Civil Rights Information and Forms

On Line Submission:

Providers now have the option of answering all questions and submitting the civil rights clearance package on line.

Facilities Requiring Civil Rights Certification:

A health care provider that applies for participation in the Medicare Part A program must receive a civil rights clearance from the Office of Civil Rights (OCR). These facilities include:

  1. skilled nursing facilities
  2. hospitals
  3. critical access hospitals
  4. home health agencies
  5. rehabilitation agencies (outpatient therapy, speech pathology)
  6. comprehensive outpatient rehabilitation facilities
  7. hospices,
  8. community mental health centers, and
  9. rural health clinics that are provider-based to a hospital or CAH

NOTE:  OCR has entered into Civil Rights Corporate Agreements with numerous major health care corporations. These corporations have adopted model civil rights policies and procedures, which OCR has determined meet the civil rights requirements necessary for participation in the Medicare Part A program.  These corporations also commit to ensuring that their facilities adopt and implement these policies and procedures.  Providers that belong to corporations with such Agreements do NOT need to submit the usual civil rights packet.  They need to submit ONLY the signed certification sheets, as specified in the Civil Rights Corporate Agreement.

Facilities Not Requiring Civil Rights Certification:

Suppliers (ambulatory surgical centers, rural health clinics that are not provider based, portable x-ray, end stage renal disease facilities, federally qualified health centers, and organ procurement organizations) are not subject to civil rights clearance. Also, Medicaid-only providers do not need OCR clearance.