• Nothing has changed with this process.

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Talking to an Applicant about Reasonable Accommodation

• Job Corps Disability Website– JC Community

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APPLICANT FILE REVIEW AT THE CENTER LEVEL

Processing Applications to the Job Corps Program

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Applicant File Review Procedures

• SOP describing center’s process for reviewing applicant files required; should describe in detail how applicant file is processed from the time it arrives on center through a final disposition.

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Applicant File Review Procedures• Responsibilities of records staff:

– Gatekeeper of files– Forwards the sealed medical, health, or

disability-related information unopened to the appropriate staff.

– Maintains records log

• Responsibilities of center file review team:– Appropriate center staff conducts a

review of each applicant’s file• All applicant files must be forwarded to the

HWM or his or her designee for a health documentation review and initial direct threat review.

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Only Potential Application Outcomes

• Enrollment• Applicant withdrawal• Found ineligible based on

information that was not reasonably available to the AC

• Recommendation for denial– Direct threat– Cannot meet basic health care needs

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Ineligible Based on New Information

• Neither the center file review team nor its individual members may revisit the determination that an applicant is qualified for admission unless: – There is new information presented that the AC could not have

reasonably known at the time the applicant’s qualification for admission was established, and

– This new information indicates that the applicant offered enrollment may not meet one of the EARs.

• Center must use same assessment/verification requirements and guidance used by AC in Exhibit 1-1 to make determination that applicant does not meet the EAR.

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New Information – Center Denial

• If the center determines that the applicant is no longer qualified for admission based on new information, the center will notify the AC.

• AC must contact the applicant to explain why the application has been denied. – This contact must be documented, and a

written explanation of denial must be provided to the applicant (see Appendix 104), along with an explanation of the applicant’s rights to appeal and to file a discrimination complaint, as described in Section 1.2.

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Direct Threat

• A direct threat assessment should be completed whenever Job Corps believes that an applicant poses a direct threat to the health or safety of himself or others. – This typically will occur after the applicant has received

conditional assignment to a Job Corps center and has completed the 6-53 Health Questionnaire. • Poses a significant risk of substantial harm to the health or safety

of the individual or others; and• Cannot be eliminated or reduced by reasonable accommodation or

modification.

• See Appendix 609

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Health Care Needs

• Center can recommend denial if determination is made that Job Corps cannot meet the health care needs of an applicant.

• Appendix 610 (future PRH release) will provide health staff with guidance on this process.

• Health staff should contact regional health specialists if questions about this process.

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Center Recommendation for Denial – Direct Threat or Health Care Needs

• Any applicant file recommended for denial for direct threat or health care needs will be forwarded to the regional office for a final disposition.

• Follow Regional Office procedures for processing these applicant files.

• If denial recommendation rejected by the Regional Office, applicant must be scheduled for arrival based on the date on which the application first arrived on center.

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Reasonable Accommodation

• The applicant is engaged in an interactive process to determine reasonable accommodation needs prior to assigning the applicant a start date in cases where an applicant requests reasonable accommodation or information/documentation in the applicant file indicates accommodation may be necessary.

• See Appendix 605.

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APPLICANT SCENARIOSLet’s Practice!

Scenario #1

• AC certifies that applicant meets all admissions criteria and file is forwarded to the center for review

• Applicant allegedly commits a crime after he receives a conditional offer of enrollment, and center learns of existing charges when health and wellness manager calls applicant to talk about a health care need

What should happen next?

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Disposition

• Center received new information that the AC could not have known– Revisit eligibility criteria for court history

• Applicant “may” not be eligible for enrollment

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Scenario #2• 18-year-old male wants to study cement masonry or

painting • He was referred to Job Corps by his social worker as

both parents are terminally ill and the social worker is seeking a residential placement for him, when his parents are no longer able to care for him

• He is described as having moderate impairment of functioning in most social areas and has obsessive rituals from OCD and conversion symptoms, with frequent anxiety attacks along with aggressive and antisocial behavior.

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Scenario #2

• The conditionally enrolled applicant came to the center with his mentor for a meeting with the HWM to review his basic health care needs.– The applicant verbalized that he wanted to complete his high

school before entering JC but the case managers and adults around him are advocating for him to come into the program now. He is in a special education day class and wants to stay in his class and would rather not come to JC now.

What should happen next?

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Disposition

• Since applicant expresses no desire to enroll in Job Corps, the health interview should stop; the applicant no longer meets the program suitability requirement which requires the applicant to want to earn a high school diploma or GED and participate in career technical training (the applicant must indicate a desire to obtain both academic and career technical training).

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RESOURCESJob Corps and Partners

National Office

• Carol Abnathy, National Office of Job Corps(202) 693-3283abnathy.carol@dol.gov

• Johnetta Davis, National Office of Job Corps(202) 693-8010davis.johnetta@dol.gov

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Job Corps Disability Web Site

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Job Accommodation Network (JAN)askjan.org

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