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Neighborhood Health Plan of Rhode Island (“Neighborhood”) contracted providers and facilities are required to accommodate members with disabilities by providing services that are geographically and physically accessible as defined by The Centers for Medicare and Medicaid Services (“CMS”) through the Americans with Disabilities Act (“ADA”) requirements.

The purpose of this survey is to determine and document if your provider location meets these requirements. All of the questions below are mandatory.

Neighborhood may perform site visits, from time to time, to ensure compliance with the CMS and ADA requirements.

Additionally, as part of the CMS requirements for Neighborhood, the information submitted will appear in Neighborhood’s Provider Pharmacy Directory in a format that will identify the provider and location.

  • If you are a sole/individual provider please enter your Type I NPI
  • If you are a group or provider within a group please enter your Type II NPI and all providers associated with this NPI will be available.

Is the information below correct?

 
Please verify the following REQUIRED information:
 
 
 
 
 
 
 
 
 

Format: 123-456-7890
 

Format: 123-456-7890
 
 Administrator Name - Help

Administrator, Practice Manager

Person with complete authority over the business and operations of the practice in concert with the owners and/or board members, final authority in fiscal decisions, supervising agent of all services, products, personnel, and quality assurance.

 

Format: 123-456-7890
 
 Disability Contact Email - Help

Disability Contact

Person with knowledge of the American Disabilities Act that can provide information on the facility's or practice's accommodations made to service-disabled patients.


Format: 123-456-7890
 
 
 
select

Please click on each location to review/update location-specific information.

To add or delete a location, please contact Neighborhood Provider Network Management at ADA@nhpri.org.

 
 
 
select

Please click on each provider to review/update the provider-specific information.

To add or delete a provider, please contact Neighborhood Provider Network Management at ADA@nhpri.org.

 
Access to Public Transportation Services
1. Are bus transportation services available?
Please check for each location.
2. Are commuter rail transportation services available?
Please check for each location.
3. Is the facility less than or equal to a ¼ mile walking distance from the bus or train?
Please check for each location.
 
Translation Services
4. Are translation services readily available, both by telephone and/or in person?
Please check for each location.
5. Is translation provided by a translation service or language line?
Please check for each location.
 
Translation Services
6. Are medical interpretation services provided for the following languages:
Please check for each location.  
Please Select Locations to Be Certified *
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General Information
7. Do/can you provide alternative appointment scheduling for those who need extra time?
Please check for each location.
8. Do/can you provide extended hours?
Please check for each location.
9. Do/can you provide home visits if needed?
Please check for each location.
 
General Information
10. What are your office hours? (Select opening and closing time for each day).
Please check for each location.  
Please Select Locations to Be Certified *
select
 
Sunday
24 Hours
Closed
Monday


Tuesday


Wednesday


Thursday


Friday


Saturday


 
Compliance for the Physically Disabled
Parking:
11. Are the correct number of accessible spaces available?
  • 1-25 total spaces= 1 required space
  • 26-50 total spaces= 2 required spaces
  • 51-75 total spaces=3 required spaces
  • 76-100 total spaces= 4 required spaces
  • 101-150 total spaces= 5 required spaces
  • 151-200 total spaces= 6 required spaces
  • 201-300 total spaces= 7 required spaces
Example: 1 accessible parking space to 25 total parking spaces ratio.

 
Compliance for the Physically Disabled
Parking:
12. Is van accessible parking available?
  • 1-400 total spaces = 1 required space
  • 401-500 total spaces= 2 required
Example: At least one space must be van-accessible. Also, one of every eight handicapped-accessible parking spaces must be van-accessible: i.e. (401-500 total spaces= 9 handicapped accessible spaces 2 of which are van-accessible spaces)

 
Compliance for the Physically Disabled
Parking:
13. Is the space(s) clearly marked by the International Symbol of Accessibility?
 
Compliance for the Physically Disabled
Parking:
14. Is there a designated drop off zone?
Please check for each location.

Example: This "Handicapped Drop-Off Zone/ No Parking" prohibits parking in the posted areas being used by vehicles dropping off those who have disabilities.

 
Compliance for the Physically Disabled
Parking:
15. If only on street parking is available, is there an unobstructed curb cut/ramp?
Please check for each location.
 
Exterior Travel Route
16. If the accessible route crosses a curb, is a curb ramp provided?
Please check for each location.
17. Is the accessible route to the building entrance consistently at least 36 inches wide?
Please check for each location.
18. Is the accessible route to the building entrance firm, slip resistant, and stable?
Please check for each location.

Guidance: A stable surface contains no loose elements such as gravel or wood chips. A firm surface consists of concrete or pavement as opposed to a soft soil, grass, or gravel. Slippery surfaces may include ceramic or tile and should be avoided.

 
Exterior Travel Route
19. Handrails
a. Are handrails provided on the ramp?
Please check for each location.
 
b. Is the ramp at least 36 inches wide?
Please check for each location.
 
Building Entrance
20. If the main entrance is not accessible, is there directional signage of the accessible location?
Please check for each location.
21. Are automatic opening doors present?
Please check for each location.
22. Doors:
a. If automatic opening doors are not present, is space available for a wheelchair user to approach and open the door?
Please check for each location.
 
b. Does the entrance door contain handles that can be opened without grasping, pinching, or twisting of the wrist?
Please check for each location.
 
Example: Approaching the door and pulling it toward you requires 60 inches of clear space perpendicular to the doorway and 18 inches parallel to the doorway. Approaching the door and pushing it away from you requires 48 inches of clear space perpendicular to the doorway.
 
Interior Route (From the building entrance to clinic entrance, registration counter, or office area)
23. Accessibility of the Interior Travel Route.
a. Are all paths of travel at least 36 inches wide?
Please check for each location.
 
b. Is the route stable, firm and slip resistant?
Please check for each location.
 
c. Is the route clear of any free objects that may stick out?
Please check for each location.
 
Example: It is best to have surfaces with low pile carpeting. Glossy or slick surfaces such as ceramic or tile may become slippery.
24. Is the elevator car large enough for a wheelchair or scooter user to enter and turn to reach controls?
Example: The doorway should be at least 36 inches wide. Measurements will vary depending on location of the door.

Please check for each location.
25. Elevators
a. Do the elevators provide audible signal indicators?
Please check for each location.
 
b. Do the elevators provide Braille signage?
Please check for each location.
 
Waiting Area
26. Is there space in the waiting area to accommodate a wheelchair?
Please check for each location.
27. Receptionist Station
a. Does the office have a method by which people that are seated or of a shorter stature can sign in/register?
Please check for each location.
 
b. Are there additional chairs available for people who cannot stand while transacting business?
Please check for each location.
 
Example: This may include a low receptionist station for transactions or desk-height writing surfaces with knee space. This may also include the use of a clip board as well. Access to additional chairs will help to decrease the risk of potential falls.
28. Is access permitted for service animals to accompany people with disabilities in all areas of the facility where the public is normally allowed to go?
Please check for each location.
 
Example: Existing policies must allow for the use of service animals in all generally public areas. If the animal must be excluded from a specific area, the patient should be notified in advance A service animal should have access to areas such as patient rooms, clinics, cafeterias, or examination rooms. However, it may be appropriate to exclude a service animal from operating rooms or burn units where the animal's presence may compromise a sterile environment.
 
Restrooms
29. Is there directional signage to an accessible toilet room?
Please check for each location.
30. Is there adequate space in a stall for a mobility device to make a 180° turn? This may-include a 60" diameter turning circle or a T-shaped turn (60"x 60"square with two 12" x 24").
Please check for each location.
31. Are grab bars provided, one on the wall behind the toilet and one next to the toilet?
Please check for each location.
32. Is the toilet paper dispenser mounted below the side grab bar in a reachable location?
Please check for each location.
33. Sink, Soap and Towel Dispensers
a. Is there at least one accessible sink?
Please check for each location.
 
b. Is there enough space for wheelchair users to park in front of the sink?
Please check for each location.
 
c. Is the faucet handle operable without needing to grasp, twist, or pinch?
Please check for each location.
 
d. Are the soap and toweling dispensers within reach (No higher than 40 inches from the floor?)
Please check for each location.
 
Example: The sink area must be clear of any movable items, such as trash cans, to make room for a wheelchair user. It is also imperative to make sure pipe lines beneath the sink are wrapped in a protective cover.
 
Exam Rooms
34. Are all exam room doors at least 36" in width?
Please check for each location.
35. Exam Rooms
a. Are the exam rooms large enough to fit the patient, caregiver, and physician?
Please check for each location.
 
b. Is there adequate space for a mobility device to make a 180° turn?
Please check for each location.
 
Example: There needs to be adequate room adjacent to an adjustable exam table for a mobility device to park to facilitate transfer from device onto the exam table. The minimum amount of space required is 30 inches by 48 inches.
 
Compliance for the Physically Disabled Equipment
36. If you have a weight scale, is the scale available with a platform to accommodate people in a wheelchair or who are unable to stand w/out assistance?
Example: Accessible scales are usable by people including; wheelchair users, those with activity limitations, and larger people. Scales must have a platform large enough to fit a wheelchair. There must also be a sloped surface that allows access to the scale platform.

Please check for each location.
37. Do you have or can you adapt an exam table for accessible transfers for people who use a wheelchair or are unable to access an exam table without assistance? This may include the use of an adjustable-height table, transfer board, portable lift or a stretcher/gurney.
Example:
  1. Adjustable-height tables must lower to the height of the wheelchair seat, 15 inches or lower from the floor.
  2. A transport board is a simple tool made of a smooth rigid material which acts as a supporting bridge between a wheelchair and another surface, along which the individual slides
  3. The portable lift base must go under or fit around the exam table for transfer
  4. Some equipment, including radiologic equipment, lacks the space beneath them necessary for a portable lift. Lifts may not be compatible with some radiological technologies. A stretcher or gurney can be raised or lowered to the height of the exam surface.
Please check for each location.
38. Is the staff trained to help a person with a disability transfer onto the exam table and to operate other accessible equipment?
Example: Staff members need to know how to operate the accessible equipment, how to assist with transfers and positioning of individuals with disabilities.

Please check for each location.
39. If the facility provides a specialized diagnostic service, is the device used handicap accessible? This may include X-Ray equipment, Ultrasound equipment, mammography equipment, and gynecological examine tables.
Example: This may include the use of: Mobile Digital X-Rays or Mobile Utlrasound Units. Mammography devices that can be used on a woman in a seated position. A gynecological accessible height exam table with adjustable, padded leg supports, rather than typical stirrups.

Please check for each location.
40. Other accessible equipment:  
List any additional accessible equipment:


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Accommodations for Intellectually and/or Cognitively Disabled
41. Do you accommodate services, teaching materials, and documents for individuals with learning, intellectual and/or cognitive disabilities?
Example: This may include: training staff members on effective communication techniques; written documents recorded on audiotape; the availability of an employee to explain/ assist in the completion of documents.

Please check for each location.
 
Accommodations for Intellectually and/or Cognitively Disabled
42. Are all printed materials made available in alternative formats?
Example: This shall include the use of large print (16-18pt font), Braille, taped text, digital versions of all written materials and Optical Recognition Software.-Ok-MB 8-30-15

For each location please select all that apply.
43. Do you have staff members available to assist with these services?
Example: Staff members may be needed to assist with the completion of documents/consents/payments either in person or over phone. It is also imperative to provide visually impaired individuals with the orientation of the room/facility. Staff should verbalize procedures prior to their implementation. Staff should be available to read notices or other written material to individuals upon request. Ok-MB-8-30-15

Please check for each location.
 
Accommodations for the Deaf or Hard-of-Hearing
44. Are proper accommodations made in order to ensure effective communication to and from individuals with hearing impairments?
Example: This may include the use of: qualified sign language interpreters; written notes between the provider and patient; the use of Computer Aided Realtime Transcription (CART); Video Relay Service (VSR); Assisted Listening Devices/Systems; telephone handset amplifiers; Closed caption decoders; or access to a TTY/TTD line.

Please check for each location.
45. Alarm System
a. Does the fire alarm system provide visual signals in all public spaces (waiting rooms, exam rooms, bathrooms)?
Please check for each location.
 
b. Are evacuation procedures clearly marked?
Example: Visual warning lights are to be mounted 6 inches below the ceiling.
 
Please check for each location.

 
Comments and Concerns

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Submit ADA Survey
I hereby certify that I have answered the above questions truthfully to the best of my knowledge on behalf of the provider and location(s) listed above.
 

Enter full name
 

Example: 05/27/2017
 
We are unable to submit your survey at this time. Please contact Neighborhood Provider Engagement and Contracting at ADA@nhpri.org."