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Americans with Disabilities Act (ADA) Attestation

Americans with Disabilities Act (ADA) Survey

The Americans with Disabilities Act (ADA) and Ohio Revised Code (ORC) 3781.111 require providers make reasonable access and accommodations for all persons with disabilities. Molina is providing you with the opportunity to self-attest to the below ADA standards in order to verify core elements of ADA compliance for the Medicaid and MyCare Ohio programs.

Please complete the following survey for each service location.

Your feedback is important, and You Matter to Molina. As a valued partner, please complete and submit the survey below. This survey will take approximately 3-5 minutes to complete. Thank you!
1.Please provide the following information:(Required.)
2.If you are an office-based provider, please check the applicable box next to each standard below and have the designated representative review and return the attestation to Molina Healthcare.

If you are NOT an office-based provider, please skip this question and move to question 3.
Yes
No
Building has accessible (handicap) designated parking. Parking spaces are accessible with ramps and curb cutouts between the parking lot, office, and at drop off locations.
Building has automatic entry option or alternative access method.
Building has elevator for public use (if building is multi-leveled). Elevator has enough room for the wheelchair and/or scooter to maneuver.
Restroom is equipped with large stall and safety bars or other reasonable accommodations.
Waiting room (including furniture) can accommodate patients with physical and non-physical disabilities. The reception and waiting areas have enough room for a wheelchair and/or scooter to maneuver and turn around.
At least one exam room can accommodate patients with physical and non-physical disabilities.
Signage and way finding is clear (e.g., color, symbol signage, and braille).
Doors to access building, office, and patient rooms are at least 32 inches wide.
The exam table moves up and down to make it easier to get on and off whether standing or using a wheelchair or scooter.
Diagnostic equipment can accommodate patients with various disabilities.
The scale is able to accommodate a wheelchair or scooter.
3.I attest to the best of my knowledge that the above information is true, accurate, and complete.(Required.)
4.Provider service locations that attest to being ADA compliant or have received an in-office assessment and determined to be ADA compliant will be published as such in the Molina Medicaid and MyCare Ohio Provider Directories.

Please let us know if you have any questions or feedback on this ADA Attestation.
Current Progress,
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