RSA-227 - Annual Client Assistance Program (CAP) Report

Kansas (DISABILITY RIGHTS CENTER OF KANSAS) - H161A130013 - FY2013

General Information

Designated Agency Identification

NameThe Disability Rights Center of Kansas
Address635 SW Harrison Suite 100
Address Line 2
CityTopeka
StateKansas
Zip Code66603
E-mail Addressrocky@drckansas.org
Website Address
Phone785-273-9661
TTY 877-335-3725
Toll-free Phone877-776-1541
Toll-free TTY877-335-3725
Fax

Operating Agency (if different from Designated Agency)

NameThe Disability Rights Center of Kansas
Address635 SW Harrison Suite 100
Address Line 2
CityTopeka
Zip Code66603
E-mail Addressrocky@drckansas.org
Website Address
Phone785-273-9661
TTY877-335-3725
Toll-free Phone877-776-1541
Toll-free TTY877-335-3725
Fax

Additional Information

Name of CAP Director/Coordinator
Person to contact regarding report
Contact Person Phone

Part I. Agency Workload Data

A. Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Information regarding the Rehabilitation Act1
2. Information regarding Title I of the ADA0
3. Other information provided3
4. Total I&R services provided (Lines A1+A2+A3)4
5. Individuals attending trainings by CAP staff (approximate)4,968

B. Individuals served

An individual is counted only once during a fiscal year. Multiple counts are not permitted for Lines B1-B3.

1. Individuals who are still being served as of October 1 (carryover from prior year)13
2. Additional individuals who were served during the year68
3. Total individuals served (Lines B1+B2)81
4. Individuals (from Line B3) who had multiple case files opened/closed this year. (In unusual situations, an individual may have more than one case file opened/closed during a fiscal year. This number is not added to the total in Line B3 above.)3

C. Individual still being served as of September 30

Carryover to next year. This total may not exceed Line I.B3. 15

D. Reasons for closing individuals' case files

Choose one primary reason for closing each case file. There may be more case files than the total number of individuals served to account for those unusual situations, referred to in Line I.B4, when an individual had multiple case files closed during the year.

1. All issues resolved in individual's favor22
2. Some issues resolved in individual's favor (when there are multiple issues)16
3. CAP determines VR agency position/decision was appropriate for the individual4
4. Individual's case lacks legal merit; (inappropriate for CAP intervention)8
5. Individual chose alternative representation0
6. Individual decided not to pursue resolution16
7. Appeals were unsuccessful1
8. CAP services not needed due to individual's death, relocation, etc.0
9. Individual refused to cooperate with CAP5
10. CAP unable to take case due to lack of resources0
11. Other (please explain)

No "Other" results

E. Results achieved for individuals

1. Controlling law/policy explained to individual37
2. Application for services completed.4
3. Eligibility determination expedited1
4. Individual participated in evaluation1
5. IPE developed/implemented16
6. Communication re-established between individual and other party10
7. Individual assigned to new counselor/office1
8. Alternative resources identified for individual2
9. ADA/504/EEO/OCR/ complaint made0
10. Other0
11. Other (please explain)

Part II. Program Data

A. Age

As of the beginning of the fiscal year. Multiple responses are not permitted.

1. 21 and under7
2. 22 - 4029
3. 41 - 6444
4. 65 and over1
5. Total (Sum of Lines A1 through A4. Total must equal Line I.B3.)81

B. Gender

Multiple responses not permitted.

1. Female38
2. Male43
3. Total (Sum of Lines B1 and B2. Total must equal Line I.B3.)81

C. Race/ethnicity

1. Hispanic/Latino of any race4
For individuals who are non-Hispanic/Latino only
2. American Indian or Alaskan Native3
3. Asian0
4. Black or African American23
5. Native Hawaiian or Other Pacific Islander0
6. White47
7. Two or more races1
8. Race/ethnicity unknown3

D. Primary disabling condition of individuals served

Multiple responses not permitted.

1. Blindness (both eyes)4
2. Other visual impairments1
3. Deafness6
4. Hard of hearing1
5. Deaf-blind0
6. Orthopedic impairments6
7. Absense of extremities0
8. Mental illness37
9. Substance abuse (alcohol or drugs)0
10. Mental retardation0
11. Specific learning disabilities (SLD)3
12. Neurological disorders6
13. Respiratory disorders0
14. Heart and other circulatory conditions4
15. Digestive disorders0
16. Genitourinary conditions1
17. Speech Impairments1
18. AIDS/HIV positive0
19. Traumatic brain injury (TBI)1
20. All other disabilities10
21. Disabilities not known0
22. Total (Sum of Lines D1 through D21. Total must equal Line I. B3.)81

E. Types of individuals served

Multiple responses permitted.

1. Applicants of VR Program11
2. Clients of VR Program67
3. Applicants or clients of IL Program1
4. Applicants or clients of other programs and projects funded under the Act2

F. Source of individual's concern

Multiple responses permitted.

1. VR agency only70
2. Other Rehabilitation Act sources only1
3. Both VR agency and other Rehabilitation Act sources7
4. Employer4

G. Problem areas

Multiple responses permitted.

1. Individual requests information8
2. Communication problems between individual and counselor14
3. Conflict about services to be provided46
4. Related to application/eligibility process7
5. Related to IPE development/implementation7
6. Other Rehabilitation Act-related problems3
7. Non-Rehabilitation Act related1
8. Related to Title I of the ADA0

H. Types of CAP services provided

Choose one primary CAP service provided for each case file/service record.

1. Information/referral26
2. Advisory/interpretational20
3. Negotiation4
4. Administrative/informal review2
5. Alternative dispute resolution18
6. Formal appeal/fair hearing1
7. Legal remedy1
8. Transportation0

Part III. Narrative

Narrative

a. Type of agency used to administer CAP: Identify the type of agency used to administer the CAP and type of agency operating the CAP, if different. Types of agencies used to administer the CAP include, but are not limited to:1) external -- P&A;2) external -- other public agency;3) external -- nonprofit agency;4) internal to State VR agency (not sub-contracted); and5) internal to State VR agency (sub-contracted).Effective 04/01/2005 the CAP was re-designated to the Disability Rights Center of Kansas, Inc., the designated Protection and Advocacy System for Kansas.b. Sources of funds expended: Specify the total expenditure of funds used in providing services to CAP-eligible individuals according to the source of funding. Provide this information even if the agency’s only source of funding is the Federal formula grant. The following chart is recommended:Source of funding Total expenditures spent on individualsFederal funds $65,955State funds 0All other funds 0Total from all sources $65,955The "all other" category is broad and includes funds from local governments, earned income (e.g., legal fees), charitable contributions, and other grants or contracts. This category does not include in-kind donations. However, it is hoped that CAP agencies will collect this information separately if appropriate.c. Budget for current and following fiscal years: Be sure to outline the budget for the current and subsequent fiscal years. This item should include a breakdown of dollars expended/allotted for administrative costs (e.g., salaries for personnel, equipment, etc.); and services to individuals and other expenses (e.g., training of staff, travel, etc.). The following chart is recommended:Category FFY 2013 FFY 2014Wages & Salaries $38,071 $84,485Fringe Benefits $11,688 $26,724Materials/Supplies $ 763 $ 2,098Postage $ 206 $ 661Telephone $ 594 $ 1,574Rent $ 4,523 $ 8,497Travel $ 2,196 $ 5,245Copying $ 0 $ 0Bonding/Insurance $ 670 $ 1,206Equip Rent/Purchase $ 771 $ 1,070Legal Services $ 0 $ 0Indirect Costs $ 0 $ 0Miscellaneous $ 6,473 $18,440Total Budget $65,955 $150,000d. Number of person-years: "Person-years" refer to the actual time that positions (both professional and clerical) were filled during the period covered by this annual report. If a position was filled throughout the year, it counts as one person-year. Positions filled for any fraction of the fiscal year should be expressed in "full-time equivalents. Person-years should be reported for all CAP personnel whose salaries are paid totally or partially by Section 112 funds. Identify the number of person-years staffing CAP this fiscal year. Be sure to include an explanation of the number of full-time, part-time, and vacant positions. Enter the full-time equivalent for all par-time positions. The following chart is recommended:Type of position FTE % yr filled Person-yearsExecutive Director 1 100% 1Deputy Director - Administrative Division 1 100% 1Deputy Director - Legal Division 1 100% 1Case Attorneys 4.33 100% 4Case Advocates 3.5 100% 3Office Assistant 1 100% 1Administrative Assistant 1 100% 1Outreach/Spec Project Dir 1 100% 1Duties:Executive Director - Overall leader and director of the agency. Administrative head of the agency. Employs staff (hires/fires). Ensures accountability, effectiveness and efficiency of agency’s programs and services.Deputy Director - Administrative Division - Responsible for accounting, bookkeeping, accounts receivable & payable, building and lease issues, human resources, etc. Supervises the Office Assistant and Outreach/Special Projects Director.Deputy Director - Legal Division - Responsible for legal work product of the agency. Supervises the staff attorneys and advocates. Carries an active caseload. Prosecutes cases.Case Attorneys - Provide legal representation.Case Advocates - Provide advocacy representation and case advocacy.Office Assistant - Answers phones, does office and administrative tasks, etc.Administrative Assistant - Provides administrative support to the legal division and assists with general administrative tasks for the entire agency.Outreach & Special Projects Director - manages the tasks associated with outreach, communications/public relations, marketing/publications, and administrative office functions of the agency.e. Summary of presentations made: Summarize the types of presentations made about CAP and other rehabilitation programs and projects. Include in the summary an estimate of the number or persons attending the presentations.DRC staff conducted numerous outreaches across Kansas to inform the disability community about the CAP, P&A programs and services, the Rehabilitation Act and disability rights issues. DRC staff completed 125 presentations to approximately 4968 people during FFY 2013 where the CAP and the Rehabilitation Act were either the focus of the presentation or these issues were part of the presentation or materials were provided.f. Involvement with advisory boards: Identify in what ways CAP is involved with advisory boards (e.g., State Rehabilitation Advisory Council, Statewide Independent Living Council, etc.).DRC is an active member of the State Rehabilitation Advisory Council and participates closely with the Kansas Association of Centers for Independent Living, the Big Tent Coalition, the Mental Health Coalition as well as many other Kansas disability organizations. The Executive Director of DRC is also the past Convener/Chair of the Big Tent Coalition, the largest cross-age, cross-disability advocacy coalition in Kansas. DRC has also been a member of the Working Healthy Advisory Board. In the past, DRC and Working Healthy have collaborated on significant projects. For example, DRC staff and Working Healthy Staff created a “Consumer Handbook.” This handbook is a calendar type tool for all consumers that are working and need to keep track of their hours, pay receipts, expenses and information that they have passed on to different agencies about their work. This is a product that can be used for many years to come. DRC and Working Healthy feel this is an important tool for consumers. This tool is especially helpful for CAP-eligible clients served by Vocational Rehabilitation and Independent Living Centers. CAP-eligible clients now has access to a convenient handbook where they can keep all their information they need to maintain benefits under Social Security and become employed. DRC has also written newsletters for Working Health clients to inform them about important changes in employment policy. g. Outreach to unserved/underserved populations: Identify the strategies used to conduct outreach to and to serve individuals previously unserved or underserved and/or individuals who are members of minority groups. Describe the impact of your outreach efforts, especially in terms of how your outreach efforts have benefited individuals who traditionally have been unserved or underserved.DRC has an on-going outreach effort to underserved populations to ensure effective access to our services. Part of DRC’s consideration of whether it will conduct an outreach or training is whether the training will reach out to previously unserved or underserved communities. In addition, DRC has collaborated with the Kansas African American Affairs Advisory Commission and the Kansas Hispanic Affairs Advisory Commissions, as well as communication with other racial minority groups (NAACP, etc.) about disability issues and solicited outreach events and opportunities.h. Alternative dispute resolutions: The Act clearly mandates CAPs to engage in mediation (or other forms of alternative dispute resolutions) prior to seeking a formal or legal remedy on behalf of the individual served. Part II-H5 of the Form RSA-227 asks you to identify the number of times your CAP agency engaged in ADR. In addition to that numerical data, be sure to describe, in the Narrative portion of your report, your efforts at engaging in ADR procedures, including how successful (or not successful) your attempts have been and an explanation of why CAP did not engage in ADR prior to seeking a formal or legal remedy.DRC has been successful in representing clients at advocacy levels less than a formal dispute resolution. Prior to pursuing any legal options, part of DRCs built-in case review process is to obtain justice and an effective remedy for the client in a manner that is short of legal action (if at all possible). Every effort is made to work directly with the VR counselor and his or her supervisor to resolve the client’s concern before legal action is needed. In fact, DRC has experienced great success in settling issues and getting matters resolved by working directly with the VR Counselor or VR Supervisor. The result of using the lowest level of advocacy necessary is a quicker resolution to the clients concerns and decreased expense of ADR and litigation.i. Systemic advocacy: Describe the systemic advocacy undertaken. Indicate the problems that have been identified in the delivery of VR and independent living services. To the extent possible, detail evidence/documentation that substantiates the problems. Summarize the activities CAP has undertaken to remedy the problems. Outline the State VR agency’s responses to those activities and explain the status of the problems at the close of the fiscal year. As appropriate, provide CAP’s plans for continuing to address the problems during the next fiscal year.Rising counselor-to-client ratios (at least 180:1 or higher in many parts of the state) seems to have resulted in the majority of CAP service requests being most easily categorized as ‘communication problems with counselor’ or ‘conflict over services to be provided.’ CAP advocates have kept up with changes to VR service regions and have been able to work out issues at the Program Director level when trends showed a lack of understanding on the part of counselors in a certain geographic region or another. Several years ago, the state VR office asked the CAP to initially contact the Regional Program Director regarding service problems instead of the individual counselor. Over time, this has helped resolve problems more quickly, particularly if a CAP advocate has credibility with the Regional Program Director through past contacts.Typical issues that have been brought to the attention of Program Administrators, as well as to the State Rehabilitation Council (SRC), have been in regards to consistent patterns of questionable denials for certain services or lack of a response to a client’s attempt to establish or reestablish communication with counselors when a client desired a change to a plan, or to ensure the counselor was informed of challenges tothe client in completing parts of the plan. Many clients have expressed frustration over an inability to reach counselors and/or difficulty in setting up appointments.Also, we have sometimes identified the difficulty with being able to exercise choice in setting goals, e.g. clients feel counselors are discounting their choices and imposing their values as to whether the client would be successful without letting them attempt certain types of employment goals. Over the past year there has also continued to be issues with VR counselors closing cases that clients do not want closed. The correspondence is sometimes unclear as to why a case is being closed or basing it on lack of response when client has been trying to reach them.These types of communication issues can make it difficult for clients to be sure changes they wish or need to make will meet the prior approval of the counselor. Clients who have not been able to document, or who did not exercise the wherewithal to document their attempts to contact their counselor have, at times, been faced with inappropriate service denials. These types of problems (communication and conflict over services to be provided) seem to disproportionately negatively impact younger VR clients and those with cognitive disabilities.During the past year, the CAP has continued to consciously make outreach a priority to Transition Age Youth, parent groups, and foster care/independent living staff, etc. to increase awareness of the benefits of accessing VR services. Through systemic advocacy we have pushed for streamlined planning and service coordination so that employment goals and support services are consistent from one plan to the next. CAP advocates are effective at getting transition services for clients who contact DRC; however, we expect that many more who do not contact DRC are declined services or never offered them. Policies and procedures used by special education, foster care, independent living services and VR services all include their own distinct processes and these systems have resisted efforts to ensure better coordination. CAP advocates plan to continue to highlight the benefits to systems of better coordination such as better utilization of counselor time, more efficient and comprehensive planning, and higher chances of successful outcomes for Transition Age VR clients.Systemic Change Advocacy:In addition, DRC has engaged in numerous systems change advocacy efforts that greatly benefit clients of Vocational Rehabilitation and CAP-eligible clients, including:.Regulating Restraint and Seclusion in Schools -In early 2013 the Kansas State board of education adopted regulations to control and limit the use of seclusion and restraint in schools based on recommendations by the Disability Rights Center of Kansas, with a promise to address three additional concerns raised by the disability community. The new regulations took effect April 13, 2013, limiting the use of seclusion and restraint for all students in Kansas schools. Now the dangerous tactics of seclusion and restraint can only be used if it is needed for "emergency safety intervention." That means the use of seclusion or physical restraint is only allowed when a student presents an immediate danger to self or others.Each school district must comply with the new limits and have written policies on the use of the dangerous tactics of seclusion and restraint. Parents must get a copy of the policy. Each district must have a local dispute resolution process in place for a parent who wishes to file a complaint for the use of seclusion and restraint. The new regulations thankfully prohibit the use of the most deadly forms of physical restraint which restrict breathing or impede the student’s primary mode of communication. Prone restraint and supine restraint are also prohibited. This prohibition has been supported in national efforts by both the disability and education communities (including the National Association of State Directors of Special Education, National Schools Boards Association, National Association of School Psychologists, National PTA, etc.). Unfortunately, some in Kansas are pushing to undo this prohibition. A Coalition of disability advocates, led by the Disability Rights Center of Kansas, is fighting against these negative undo these protections. DRC continues to work with members of the public and State Board of Education to address the three concerns raised by parents and disability rights advocates: 1) ensuring effective investigation and enforcement of the regulations by the State Department of Education, 2) improving the definition of when these dangerous and deadly tactics can be used, and 3) requiring staff training prior to use of the tactics. These issues must be adequately addressed to ensure that the regulations are both effective and enforceable. Progress on the Physical Disability (PD) & Developmental Disability (DD) HCBS Waiver Waiting listsDuring the 2013 Legislative session, the Disability Rights Center of Kansas (DRC) worked in a collaborative effort with the disability community in educating the public about the need for additional funds to be appropriated for the purposes of reduction of the Physical Disability (PD) & Developmental Disability (DD) HCBS Medicaid Waiver waiting lists. DRC identified a clause in the Special Terms and Conditions (STCs) of the approval letter sent by CMS regarding Kansas’ 1115 Waiver. This STC stipulate that the state SHALL designate a portion of KanCare 1115 Waiver savings to reduce HCBS waiting lists. DRC utilized this clause and educated the public and policy makers about the commitment that Kansas had made regarding dedicating savings towards the waiting list. It was no longer a question of whether the state had to dedicate 1115 Waiver savings toward reducing waiting lists. The only question was how much savings should Kansas dedicate. Before DRC’s efforts there were no effective efforts to increase funding for HCBS Waiting lists. However, after DRC’s efforts regarding the STC, dedicating funding to reduce the Waiting lists picked up significant momentum. After much education of the public on this matter, the Governor ultimately agreed with DRC’s assessment and added a total of 18.4 million to reduce the PD and DD waiting lists. In addition to the $18.4 million (All Funds), the legislature added $600,000 to the effort of further reducing the DD waiting list due to a closure of a cottage at Kansas Neurological Institute (a public, large-bed ICF/MR). The total of nearly the $19 million in funding is expected to remove approximately 250 individuals from the DD waiting list and 400 from the PD waiting list. This was widely believed to be one of the largest increases to the HCBS Waivers in recent years. The increase would not have been possible if not for DRC carefully reviewing every page of correspondence between the State and CMS and finding the STC regarding dedicating 1115 Waiver savings towards the waiting list. DRC used the STC between CMS and the State of Kansas as a teachable moment in order to have the public and policy makers focus more efforts towards reducing the HCBS waiting lists. KanCare Oversight CommitteeWhen Governor Sam Brownback took office in January of 2011, one of his top initiatives was the implementation of KanCare. KanCare is the state’s new Medicaid Managed Care Program (MMCP). While moving some portion of the state’s Medicaid program into a full risk managed care arrangement is not a new idea, the fact that Kansas took basically ALL of its Medicaid program and placed it into a for-profit, managed care arrangement is unprecedented. The disability advocacy community believed that sheer size, scope and speed of this change was dangerous. Virtually all of Medicaid was moved into an arrangement where three for-profit Managed Care Organizations (MCOs) from out-of-state would come in and take over the management of all Medicaid services in the State of Kansas--including long term services and supports (LTSS). Of course, there was a great deal of anxiety among consumers, providers, and disability advocates. At the onset of the planning phase of KanCare, the Disability Rights Center of Kansas (DRC) began meeting with the Governor’s administration, the MCOs, consumers, and various stakeholders to provide input on the design of the program. DRC, along with numerous other stakeholders, cautioned the state to proceed slowly with managed care, particularly for populations that require highly specialized services and supports. There was a groundswell of support for intense oversight of the managed care arrangement called KanCare. In the 2013 Legislative Session a bill was passed to create the KanCare Oversight Committee. As the Protection and Advocacy system for Kansas, policymakers contacted DRC with questions about how an oversight committee should be set up. DRC responded by educating both policymakers and the public about the importance of the KanCare oversight committee in order to ensure that there would be adequate oversight of the KanCare program. After the KanCare Oversight Committee was passed into law, the committee held its first meeting on October 7, 2013, ten months after KanCare’s initial implementation.j. Interesting cases: Describe a few of the more interesting or unique cases that CAP worked on during the fiscal year. Summarize the facts of the case and the activities that CAP undertook or is undertaking to resolve the issues raised by the individual served. Explain whether the case raised systemic or policy-making issues and CAP’s plan to address those issues.Example 1Saline County - AH is blind, receives SSI, and has an Individual Plan of Employment (IPE) with the state Vocational Rehabilitation (VR) agency. The IPE services included payment to attend college. She contacted DRC after VR would not include her dorm fees and meal plan in her IPE because VR wanted AH to use her SSI benefits to pay for them instead. VR’s refusal violated federal regulations for VR participants. A DRC attorney represented her in an administrative hearing and appeal, both resulting in decisions in VR’s favor. AH and the DRC attorney appealed again with a Petition for Judicial Review in state court. During pre-hearing negotiations, VR agreed to reverse its denial and pay all the cost of the dorm fees and meal plan. AH is now ready to return to actively pursuing her IPE goal.Example 2Atchison County- SH contacted DRC to request assistance advocating for a new Vocational Rehabilitation (VR) counselor who would be more responsive to her case. SH felt that VR was intentionally delaying the process to avoid providing her with the necessary services she needed to become gainfully employed. SH was requesting prescription eye glasses, dental care, transportation, and a lap top to assist her in furthering her education. A DRC advocate contacted the regional VR administrator on SH’s behalf. Although the area agency was having a difficult time with turnover, which was a significant reason for the delay in services to SH, the administrator found a new counselor and scheduled meetings to begin development of a new Individual Plan for Employment (IPE). SH is happy to be receiving the VR counseling she needs to obtain an IPE and career. Example 3Wyandotte County—EB is a 16 year old high school student with mild Intellectual Disability and Crohn’s disease. Her mother contacted DRC because she felt her daughter was not on a path to success in society, and wanted to make sure EB was receiving all available resources in school. EB’s IEP contained an inappropriate transition goal/plan. A DRC advocate provided technical assistance to EB on her rights to transition services pursuant to the IDEA and strategies on giving her input. The DRC advocate also provided referrals for parental support networks to her mother. As a result, EB has been able to have more effective transition services, including services funded by the Rehabilitation Act, such as VR. k. On-line information/outreach: Describe efforts CAP may have put forth to create a web page or some other on-line means of providing information to the public. Include information about the number of "hits" your on-line site received.DRC operates a web site, which has been tested and found to be accessibility to persons with disabilities. DRC had 38,427 hits on its web site during the last fiscal yearIn addition, DRC completed an overhaul of the look and feel of the website to make it more appealing and easier to navigate. This is part of DRC’s continuous quality improvement planning process. DRC also e-mails out its semi-annual newsletter in various accessible electronic formats. DRC has worked diligently to improve the content on the DRC web site. For example, DRC has within the past 3 fiscal years added exclusive and original video content about our services and the rights of people with disabilities on our web site. This video content has been very popular with Kansas consumers, because it allows them to have access to information about disability rights issues in a format that is easily accessible, especially to those with mental or intellectual functioning disabilities. The video format is also good for busy people with jobs who are on-the-go throughout the day. Instead of having to read through brochures and more paper, they can access short, easy to understand videos on the topic. These videos specifically cover the CAP and educate consumers about VR services and employment issues. To our knowledge, this is the first time that VR consumers had access to information about VR services and advocacy for employment issues in an easy to access video format.

Certification

Approved

This Report is Complete and Correct.Yes
Date Signed:29-Dec-13
Name of Designated Agency Official:Rocky Nichols
Title of Designated Agency Official:Executive Director