Thomas M Anderson DDS PA complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
It is the policy of Thomas M Anderson DDS PA not to discriminate on the basis of race, color, national origin, sex, age or disability. Thomas M Anderson DDS PA 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 Thomas M Anderson DDS PA, Section 1557 Coordinator, 2245 Lewisville Clemmons Road Suite B Clemmons, NC 27012 336-766-3377 336-766-3661 nicepar4@Aol.com who has been designated to coordinate the efforts of Thomas M Anderson DDS PA 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 Thomas M Anderson DDS PA to retaliate against anyone who opposes discrimination, ﬁles a grievance, or participates in the investigation of a grievance.
• 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 Thomas M Anderson DDS PA 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 (Administrator/Chief Executive Ofﬁcer/Board of Directors/etc.) within 15 days of receiving the Section 1557 Coordinator’s decision. The (Administrator/Chief Executive Ofﬁcer/Board of Directors/etc.) 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.
Thomas M Anderson DDS PA 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: October 6, 2016