RSA-509 - Protection & Advocacy of Individual Rights (PAIR) Program Performance Report

Delaware (COMMUNITY LEGAL AID SOCIETY,) - H240A110008 - FY2011

General Information

Designated Agency Identification

NameCommunity Legal Aid Society Inc.
Address100 W. 10th Street Suite 801
Address Line 2
CityWilmington
StateDelaware
Zip Code19801
E-mail Addressbhartman@declasi.org
Website Addresshttp://www.declasi.org
Phone302-575-0660
TTY 302-575-0696
Toll-free Phone800-292-7980
Toll-free TTY
Fax302-575-0840
Name of P&A Executive DirectorTeresa Cheek, Executive Director
Name of PAIR Director/CoordinatorBrian J. Hartman
Person to contact regarding reportBrian J. Hartman
Contact Person phone302-575-0660
Ext.220

Part I. Non-Case Services

A. Individual Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas150
2. Individuals receiving I&R outside PAIR priority areas0
3. Total individuals receiving I&R (lines A1 + A2)150

B. Training Activities

1. Number of trainings presented by PAIR staff25
2. Number of individuals who attended training (approximate)2,615

The DLP staff gave a presentation at the Senior Seminar in Disabilities Studies at the University of Delaware on October 5, 2010. Staff gave an overview of all DLP programs and services including the PAIR program. There were 28 persons in attendance. Staff distributed 28 brochures that included information about the PAIR program. [10-1029125]

DLP staff exhibited at the Delaware Veteran’s Stand Down/Employment Expo on October 8, 2010. Staff spoke to attendees about all DLP programs and services including PAIR. There were approximately 150 persons in attendance. There were 39 brochures and pamphlets distributed that contained PAIR related information. [10-2029149]

The DLP staff gave a presentation at the Division of Human Relations Conference on October 14, 2010. Staff gave an overview of all DLP programs and services including the PAIR program. There were 100 persons in attendance. Staff distributed 100 sets of materials that contained information about the PAIR program. [10-1029316]

The DLP gave a presentation at a DVR-sponsored event held October 11, 2010. Staff spoke to attendees about all DLP programs and services including PAIR. There were 11 persons in attendance and 33 brochures and pamphlets were distributed which contained information about the PAIR program. [10-2029150]

The DLP gave a presentation at a DVR-sponsored event held October 26, 2010. Staff spoke to attendees about all DLP programs and services including PAIR. There were 20 persons in attendance and 40 brochures were distributed which contained PAIR related information. [10-1029396]

The DLP Legal Advocacy director gave a presentation to the Widener Law Institute Board of Advisors on October 28, 2010. The Legal Advocacy Director presented on the Medical Legal Partnership model and creation of a regional MLP. Staff gave an overview of all DLP services including the PAIR program. There were 10 persons in attendance. Staff distributed 10 brochures that contained information about the PAIR program. [10-1029423]

Staff participated on a panel at the People of Color Mental Health Conference on November 6, 2010. Staff addressed legal issues for victims of crime. There were 25 persons in attendance. Staff distributed 25 brochures that contained PAIR related information. [10-1029454]

The DLP staff exhibited at the People of Color Mental Health Conference on November 6, 2010. The DLP spoke to attendees about all DLP programs and services including PAIR. There were approximately 600 persons in attendance. Staff distributed 265 brochures and pamphlets that contained PAIR-related information. [10-1029601]

DLP staff gave a presentation at Central High School on November 18, 2010. Staff gave an overview of all DLP programs and services including PAIR. There were 20 persons in attendance and staff distributed 20 brochures that contained information about the PAIR program. [10-1029765]

DLP staff exhibited at the Alzheimers Association’s Annual Conference on November 16, 2010. Staff spoke to attendees about all DLP programs including PAIR. There were approximately 200 persons in attendance. Staff distributed 184 brochures and pamphlets that contained PAIR-related information. [10-2029636]

DLP staff gave a presentation at a DVR sponsored event on December 9, 2010. Staff answered questions and gave an overview of all DLP programs including the PAIR program. There were 15 persons in attendance. Staff distributed 15 brochures that contained information about the PAIR program. [10-1029953]

The DLP exhibited and attended the annual LIFE Conference on January 19, 2011. There were approximately 400 persons in attendance. Staff spoke to attendees and answered questions about all DLP programs and services including PAIR. Staff distributed an assortment of 529 brochures and pamphlets containing PAIR related information. [11-2030219]

DLP staff gave a presentation at the Office of the Child Advocate on March 17, 2011. The Office frequently addresses issues related to the transition of youth with disabilities to the adult services system. Staff spoke to attendees and answered questions about all DLP programs and services including the PAIR program. There were 25 persons in attendance. There were 28 brochures distributed which included information related to the DLP PAIR project. [11-1030692]

The DLP Legal Advocacy Director gave a presentation at the annual Brain Injury Association conference on March 23, 2011. The presentation was on Guardianship and Alternatives. There were 12 persons in attendance. Staff distributed 12 materials that contained PAIR related information. [10-1029040]

The DLP exhibited at the annual Brain Injury Association conference on March 23-24, 2011. Staff spoke to attendees and answered questions about DLP programs and services including the PAIR program. There were approximately 200 persons in attendance. Staff distributed an assortment of 240 brochures and pamphlets that contained PAIR related information. [11-2030887]

The DLP Project Director and staff attorney gave a presentation to NAMI-DE senior staff at NAMI Delaware on March 29, 2011. Included in the presentation was an overview of all DLP programs and services including the PAIR program. There were 15 persons in attendance. There were 15 brochures distributed which included information related to the PAIR project. [11-1030566]

The DLP Legal Advocacy Director gave a presentation on Reasonable Accommodations at the Fair Housing Conference on April 6, 2011. Included in the presentation was an overview of all DLP programs and services including PAIR. There were 200 persons in attendance. Staff distributed 200 sets of materials which included information related to the PAIR project. [11-1030707]

DLP staff gave a presentation at the Central School Career Day on April 7, 2011. The student body is primarily composed of students with behavioral health profiles who will be transitioning to the adult services system. Staff spoke to attendees and answered questions about all DLP programs and services including the PAIR program. There were 13 persons in attendance. There were 13 brochures distributed which included information related to the PAIR project. [11-1030930]

The DLP exhibited at Del Tech’s Community Mental Health Awareness Fair on April 21, 2011. Staff spoke to attendees about all DLP programs and services including the PAIR program. There were approximately 250 persons in attendance. Staff distributed an assortment of 289 brochures and pamphlets which included information related to the PAIR project. [11-1031098]

DLP staff gave a presentation at Brandywine Counseling and Community Service (BCCS) on May 2, 2011. Included in the presentation was an overview of all DLP programs and services including PAIR. There were 27 BCCS staff members in attendance. Staff distributed 40 sets of materials which contained information related to the PAIR project. [11-1031133]

The DLP Legal Advocacy Director gave a presentation at Wilmington University on May 7, 2011. The Legal Advocacy Director gave an overview of all DLP programs and services including PAIR. There were 14 persons in attendance. Staff distributed 14 sets of materials which included information related to the PAIR project. [11-1031123]

DLP staff gave a presentation to DDS hearing examiners on June 14, 2011. Staff spoke to attendees and answered question about all DLP programs and services including PAIR. There were 20 persons in attendance and staff distributed 40 brochures which included information about the PAIR project. [11-1031335]

The DLP Legal Advocacy Director gave a presentation at the Brandywine Counseling Community Services Group Meeting on July 13, 2011. Included in the presentation was an overview of all DLP programs and services including PAIR. There were 5 persons in attendance. Staff distributed 3 brochures that included information related to the PAIR project. [11-1031880]

DLP staff gave a presentation on community resources at a DVR sponsored event on August 25, 2011. Staff included an overview of the availability of DLP advocacy and services, including the PAIR program. Staff spoke to attendees and answered questions about all DLP programs and services. There were 5 persons in attendance. There were 5 brochures distributed which included information related to the PAIR project. [11-2032308]

The DLP exhibited at Wilmington Wellness Day on September 19, 2011. Staff spoke to attendees about all DLP programs and services including the PAIR program. There were approximately 250 persons in attendance. Staff distributed an assortment of 115 brochures and pamphlets which included information related to the PAIR project. [11-1032475]

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles2
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website12,123
5. Publications/booklets/brochures disseminated2,302
6. Other (specify separately)0

Narrative

Part II. Individuals Served

A. Individuals Served

Count individual once per FY. Multiple counts not permitted for lines A1 through A3.

1. Individuals still served as of October 1 (carryover from prior FY)46
2. Additional individuals served during the year61
3. Total individuals served (lines A1 + A2)107
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)7

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 45

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility6
2. Employment5
3. Program access1
4. Housing15
5. Government benefits/services35
6. Transportation1
7. Education1
8. Assistive technology0
9. Voting0
10. Health care12
11. Insurance7
12. Non-government services2
13. Privacy rights0
14. Access to records0
15. Abuse1
16. Neglect1
17. Other20

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor61
2. Other representation found0
3. Individual withdrew complaint2
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit4
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

List the highest level of intervention used by PAIR prior to closing each case file.

1. Technical assistance in self-advocacy7
2. Short-term assistance26
3. Investigation/monitoring10
4. Negotiation7
5. Mediation/alternative dispute resolution0
6. Administrative hearings15
7. Litigation (including class actions)2
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 222
3. 23 - 5990
4. 60 - 648
5. 65 and over7

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females58
2. Males49

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaskan Native1
3. Asian1
4. Black or African American31
5. Native Hawaiian or Other Pacific Islander0
6. White74
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent77
2. Parental or other family home15
3. Community residential home0
4. Foster care0
5. Nursing home9
6. Public institutional living arrangement1
7. Private institutional living arrangement0
8. Jail/prison/detention center3
9. Homeless2
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

Identify the individual's primary disability, namely the one directly related to the issues/complaints

1. Blind/visual impairment6
2. Deaf/hard of hearing4
3. Deaf-blind0
4. Orthopedic impairment39
5. Mental illness7
6. Substance abuse1
7. Mental retardation0
8. Learning disability1
9. Neurological impairment24
10. Respiratory impairment6
11. Heart/other circulatory impairment6
12. Muscular/skeletal impairment1
13. Speech impairment0
14. AIDS/HIV3
15. Traumatic brain injury1
16. Other disability8

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities133

2. Number of individuals potentially impacted by policy changes40,544

Describe your systemic activities. Be sure to include information about the policies that were changed and how these changes benefit individuals with disabilities. Include case examples of how your systemic activities impacted individuals served.

The DLP had many non-litigation systemic successes. For ease of reference, legislative, regulatory, and policy achievements are compiled in Section V.A by priority,, i.e. Accessibility, Par. 4; Transportation, Par. 4; Housing/Independent Living, Par. 4; and Autonomy, Par. 4.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts17
2. Number of individuals named in class actions0

Describe your litigation/class action activities. Explain how individuals with disabilities benefited from your litigation activities. Be sure to include case examples that demonstrate the impact of your litigation.

Judicial Level Advocacy

Fifty-five year old Section 8 tenant on SSI had experienced a stroke resulting in right side weakness and inability to speak. Co-habiting adult son filed application for protection from abuse (PFA) order to oust client from apartment alleging she threw shoes at him and yelled at him. DLP entered appearance, facilitated acquisition of augmentative communication device, and obtained dismissal of PFA application by Family Court. [11-2030582]

Forty-two year old SSI beneficiary with neurological impairment and brain damage due to stroke was under child support order for $25/month. DLP represented in Family Court and secured reduction of monthly support obligation to zero. [11-1030876]

Administrative Agency Level Advocacy

Fifty-one year old tenant with asthma, diabetes, and orthopedic impairments had fallen in apartment and requested landlord permission to install handrail at entrance to unit. Landlord withheld permission and issued lease termination notice. DLP represented tenant in administrative fair housing complaint and eviction. DLP negotiated settlement in which lease would continue and permission was granted to install handrail contingent upon approval of plans and performance of work by licensed contractor. [10-2028695]

Sixty-one year old with coronary artery disease, congestive heart failure, and COPD was dependent on oxygen machine. She received notice of termination of her Medicaid when she became eligible for $907 in monthly SSDI benefits. DLP determined that Medicaid should continue under “MAT” program which allows transitional continuation of Medicaid for individuals who are ineligible for Medicaid due to SSDI income pending Medicare eligibility. Fair hearing was requested to contest termination. Local Division of Social Services office conceded oversight and reinstated Medicaid based on “MAT” program. DLP then contacted State Medicaid Director since DLP identified multiple cases in which local DSS offices were inappropriately terminating Medicaid based on lack of familiarity with “MAT” program. Medicaid Director followed up with local offices and initiated corrective action of the processing system. [11-3030518]

Fifty-eight year old received Medicaid termination notice based on receipt of $934 in monthly SSDI benefits. DLP determined that Medicaid should continue under “MAT” program which allows transitional continuation of Medicaid for individuals who are ineligible for Medicaid due to SSDI income pending Medicare eligibility. Fair hearing was requested to contest termination. DSS conceded error and reinstated Medicaid retroactively. Client then experienced difficulty with Medicaid payment of medical bills in prior month. DLP contacted DSS and facilitated payment of all medical bills. [10-3029217]

Forty-six year old SSDI beneficiary had experienced aneurysm resulting in severe expressive aphasia. Assisted living facility issued termination notice due to concerns about her behavior. DLP contested discharge through administrative hearing request. After negotiation, facility abandoned attempt to discharge client. [10-2008782]

Fifty-four year old SSI beneficiary questioned reduction in her benefit check. DLP represented in administrative conferences at local office and secured reinstatement of full benefit check. [10-1028074]

Fifty-three year old SSI beneficiary received notice of an overpayment due to receipt of Worker’s Compensation benefits. The DLP assessed, represented in administrative overpayment conference, and secured a waiver of the small ($396) overpayment. [10-1028000]

Fifty-five year SSDI beneficiary received notice of termination of his SSDI benefits. DLP represented in administrative conference with SSA representative who confirmed reason for termination was lack of cooperation with continuing disability review. However, per client’s disability type, a review should not have been undertaken. The local office immediately issued a check and reinstated his payment status. [10-1028326]

Fifty-three year old dual eligible (SSI/SSDI) beneficiary had benefits reduced due to incorrect treatment of Worker’s Compensation payment resulting in overpayment. DLP represented in administrative conference with SSA representative and secured both reinstatement of full benefits and waiver of entire overpayment. [10-1027391]

Fifty-four year old with neurological disorder on SSI since 1993 received termination notice finding her ineligible retroactive to 2002. DLP represented in administrative hearing to contest termination but received unfavorable ALJ decision. [09-1025890]

Fifty-four year old SSDI beneficiary received notice of $5,152 overpayment. DLP represented in administrative conference and secured determination that client was without fault in causing overpayment. However, client had sufficient resources to repay overpayment resulting in denial of waiver. The DLP negotiated repayment agreement of $144/month in lieu of cessation of client’s monthly $1,259 SSDI check until the overpayment was paid in full. [10-028678]

Forty-six year old SSDI beneficiary due to orthopedic impairment received notice of termination of her Section 8 voucher when her son, a registered sex offender, listed her address as his residence without her consent. The DLP documented the inaccurate representation and secured the reinstatement of the client’s Section 8 voucher. [09-1026819]

Sixty-five year old with brain cancer received notice of $11,140 SSDI overpayment. DLP determined that overpayment was result of agency failure to properly calculate benefits, filed request for waiver, and secured favorable administrative decision. The SSA agreed to waive the entire overpayment. [10-1028629]

Forty-nine year old SSDI beneficiary received notice of $34,569 SSDI overpayment based on unreported employment income. DLP represented in administrative overpayment conference and negotiated a favorable $20/month repayment schedule. [11-1030123]

Fifty year old SSDI beneficiary received notice of $13,641 SSDI overpayment due to receipt of Worker’s Compensation income. DLP represented in administrative conference with local office, demonstrated that Worker’s Compensation income had been reported, and secured waiver of entire overpayment amount. [11-1030228]

Fifty year old SSDI beneficiary with seizure disorder and migraines received notice of $11,146 overpayment due to receipt of checks while employed. The DLP represented in administrative conference with Social Security Administration and obtained favorable $20/month repayment plan. DLP also facilitated client qualification for State payment of her $115/month Medicare premium under QMB program effectively resulting in a net increase of $95 in SSDI income. [10-1029775]

Part V. PAIR'S Priorities and Objectives

A. Priorities and Objectives for the Fiscal Year Covered by this Report

For each of your PAIR program priorities for the fiscal year covered by this report, please:

  1. Identify and describe priority.
  2. Identify the need, issue or barrier addressed by this priority.
  3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.
  4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.
  5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.
  6. Provide at least one case summary that demonstrates the impact of the priority.

A. FIRST PRIORITY: ACCESSIBILITY.

1. Identification

The PAIR program will promote and facilitate access to governmental programs and public accommodations.

2. Need, Issue or Barrier Addressed

Persons with disabilities are frequently denied services because they cannot "get in the door" or because they need accommodations (e.g. interpreters; service dog accompaniment). Safety-net public benefits programs may also present eligibility or standards-based barriers to effective access by persons with disabilities.

3. Outcome Indicators

Successful outcomes under this priority include the removal of architectural barriers, cessation of discriminatory practices, and amending policies to provide equal and effective access to governmental programs and places of public accommodation by people with disabilities. As reflected in the PAIR FY 11 Priorities, the outcome indicators for this objective were as follows:

a. As a result of DLP intervention, 30 persons will secure equal or improved access to governmental services or public accommodations.

b. As a result of DLP intervention, 10 laws, regulations, policies or other barriers to government services or public accommodations will be eliminated or reduced.

4. Collaborative Efforts

DLP staff participated in meetings of the following groups: Division of Vocational Rehabilitation State Rehabilitation Council, Architectural Accessibility Board, AT Loan Program Advisory Board, and Access Wilmington Committee.

The DLP routinely collaborated with the State Council for Persons with Disabilities, Governor’s Advisory Council for Exceptional Citizens, and other groups to prevent adoption of laws, regulations and policies having a discriminatory or adverse effect on PAIR constituents. Concomitantly, the DLP promoted initiatives which enhanced access to government services and public accommodations. The following are illustrative:

Legislation

Legislation (H.B. No. 19) was introduced to revise drug offense penalties, eliminate some minimum-mandatory sentences, and effect other common-sense changes. In the autonomy context, the bill eliminated a statute creating a crime for not keeping a prescription drug in its original container. The DLP had previously criticized the statute which made the elderly and persons with disabilities guilty of a Class A Misdemeanor for simply using daily-dose weekly pill containers. The DLP issued a positive critique which was adopted by multiple councils and shared with policymakers. The bill was enacted and signed by the Governor on April 20, 2011.

Legislation (S.B. No. 13) was introduced to reauthorize a needle exchange program operating in the City of Wilmington. The preamble noted that Delaware has consistently ranked among the top ten states in the rate of new HIV cases and that 70% of Delawareans living with HIV/AIDS live in New Castle County (which includes the City of Wilmington). The DLP issued a comprehensive, favorable critique of the bill accompanied by two (2) recommended amendments. The sponsors added the amendments and the revised bill was enacted and signed by the Governor on July 5, 2011.

Legislation (S.B. No. 17) was introduced to authorize access to marijuana for a “debilitating medical condition” defined as including glaucoma, cancer, HIV, and PTSD under strict guidelines. More than fifteen (15) states have enacted laws authorizing limited access to marijuana for medical purposes. The DLP issued a favorable critique which was adopted by multiple councils and shared with policymakers. The legislation was enacted and signed by the Governor on May 13, 2011.

Federal law generally imposes a lifetime ban on Food Supplement Program (formerly “Food Stamps”) eligibility for convicted drug felons. States are allowed to “opt out” of the ban and nineteen states have already lifted the ban altogether. S.B. No. 12, introduced on January 20, 2011, was intended to lift the ban in Delaware. The DLP issued a favorable critique of the bill in January, 2011 which was adopted by multiple councils and shared with policymakers. The bill would be beneficial to individuals with histories of past substance addiction resulting in criminal conviction. According to a June 15, 2011 article, the bill would benefit 674 adult drug felons and 1381 children living with them. The legislation was enacted and signed by the Governor on June 22, 2011.

Delaware includes dental coverage for children in its Medicaid and CHIP program. However, there is no coverage for adults. Several studies have documented the adverse effects of dental disease on other conditions, including diabetes and cardiovascular health. Legislation (S.B. No. 11) was introduced on January 20, 2011 to authorize both urgent and preventative dental care for Medicaid beneficiaries who are pregnant or become pregnant while enrolled in Medicaid, including SSI beneficiaries. In January, the DLP issued a favorable critique of the bill which was adopted by multiple councils and shared with policymakers. The bill, which was earmarked with a fiscal note, remained in the Senate Finance Committee as of the end of the reporting period.

In March, 2011 the DLP critiqued legislation (H.B. No. 17) which purported to assist “disabled veteran-owned businesses” by establishing a goal of awarding not less than 3% of State material and public works contracts to such entities. The DLP analysis was critical since the bill’s text contained no provisions addressing disability whatsoever. The DLP suggested that it would be preferable to provide incentives to firms employing individuals with disabilities. Multiple councils endorsed the critique which was shared with policymakers. The problematic bill was stricken on June 14, 2011.

In May, 2011, the DLP issued a favorable critique of legislation (H.B. No. 76) patterned on prosthetic parity bills enacted in at least nineteen (19) states. The legislation would require State-regulated individual and group health insurers to provide coverage for orthotic and prosthetic devices at a reimbursement rate equal to a Federal fee schedule. Enactment would facilitate access to prosthetic devices for individuals with private insurance. Multiple councils adopted the critique which was shared with policymakers. The legislation was enacted and signed by the Governor on August 15, 2011.

Legislation (S.B. No. 84) was introduced on May 31, 2011 to establish a “Heart Disease and Stroke Prevention Program” within the Division of Public Health. The synopsis describes cardiovascular disease as the leading cause of death and stroke as the third leading cause of death in Delaware. The legislation envisioned data collection, education activities, and prevention activities. The DLP issued a favorable critique with one (1) recommended amendment. The critique was adopted by multiple councils and shared with policymakers. As of the end of the reporting period, the bill had been approved by the Senate Health & Social Services Committee and awaited action by the full Senate.

Regulations & Policies

DMMA proposed to consolidate its elderly/disabled, assisted living, and acquired brain injury waivers into a single waiver. The proposed waiver contained many support services, including adult day services, assisted living, cognitive services, day habilitation, emergency response system, personal care, respite care, and specialized medical equipment and supplies. In the prior reporting period, the DLP had provided extensive technical assistance and commentary on drafts of the 168-page proposed waiver application and appendices. DMMA incorporated several recommendations in its application. CMS approved the revised waiver application and the new waiver was implemented effective December 1, 2010. [14 DE Reg. 88 (August 1, 2010) (proposed); 14 DE Reg. 461 (November 1, 2010) (final)]

The Division of Medicaid and Medical Assistance (“DMMA”) proposed to adopt an 84-page regulation covering quality assurance in Delaware’s Medicaid program. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division resulting in several amendments. The regulation contained many features that would benefit Medicaid beneficiaries, including the right to a no-cost second medical opinion and promotion of accessibility of medical offices through advance on-site surveys. [14 DE Reg. 361 (November 1, 2010) (proposed); 14 DE Reg. 650 (January 1, 2011) (final)]

DMMA proposed to adopt a Medicaid Plan amendment contemplating contracting with auditing entities to identify Medicaid overpayments to providers. The DLP issued a critique which was adopted by multiple councils and shared with the Division. The DLP expressed concern with a system in which auditors are paid on a contingency basis based on amounts recovered since this could skew the impartiality of the audit. The DLP also noted that reimbursement rates are so low that imposing an aggressive auditing system could prompt a shortage in providers participating in the Medicaid program. The Division adopted a final regulation noting that safeguards will be in place to promote the accuracy of findings. [14 DE Reg. 513 (December 1, 2010) (proposed); 14 DE Reg. 809 (February 1, 2011) (final)]

DMMA proposed adoption of a regulation implementing a CMS bar on Medicaid payments to hospitals for services related to provider preventable conditions (e.g. foreign objects left after surgery; blood transfusions with incompatible blood). The DLP issued a critique which was adopted by multiple councils and shared with the Division. The critique included a recommendation to insert the following standard in the State regulation to deter hospitals from denying treatment to Medicaid patients or attempting to charge Medicaid patients for the cost of remedial treatment necessitated by provider preventable conditions: “Providers identifying a provider-preventable condition whose costs of treatment are barred under this section shall not deny medically necessary treatment to the affected patient nor attempt to impose financial liability on the affected patient.” A final regulation had not been adopted by the end of the reporting period. [15 DE Reg. 276 (September 1, 2011) (proposed)]

The Division of Social Services (“DSS”) proposed extensive revisions to its fair hearing process covering Medicaid, Food Supplement Program, TANF, and many other safety-net programs. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division. In July, the Division adopted a final regulation incorporating eleven (11) amendments prompted by the DLP commentary. [14 DE Reg. 618 (January 1, 2011) (proposed); 14 DE Reg. 86 (July 1, 2011) (final)]

The Division of Social Services proposed amendments to its Food Supplement Program (formerly “Food Stamps”) standards. The DLP issued a critique which was adopted by multiple councils and shared with the Division. The commentary included a concern with a provision covering beneficiaries with disabilities which contained the following limitation: “The limitation must be one considered permanent under the Social Security Act.” The DLP suggested adoption of a more encompassing standard since disability need not be “permanent” under the SSI and SSDI programs. DSS adopted a final regulation with no changes. [14 DE Reg. 620 (January 1, 2011) (proposed); 14 DE Reg. 900 (March 1, 2011) (final)]

The State Victim Compensation Assistance Program (“VCAP”) is a federally funded agency which pays approved medical claims which are not covered by Medicaid, Medicare, or private insurance to victims of violent crimes. Many individuals with disabilities caused by perpetrators of violent crime benefit from the program. The DLP Project Director is a Governor’s appointee to the VCAP Advisory Council. The VCAP proposed adoption of a uniform standard for payment of medical claims. The DLP negotiated several amendments to protect beneficiaries from “balance billing” by providers. A final regulation was adopted which incorporated specific provisions drafted by the DLP. In later months, the VCAP issued regulations adopting the same template for payment of mental health and dental claims incorporating the DLP-drafted balance billing protections. [14 DE Reg. 383 (November 1, 2010) (proposed); 14 DE Reg. 666 (January 1, 2011) (final); 14 DE Reg. 771 (February 1, 2011) (proposed); 14 DE Reg. 1082 (April 1, 2011) (final); 15 DE Reg. 175 (August 1, 2011) (proposed)]

The Department of Insurance proposed a regulation requiring health insurers to respond to a Department survey of rates/premiums on an annual basis. The data will be published on the Web to permit consumer comparisons and consumers will be able to submit requests for a quote directly through the Website. This system would benefit individuals with disabilities obtain the most competitive rates on individual health insurance policies. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Department. A final regulation had not been issued by the end of the reporting period. [15 DE Reg. 164 (August 1, 2011) (proposed)]

The Division of Public Health proposed adoption of a regulation covering pre-hospital advance health care directives. Such directives enable individuals with disabilities to clarify their wishes concerning treatment in the event of involvement by EMS and other emergency personnel. The DLP issued a critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation which incorporated several amendments prompted by the DLP commentary. [14 DE Reg. 1195 (May 1, 2011) (proposed); 15 DE Reg. 211 (August 1, 2011) (final)]

DMMA proposed adoption of a new Diamond State Health Plan Plus program through an amendment to its Medicaid managed care waiver. The new program would pay managed care organizations a capitated rate to provide “wrap-around” services to covered Medicaid beneficiaries in nursing homes, currently enrolled in waivers, or those at risk of nursing home placement. The new program would cover thousands of individuals and include incentives to transfer current nursing home residents to community-based residential settings. In September, 2011 the DLP issued a comprehensive (13-page) critique of the program documents which was adopted by multiple councils and shared with the Division. In the context of autonomy, the DLP was highly critical of several aspects of the Plan which constrained consumer choice, including the use of only two (2) managed care organizations (MCOs), limits on designation of a specialist as primary care physician, and requirement that a participant transferred from one MCO to second MCO remain with second MCO forever. The Division was in the process of incorporating changes in its standards based on the commentary at the end of FY11. [15 DE Reg. 45 (July 1, 2011) (proposed)]

Architectural Accessibility Board Reviews

A DLP Senior Staff Attorney is a Governor’s appointee to the Architectural Accessibility Board (AAB) which must approve plans for new construction and renovations of buildings using State funding. During FY11, the DLP participated in formal reviews of eighty (80) sites. The AAB disapproved eighteen (18) sets of plans, prompting revisions to ensure conformity with ADA accessibility standards. The DLP also referred four (4) election sites to the AAB which identified deficiencies in all four (4) sites which were then referred to the Election Commissioner for remedial action.

5. Number of Cases

Six (6) architectural accessibility cases and thirty-five (35) government benefits/services cases were open during the fiscal year.

6. Case Summary

Sixty-one year old with coronary artery disease, congestive heart failure, and COPD was dependent on oxygen machine. She received notice of termination of her Medicaid when she became eligible for $907 in monthly SSDI benefits. DLP determined that Medicaid should continue under “MAT” program which allows transitional continuation of Medicaid for individuals who are ineligible for Medicaid due to SSDI income pending Medicare eligibility. Fair hearing was requested to contest termination. Local Division of Social Services office conceded oversight and reinstated Medicaid based on “MAT” program. DLP then contacted State Medicaid Director since DLP identified multiple cases in which local DSS offices were inappropriately terminating Medicaid based on lack of familiarity with “MAT” program. Medicaid Director followed up with local offices. [11-3030518]

Fifty-eight year old received Medicaid termination notice based on receipt of $934 in monthly SSDI benefits. DLP determined that Medicaid should continue under “MAT” program which allows transitional continuation of Medicaid for individuals who are ineligible for Medicaid due to SSDI income pending Medicare eligibility. Fair hearing was requested to contest termination. DSS conceded error and reinstated Medicaid retroactively. Client then experienced difficulty with Medicaid payment of medical bills in prior month. DLP contacted DSS and facilitated payment of all medical bills. [10-3029217]

General Assistance (“GA”) benefits of twenty-four year old with orthopedic impairments had been suspended due to lack of renewed physician certification of continuing disability. DLP assessed termination with DSS, provided client with information on health care clinics, contacted prior physician to retrieve medical records, and provided the blank certification form to client to have clinic complete to ensure reinstatement. [09-1026705]

Twenty-five year old with rare Gauchers Disease needed infusion treatments. New physician was unwilling to prescribe without reviewing prior medical records. DLP contacted former physician who was uncooperative with providing records. DLP contacted health insurer who prompted release of records. [10-1028298]

Fifty-four year old with neurological disorder on SSI since 1993 received termination notice finding her ineligible retroactive to 2002. DLP represented in administrative hearing to contest termination but received unfavorable ALJ decision. [09-1025890]

Forty-one year old with private health insurance coverage was denied Medicaid due to family income. DLP assessed eligibility and determined that denial was appropriate under regulations. Client was advised of basis for determination. [11-1031690]

Forty-three year old SSDI beneficiary with Multiple Sclerosis had been denied enrollment in Medicaid Elderly/Disabled waiver based on not meeting nursing level of care. DLP obtained medical records and determined that denial was appropriate given current profile. Client was advised of basis for determination. [10-2028323]

Thirty-year old in treatment for substance addiction contacted DLP when Medicaid denied prescription for Suboxone. DLP determined that prescription had been denied due to failing urine test but secured commitment to reinstate if prescribing physician authorized “fresh start” for medication. Client decided to pursue that option. [11-1031667]

Forty-eight year old SSDI beneficiary was placed in nursing home after surgery resulting in $3,411 bill after Medicare contribution. She was sending facility $50 monthly on debt. Facility insisted this was insufficient and forwarded $150 monthly payment contract to her. She requested DLP advice on contract. DLP determined that client had no real estate or assets and was essentially judgment proof. Based on advice, client declined to sign contract. [11-1032521]

Twenty-five year old with severe ulcerative colitis was without health insurance after termination of employment. The DLP provided information on available public and private health care options. [10-1029324]

Thirty-nine year old with respiratory impairment sought assistance when employer retroactively cancelled her health insurance effective one day prior to throat surgery. DLP presented options, including applying for COBRA coverage to extend employer-based coverage. [10-1028391]

Fifty-three year old with visual impairment had been contacted by collection agency for unpaid medical bills which client believed had been covered by Medicaid. DLP obtained background documents and determined that most of the debt had been incurred when client was not enrolled in Medicaid. DLP did identify one charge that should have been paid by Medicaid and provider agreed to credit account and notify collection agency which reduced overall indebtedness. [10-1028261]

Fifty year old SSDI beneficiary alleged that he had been paying Medicare Part B premiums but Medicare declined payment of recent hospital bill. DLP investigated and determined that client had not paid Part B premiums in recent years and advised client of option to reinstate subject to a penalty. [10-1029146]

Fifty year old SSDI beneficiary with seizure disorder and migraines received notice of $11,146 overpayment due to receipt of checks while employed. The DLP represented in administrative conference with Social Security Administration and obtained favorable $20/month repayment plan. DLP also facilitated client qualification for State payment of her $115/month Medicare premium under QMB program effectively resulting in a net increase of $95 in SSDI income. [10-1029775]

Fifty-three year old dual eligible (SSI/SSDI) beneficiary had benefits reduced due to incorrect treatment of Worker’s Compensation payment resulting in overpayment. DLP represented in administrative conference with SSA representative and prompted both reinstatement of full benefits and waiver of entire overpayment. [10-1027391]

Sixty-five year old with brain cancer received notice of $11,140 SSDI overpayment. DLP determined that overpayment was result of agency failure to properly calculate benefits, filed request for waiver, and secured favorable administrative decision. The SSA agreed to waive the entire overpayment. [10-1028629]

Fifty-four year old SSDI beneficiary received notice of $5,152 overpayment. DLP represented in administrative conference and secured determination that client was without fault in causing overpayment. However, client had sufficient resources to repay overpayment resulting in denial of waiver. The DLP negotiated repayment agreement of $144/month in lieu of cessation of client’s monthly $1,259 SSDI check until the overpayment was paid in full. [10-028678]

Fifty-three year old SSI beneficiary received notice of an overpayment due to receipt of Worker’s Compensation benefits. The DLP assessed, represented in administrative overpayment conference, and secured a waiver of the small ($396) overpayment. [10-1028000]

Forty-nine year old SSDI beneficiary received notice of $34,569 SSDI overpayment based on unreported employment income. DLP represented in administrative overpayment conference and negotiated a favorable $20/month repayment schedule. [11-1030123]

Fifty year old SSDI beneficiary received notice of $13,641 SSDI overpayment due to receipt of Worker’s Compensation income. DLP represented in administrative conference with local office, demonstrated that Worker’s Compensation income had been reported, and secured waiver of entire overpayment amount. [11-1030228]

Fifty-five year old SSI beneficiary was receiving reduced check due to recoupment of overpayment due to excess resources. DLP investigated, determined that SSA action was justified under applicable regulations, and provided options to client. [11-1031269]

Fifty-four year old dual eligible (SSDI; SSI) beneficiary did not receive his SSDI check without explanation. The DLP met with representative at local SSA office, determined that check had essentially been lost in mail, and arranged for issuance of replacement check. [10-1029135]

Fifty-four year old SSI beneficiary questioned reduction in her benefit check. DLP represented in administrative conferences at local office and secured reinstatement of full benefit check. [10-1028074]

Fifty-five year SSDI beneficiary received notice of termination of his SSDI benefits. DLP represented in administrative conference with SSA representative who confirmed reason for termination was lack of cooperation with continuing disability review. However, per client’s disability type, a review should not have been undertaken. The local office immediately issued a check and reinstated his payment status. [10-1028326]

Fifty-three year old with orthopedic and hearing impairments who had been approved for SSI in 2007 owed $40,000 in child support arrears. Court Commissioner had advised obligor to file for reduction in support in 2009 but obligor had taken no action. The DLP provided detailed advice on need to promptly file for reduction to stop increase in arrears and limited option to reopen earlier orders. [10-1029343]

Forty-two year old SSI beneficiary with neurological impairment and brain damage due to stroke was under child support order for $25/month. DLP represented in Family Court and secured reduction of monthly support obligation to zero. [11-1030876]

Sixty-one year old client contacted DLP when physicians declined to schedule sign language interpreter for medical appointments. DLP contacted offices of both physicians and prompted agreement to supply interpreters. [11-1-31702]

Forty-nine year old maintenance mechanic at private facility suddenly became profoundly deaf. Employer “overreacted” to safety concerns by requiring him to work with assistant and demanded blanket release for medical records. DLP negotiated a more restrained release of information and approval of intermittent FMLA to cover medical appointments at John Hopkins. [11-3031082]

Thirty-eight year old veteran with learning disabilities requested information about availability of accommodations from university. DLP provided information on available accommodations and process to request. [11-3030314]

Forty-seven year old prison inmate with Stage 3 chronic kidney disease, hepatitis, gastro-esophageal reflux disease alleged gross lack of medical care. DLP determined that inmate’s claims for inadequate care, with exception of Stage 3 chronic kidney disease, had already been dismissed by district court. DLP thoroughly investigated treatment of kidney disease and determined that adequate care was being provided. [10-1029259]

Thirty-eight year old short-term prison inmate alleged lack of prescribed medications for anti-rejection post kidney transplant, hypertension, and depression. DLP obtained medical records and initiated assessment. Inmate was provided with prescribed medications and released from prison. DLP assessment did not support determination of deliberate indifference to health needs. [11-1030087]

Thirty-eight year old short-term prison inmate with orthopedic impairments requested representation in a civil rights action he had filed in district court alleging that he had been dragged across ground and thrown in his wheelchair on multiple occasions. DLP assessed merits and determined there was insufficient evidence to substantiate claims. [11-1030286]

B. SECOND PRIORITY: TRANSPORTATION.

1. Identification

The PAIR program will promote a consumer-friendly public transportation system and reduction of barriers to constituent travel.

2. Need, Issue, or Barrier Addressed

People with disabilities have difficulty commuting to work, traveling to medical appointments, and living independently when they cannot access the public transportation system. This inability to use the public transportation system has a disproportionate impact on less affluent persons with disabilities. Apart from the public transportation system, consumers are also affected by motor vehicle laws, parking ordinances, and private transportation providers. Finally, vehicular safety standards affect the incidence and exacerbation of injuries resulting in disability.

3. Outcome Indicators

Indicators of a successful outcome under this priority include gaining access to public and private transportation, enhanced access to designated parking options, and removal of barriers to pedestrian travel. As reflected in the PAIR FY 11 Priorities, the outcome indicators for this objective were as follows:

a. As a result of DLP intervention, 10 persons will secure equal or improved access to transportation.

b. As a result of DLP intervention, 5 laws, regulations, or policies will be changed or barriers to transportation eliminated or reduced.

4. Collaborative Efforts The DLP addressed transportation-related concerns through active participation in a Delaware Transit Corporation [“DTC”] paratransit advisory committee ("EDTAC"). The DLP also addressed Division of Motor Vehicles ("DMV") initiatives in conjunction with the State Council for Persons with Disabilities (“SCPD”). The DMV periodically consulted the Council on matters related to disability, including parking placards and license plates. A DTC paratransit representative and DLP representative serve on the Council. The DLP was a member of the advisory committee to the State=s Medicaid transportation broker, Logisticare.

Legislation The DLP critiqued draft legislation authorizing the issuance of a Disabled American Veteran (“DAV”) license plate incorporating the universally-recognized symbol authorizing parking in ADA-designated accessible parking spaces. Prior practice required an applicant to choose either a “DAV” plate (which does not confer a right to park in accessible spaces) or a special license plate for persons with disabilities (which confers a right to park in accessible spaces). The critique prompted two (2) amendments in the contexts of visual impairment and “people-first” language. The legislation (S.B. No. 136), as amended, was introduced, enacted, and signed by the Governor in July, 2011.

The DLP issued a negative critique of legislation (H.B. No. 202) designed to deter fraudulent use of special license plates and placards authorizing parking in ADA-designated accessible parking spaces. The DLP identified several deficiencies in the bill which would result in deterring legitimate transportation of individuals with disabilities. Multiple councils adopted the critique which was shared with policymakers. The legislation awaited action in the Senate as of the end of FY11.

The DLP issued a favorable critique of legislation (H.B. No. 51) to enhance Delaware’s “Gold Alert” program originally established in 2008. The program is designed to prompt a coordinated DelDOT, law enforcement and media response to facilitate location of missing senior citizens, missing persons with disabilities, and “suicidal persons”. H.B. No. 51 authorized display of qualifying missing person information on variable message signs along highways. Multiple councils adopted the favorable critique which was shared with policymakers. The legislation was enacted and signed by the Governor in May, 2011.

Legislation (H.B. No. 19) was introduced to revise drug offense penalties, eliminate some minimum-mandatory sentences, and effect other common-sense changes. In the transportation context, it reduced the length of a driver license suspension from 2-3 years to 6 months for drug convictions. The synopsis noted that the 2-3 year suspension was the harshest in the Nation. The DLP issued a positive critique which was adopted by multiple councils and shared with policymakers. The bill was enacted and signed by the Governor on April 20, 2011.

Regulations and Policies

In the context of disability prevention, the Delaware Office of Highway Safety (“OHS”) proposed to adopt a regulation covering motorcycle helmet and eye protection. Motorcycle-related injuries are a common basis for disability. The DLP issued a comprehensive critique which was adopted by multiple councils and shared with the OHS. The OHS agreed to effect one amendment based on the commentary to ensure conformity with Federal Motor Vehicle Safety Standard (“FMVSS”) 218. [14 DE Reg. 432 (November 1, 2010) (proposed); 14 DE Reg. 670 (January 1, 2011) (final)]

The Delaware Division of Motor Vehicles proposed to adopt a new regulation covering driver licenses and identification cards. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. A final regulation had not been issued by the end of FY11. [15 DE Reg. 323 (September 1, 2011) (proposed)]

The Division of Vocational Rehabilitation (“DVR”) mileage policy reimbursed clients based on the number of miles driven and was as low as 11 cents per mile. The client was expected to pay for fuel, vehicle insurance, maintenance, and repairs from this amount. The DLP researched the rate structure and presented a comprehensive written and oral critique of the policy to the DVR Policy Committee. The effort was successful and DVR adopted a mileage reimbursement rate in December, 2010 equivalent to that for State employees, i.e. 40 cents/mile for all miles driven.

DelDOT operates programs offering subsidized fares to individuals with disabilities on its fixed route buses and in private taxis. The DLP identified several problems with eligibility standards. For example, criteria for qualifying with a “sight” disability and “non-ambulatory” disability were overly constrictive. Moreover, individuals with “chronic alcoholism or drug addiction”, even those in treatment, were excluded from program enrollment. Based on multiple DLP critiques, DelDOT overhauled its standards and eligibility forms resulting in adoption of acceptable eligibility criteria published in June, 2011.

Based on federal DOT prompting, DelDOT initiated the process to develop an ADA Self Assessment and Transition Plan. In July, 2011, the DLP critiqued the draft and submitted comments in concert with the SCPD to DelDOT. In September, 2011 DelDOT released a revised draft incorporating several amendments based on the commentary. The revised draft added more specific references to regulations and prospective plans to enhance accessibility. DelDOT plans to adopt a final version during FY12.

DelDOT uses a private contractor to provide paratransit rides when the State paratransit buses cannot meet expected demand. Contract buses provide 36,000 trips annually for DelDOT. A rider shared a safety concern with the contractor’s fleet of paratransit buses since they contain no rear door for evacuation during a fire or emergency. The DLP researched the issue and shared its findings and recommendations with the SCPD. The DLP also submitted comments on the issue to the U.S. Access Board which had solicited input on updated vehicle guidelines. In September, 2011, DelDOT announced that it had negotiated with the private contractor to include a rear fire extinguisher in all buses as an interim measure and that it was considering including a rear door requirement in its contractor bus specifications in the next RFP.

The State Division of Aging & Adults with Physical Disabilities (“DSAAPD”) planned to screen all residents of State nursing homes to assess prospects and amenability to live in the community. The DLP requested the opportunity to provide technical assistance on the screening instrument. The DLP then commented on sequential drafts of the instrument and prompted inclusion of an enhanced transportation section to cover eligibility for DelDOT’s recently revised reduced fare taxi and fixed route bus programs.

5. Number of Cases

One (1) transportation case was open during the fiscal year. Other transportation-related cases involving tenants were opened under "housing" or “accessibility”.

6. Case Summaries

Fifty-eight year old suffered stoke and was placed in State nursing home by Adult Protective Services. Spouse had difficulty visiting since nursing home was not on bus route. DLP provided spouse with information about eligibility and application process for DelDOT subsidized taxi service to facilitate visits and monitoring of wife’s health care. DLP also secured nursing home social worker commitment to assist with application for long-term care Medicaid which, if approved, could be used to transfer spouse to a closer nursing home or residence with waiver supports. [11-1030421]

Seventy-five year old with dementia and mobility impairment used a Rolator walker to travel from her apartment to accessible parking space on street near her unit. However, there was no curb cut. DLP contacted DelDOT which agreed to install curb cut. However, two weeks later client entered nursing home with poor prognosis and curb cut was obviated. [10-1027749]

Health clinic referred forty-seven year old client with intellectual limitations to DLP for assistance in obtaining a passport. DLP facilitated acquisition of official birth certificate from Puerto Rico and provided technical assistance on passport application process. [10-1027350]

DLP assessed termination of eligibility of sixty-four year old with gout and arthritis from DART paratransit system. DLP determined that client had conceded ability to ride fixed route bus and walked half block to reach fixed route bus stop. The DLP provided advice on securing supportive medical opinion but declined representation in appeals due to lack of merit. [11-1030476]

Sixty-one year old tenant with orthopedic impairments had limited ability to walk short distances. Five accessible parking spaces near her building were often filled with other vehicles with placards or special plates. She desired designated space for her use only. DLP submitted request to landlord who offered to install two additional designated spaces to accommodate need. [10-2029044]

C.THIRD PRIORITY, HOUSING;INDEPENDENT LIVING.

1.Identification

The PAIR program will promote freedom from disability-based discrimination in housing and the reduction of barriers to independent living.

2.Need, Issue, or Barrier Addressed

Without adequate housing and support services, people with disabilities are unable to live independently in the community. When a landlord, mobile home park owner, or zoning board refuses to make accommodations in its policies or practices, it denies the person with a disability the right to live in a setting of the individual’s choice.

3.Outcome Indicators

Factors used to determine a successful outcome under this priority include gaining access to an accessible residence; compensatory or injunctive relief for discriminatory acts by a landlord or housing program; retention of a residence in the community; enjoyment of all the rights/privileges related to tenancy or home ownership; safety and quality of services within congregate residential settings; and promotion of supports to facilitate persons with disabilities living successfully in the community. As reflected in the PAIR FY 11 Priorities, the outcome indicators for this objective were as follows:

a. As a result of DLP intervention, 20 persons with disabilities will secure equal access to or maintain housing or independent living supports.

b. As a result of DLP intervention, 10 laws, regulations, or policies will be changed or other barriers to housing eliminated or reduced.

4.Collaborative Efforts

DLP staff served on the Governor’s Commission on Community Alternatives for Persons with Disabilities Housing Committee which was merged with the SCPD Housing Committee. The Committee focused on a housing needs assessment, development of a comprehensive plan, review of a draft county universal design ordinance, and inclusion of a housing inquiry in the DHSS intake system.

The DLP addressed several bills, regulations, and policies affecting housing or reducing barriers to independent living. The following is a partial list:

Legislation In the prior reporting period, the DLP had drafted universal design legislation to require newly constructed residences using public financial assistance to meet universal design accessibility standards. In FY 11, the DLP participated in meetings to secure support from both public and private agencies. The DDC maintained a universal design website to facilitate the work of the Universal Design Coalition. A revised version of the legislation (H.B. No. 227) was introduced at the end of the legislative session (June 30, 2011) in anticipation of legislative action during the 2012 session.

The federal Administration on Aging identified a conflict of interest insofar as the Long-term Care Ombudsman (responsible for abuse/neglect investigations) was administratively placed in the same division (“DSAAPD”) that operated public nursing homes. Legislation (S.B. No. 102) was introduced to transfer the Ombudsman to the Office of the DHSS Secretary. The DLP issued a critique which focused on the continuing potential for conflict through placement of the Ombudsman in the Secretary’s Office as well as the need for independent legal counsel. Multiple councils adopted the critique which was shared with policymakers. As a result, the Department agreed to work with the Councils subsequent to enactment to administratively establish policies and procedures to obviate conflicts. The legislation was enacted and signed by the Governor on July 13, 2011.

Regulations and Policies In the prior reporting period, the DLP had submitted extensive commentary on a Department of Insurance regulation covering long-term care insurance policies. Such policies typically cover both nursing home care and home health services. The regulation contained provisions effectively deterring home health services. Multiple councils adopted the commentary which was submitted to the Department. In October, 2010, the Department adopted a final regulation incorporating one (1) amendment prompted by the critique. [14 DE Reg. 92 (August 1, 2010) (proposed); 14 DE Reg. 316 (October 1, 2010) (final)]

In the prior reporting period, the DLP had issued a lengthy (36- paragraph) critique of a comprehensive (76-page) set of revised substance abuse treatment facility licensing regulations. Multiple councils had adopted the critique which was shared with the Division of Substance Abuse & Mental Health. In November 2011 the Division adopted a final regulation incorporating thirteen (13) amendments prompted by the commentary. For example, the Division decided to include a mandatory abuse/neglect reporting requirement and not delete a requirement that waiver requests be posted to facilitate resident input to the licensing agency. [14 DE Reg. 18 (July 1, 2010) (proposed); 14 DE Reg. 471 (November 1, 2010) (final)]

In the prior reporting period, the DLP had compiled a comprehensive critique of a DMMA proposed consolidated Medicaid waiver application. The initiative was designed to merge three waivers (elderly/disabled; acquired brain injury; assisted living) into a single waiver. Such waivers provide important community-based supports to deflect individuals from institutions. The SCPD adopted the DLP’s 10-page critique which was shared with the Division. In November, 2010 DMMA adopted a final regulation which incorporated responses to the commentary. [14 DE Reg. 88 (August 1, 2010) (proposed); 14 DE Reg. 461 (November 1, 2010) (final)]

The Division of Medicaid & Medical Assistance (“DMMA”) to amend its Pre-admission Screening and Resident Review (“PASRR”) regulation designed to deflect individuals with mental health and intellectual disabilities from nursing home placement. Multiple councils adopted a DLP critique which was shared with the Division. In March, 2011 the Division adopted a final regulation incorporating nine (9) amendments prompted by the commentary. [14 DE Reg. 615 (January 1, 2011) (proposed); 14 DE Reg. 895 (March 1, 2011) (final)]

DMMA proposed to amend it Medicaid long-term care resource exclusion standards to conform to federal law. The new standard would result in a 9-month disregard of retroactive SSI/SSDI benefits and a 12-month disregard of federal income tax refunds. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. The Division acknowledged the endorsements and adopted a conforming final regulation in June, 2011. [14 DE Reg. 1001 (April 1, 2011) (proposed); 14 DE Reg. 1364 (final) (June 1, 2011)]

DLP-authored legislation had been enacted in 2009 which required DHSS to issue regulations requiring licensed long-term care facilities to cooperate with DLP monitoring and abuse/neglect investigations. After prompting by the DLP, DHSS issued an implementing proposed regulation in April, 2011 covering seven (7) forms of long-term care facilities, including nursing homes and group homes. The DLP’s favorable critique was adopted by multiple councils and shared with DHSS. A conforming final regulation was adopted in June, 2011. [14 DE Reg. 983 (April 1, 2011) (proposed); 14 DE Reg. 1360 (June 1, 2011) (final)]

The Division of Long-term Care Residents’ Protection (“DLTCRP”) issued a proposed regulation revising its assisted living facility standards. The DLP prepared an analysis recommending two (2) amendments to clarify that: 1) waiver requests should focus on the patient’s well being rather than effect on other patients; and 2) a resident temporarily transferred to an acute care setting has the right to return to the assisted living facility when the resident no longer needs acute care. The analysis was adopted by multiple councils and shared with the Division. In July, 2011 the Division adopted a final regulation which incorporated both recommended amendments. [14 DE Reg. 1190 (May 1, 2011) (proposed); 15 DE Reg. 81 (July 1, 2011) (final)]

The DLTCRP proposed adoption of some discrete changes to its nursing home standards in the context of communicable diseases. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. In July, 2011 the Division acknowledged the endorsements and adopted a conforming final regulation. [14 DE Reg. 1189 (May 1, 2011) (proposed); 15 DE Reg. 79 (July 1, 2011) (final)]

The Division of Social Services (“DSS”) proposed comprehensive revision of its fair hearing practices and procedures regulation. The DLP issued a lengthy (6-page) critique. In particular, the DLP highlighted the complete lack of standards covering resident appeals of proposed nursing home and long-term care facility discharges and transfers. The DLP also criticized inconsistent standards identifying the agency entrusted with jurisdiction over such appeals. Multiple councils adopted the critique which was shared with the Division and Department Secretary. DHSS notified the councils in February, 2011 that it was considering the issue of a lack of hearing standards applicable to long-term care facility discharges and transfers. The Division later drafted a final regulation incorporating eleven (11) amendments prompted by the commentary. [14 DE Reg. 618 (January 1, 2011) (proposed)]; 15 DE Reg. 86 (July 1, 2011) (final)]

DMMA proposed adoption of a new Diamond State Health Plan Plus program through an amendment to its Medicaid managed care waiver. The new program would pay managed care organizations a capitated rate to provide “wrap-around” services to covered Medicaid beneficiaries in nursing homes, currently enrolled in waivers, or those at risk of nursing home placement. The new program would cover thousands of individuals and include incentives to transfer current nursing home residents to community-based residential settings. In September, 2011 the DLP issued a comprehensive (13-page) critique of the program documents which was adopted by multiple councils and shared with the Division. The Division was in the process of incorporating changes in its standards based on the commentary at the end of FY11. [15 DE Reg. 45 (July 1, 2011) (proposed)]

DMMA proposed adoption of restrictive State residency standards applicable to individuals owning out-of-state homes seeking Delaware Medicaid coverage of nursing home stays. The DLP issued a negative critique noting that some aspects of the standards violated federal law. Multiple councils adopted the critique which was shared with the Division. In September, the Division adopted a final regulation which included one (1) amendment and some clarifying guidance limiting the application of the new standards. [15 DE Reg. 46 (July 1, 2011) (proposed); 15 DE Reg. 362 (September 1, 2011) (final)]

In the prior reporting period, the DLP prompted the DLTCRP to commit to licensing of a large residential program exclusively serving individuals with disabilities. In December, 2010, an interim agreement was executed in which the facility agreed to apply regulations from the Office of Child Care Licensing to its adult population on an interim basis. The DLTCRP then requested DLP technical assistance in developing a set of adult regulations. The DLP submitted extensive comments on a 38-page set of draft standards followed by a meeting among DLTCRP staff and representatives from multiple councils. The DLTCRP agreed to adopt most recommendations. A revised draft was issued in September, 2011 in anticipation of formal publication in October, 2011.

In a prior reporting period, the DLP presented a critique of restrictive Medicaid private duty nursing (“PDN”) standards to DHSS which were reviewed with the DHSS Secretary, Medicaid Director, and State council representatives in a meeting. As a result, DHSS agreed to offer exceptions to its standard 8-hour daily cap on PDN services if necessary to avoid institutionalization. Later, DHSS submitted proposed implementing standards to the DLP and councils. In September, 2011 the DLP issued a 5-page critique of the standards. DHSS had not issued a revised proposal as of the end of the reporting period.

The State Division of Aging & Adults with Physical Disabilities (“DSAAPD”) planned to screen all residents of three (3) State nursing homes with an aggregate of 526 licensed beds to assess prospects and amenability to live in the community. The DLP requested the opportunity to provide technical assistance on the screening instrument. The DLP then commented on sequential drafts of the instrument and prompted inclusion of several amendments, including adding a “legal assistance” field and expanding inquiries in the contexts of guardianship, representative payees, power of attorney agents, support animals, debts, and Food Supplement Program eligibility. DSAAPD adopted a final form which was used to initiate screening of State nursing home residents. The DLP forwarded an electronic version of the final form to NDRN as a resource for other state P&As.

In December, 2010, the DLP provided technical assistance and materials to the U.S. Department of Justice to facilitate assessment of State compliance with the Olmstead decision by housing many individuals with disabilities in a large (397-bed) public long-term care institution.

In December, 2010, the DLP facilitated submission of SCPD comments to the Delaware State Housing Authority on low income tax credits to include an accessibility incentive.

In January, 2011, the DLP spearheaded opposition to a legislative proposal to “weaken” due process protections which require licensed long-term care facilities (including nursing homes, assisted living facilities; group homes) to: 1) provide 30-day notice of discharge and 2) initiate discharge only in narrow contexts (e.g. non-payment; failure to meet standard of care). The DLP, along with staff of three councils, met with DHSS and nursing home representatives and convinced DHSS to abandon the initiative.

The DLP submitted testimony in November, 2010 and March, 2011 budget hearings in favor of at least level State funding of DSAAPD’s attendant services program which supports independent living in the community. By enrolling many of the 77 program participants in a consolidated Medicaid waiver, the State anticipated a 2/3 reduction in its waiting list. The effort was successful and level State funding was maintained in the FY12 budget.

In October, 2010, the DLP issued comments on draft DSAAPD guidelines on termination of self-directed services for use in the consolidated Elderly/Disabled Medicaid waiver. The DLP recommended several amendments to the standards to enhance participant protections and due process procedures. The commentary was adopted by the SCPD and shared with the Division which adopted final guidelines incorporating the recommended amendments.

In May, 2011, the DLP supported submission of comments to the Legislature’s Joint Finance Committee favoring a 2% increase to providers of community-based residential services while opposing a 2% ($1.4 million) increase to nursing home providers. The effort was successful, i.e., increased funding for community-based providers, but not nursing home providers, was included in the FY12 budget.

In 2004, DLP-authored legislation had been enacted establishing an exception to the nurse practice act to permit individuals to delegate health care acts to unlicensed persons. Home health agencies and other health care providers had not uniformly “embraced” this authorization which undermined independent living in the community. For example, some home health agencies refused to allow their employees to assist with medications. In the Spring of 2011, the DLP collaborated with the SCPD and DHSS to secure a Board of Nursing policy letter which was distributed to providers to promote full implementation of the patient delegation authorization statute.

5. Number of Cases

Fifteen (15) housing cases were open during the fiscal year.

6. Case Summaries

Fifty-one year old tenant with asthma, diabetes, and orthopedic impairments had fallen in apartment and requested landlord permission to install handrail at entrance to unit. Landlord withheld permission and issued lease termination notice. DLP represented tenant in administrative fair housing complaint and eviction. DLP negotiated settlement in which lease would continue and permission was granted to install handrail contingent upon approval of plans and work would be performed by licensed contractor. [10-2028695]

Forty-six year old SSDI beneficiary had experienced aneurysm resulting in severe expressive aphasia. Assisted living facility issued termination notice due to concerns about her behavior. DLP contested discharge through administrative hearing request. After negotiation, facility abandoned attempt to discharge client. [10-2008782]

Fifty-five year old Section 8 tenant on SSI had experienced a stroke resulting in right side weakness and inability to speak. Co-habiting adult son filed application for protection from abuse (PFA) order to oust client from apartment alleging she threw shoes at him and yelled at him. DLP entered appearance, facilitated acquisition of augmentative communication device, and obtained dismissal of PFA application by Family Court. [1-2030582]

Fifty-six year old double amputee with diabetes was homeless. He alleged local emergency shelters denied bed based on his need for wheelchair access. DLP contacted shelters and secured his admission. DLP also contacted DSAAPD to facilitate application for longer-term housing and support services. [11-2031972]

Fifty-eight year old SSDI beneficiary faced eviction. State of Maryland attached his SSDI benefits to pay for alleged $10,298 back child support arrears for daughter who was now 41 years old. Maryland took $685 of his $1,074 SSDI check. Client’s driver’s license was also suspended based on arrears. DLP intervened and secured reinstatement of SSDI, reimbursement of $1,265, and reinstatement of driver’s license. Loss of income resulted in termination of electric and two months arrears in rent. DLP contacted social services agencies which assisted with restoration of electric and payment of back rent. [10-1027314]

Forty-two year old was on SSI due to stroke resulting in neurological and brain damage. She wished to eject co-habiting boyfriend from her subsidized rental unit since he was not contributing to payment of bills. DLP assessed and determined that boyfriend was co-lessee. DLP provided options to client who decided to vacate and live with relatives. [11-1030444]

Forty-six year old with acquired brain injury and orthopedic impairments was informed of DHSS intention to terminate her Medicaid waiver services based on no longer qualifying for nursing level of care. DLP assessed, determined that information was based on misunderstanding, and secured commitment of continued eligibility. [11-2030933]

Thirty-four year old SSDI beneficiary received notice from Attorney General’s Office of intent to file action in Superior Court to abate nuisance, i.e., drug dealing at her residence. Such an action would jeopardize continued residency. DLP contacted Attorney General’s Office and supplied background information, including departure of individual charged with drug possession. Attorney General’s Office deferred filing action until time lapsed to file in Superior Court. [09-3009939]

Forty-seven year old with visual impairment (blind) was abandoned by wife. His sole income was SSDI. Electric bill ($900) and rent ($1,250) were in arrears. DLP secured 30-day deferral of utility cut-off and facilitated application for emergency assistance. DLP also secured commitment of DVLS to represent client in spousal support action. [10-1029322]

Fifty-seven year old with renal failure and diabetes was homeless. He signed lease for subsidized efficiency for $192 rent and $174 for food. He wanted to discontinue the food since it did not accommodate his diabetes. Agreement was reached to transfer to a different unit which did not include non-refundable food fee. [10-1028773]

Fifty-eight year old with COPD was dependent of oxygen but, due to limited SSI income, had amassed $21,775 electric bill. DLP assessed circumstances and provided advice on options, including bankruptcy. [09-1026140]

Forty-six year old SSDI beneficiary due to orthopedic impairment received notice of termination of her Section 8 voucher when her son, a registered sex offender, listed her address as his residence without her consent. The DLP documented the inaccurate representation and secured the reinstatement of the client’s Section 8 voucher. [09-1026819]

Fifty-one year old public housing tenant with seizure disorder and intellectual impairment was displaced when unit suffered extensive fire damage attributed to negligence of family member. Public housing authority threatened eviction due to $14,000+ damages and rent arrears. DLP obtained temporary hotel voucher since tenant was rendered homeless. DLP then negotiated reinstatement to a different unit and secured rental assistance so current on rent. [10-1028049]

Forty-nine year old with orthopedic disability was unable to pay “past-due” lot rent on mobile home lot due to SSA interception of $5,461 federal tax refund. DLP provided advice on options and client secured short-term loan to pay lot rent. [11-3030981]

D. FOURTH PRIORITY: AUTONOMY.

1. Identification

The PAIR program will promote constituent autonomy and self-assurance through training, information dissemination, and assistance with substitute or advance consent documents.

2. Need, Issue, or Barrier Addressed

The PAIR program promotes consumer self-advocacy through both group training and answering individual inquiries. Autonomy is also enhanced by DLP preparation of advance health care directives and powers of attorney for clients on a limited basis. This facilitates implementation of consumer choice in health care and financial matters.

3. Outcome Indicators

Factors used to determine success include the number of individuals trained in group settings, the number of individuals provided with individual technical assistance, and the number of individuals obtaining advance health care directives or powers of attorney. As reflected in the PAIR FY 11 Priorities, the outcome indicators for this objective were as follows:

a. The DLP will provide information and referral services to 175 individuals and agencies.

b. The DLP will provide training to 10,000 individuals through articles, seminars, training events, and dissemination of training materials.

c. The DLP will prepare a minimum of 10 powers of attorney, advance directives, and similar authorizing documents.

4. Collaborative Efforts

Consistent with the PPR, Part I, Section B., the DLP conducted 25 group training events. Collaborating agencies included the State Council for Persons with Disabilities, the Division of Vocational Rehabilitation, and the Department of Health and Social Services. In addition, the DLP engaged in the following collaborative systemic activities to promote constituent autonomy.

The Division of Public Health proposed adoption of a regulation covering pre-hospital advance health care directives. Such directives enable individuals with disabilities to clarify their wishes concerning treatment in the event of involvement by EMS and other emergency personnel. The DLP issued a critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation which incorporated several amendments prompted by the DLP commentary. [14 DE Reg. 1195 (May 1, 2011) (proposed); 15 DE Reg. 211 (August 1, 2011) (final)]

DMMA proposed adoption of a new Diamond State Health Plan Plus program through an amendment to its Medicaid managed care waiver. The new program would pay managed care organizations a capitated rate to provide “wrap-around” services to covered Medicaid beneficiaries in nursing homes, currently enrolled in waivers, or those at risk of nursing home placement. The new program would cover thousands of individuals and include incentives to transfer current nursing home residents to community-based residential settings. In September, 2011 the DLP issued a comprehensive (13-page) critique of the program documents which was adopted by multiple councils and shared with the Division. In the context of autonomy, the DLP was highly critical of several aspects of the Plan which constrained consumer choice, including the use of only two (2) managed care organizations (MCOs), limits on designation of a specialist as primary care physician, and requirement that a participant transferred from one MCO to second MCO remain with second MCO forever. The Division was in the process of incorporating changes in its standards based on the commentary at the end of FY11. [15 DE Reg. 45 (July 1, 2011) (proposed)]

Legislation (H.B. No. 19) was introduced to revise drug offense penalties, eliminate some minimum-mandatory sentences, and effect other common-sense changes. In the autonomy context, the bill eliminated a statute creating a crime for not keeping a prescription drug in its original container. The DLP had previously criticized the statute which made the elderly and persons with disabilities guilty of a Class A Misdemeanor for simply using daily-dose weekly pill containers. The DLP issued a positive critique which was adopted by multiple councils and shared with policymakers. The bill was enacted and signed by the Governor on April 20, 2011.

**PRIORITIES & OBJECTIVE SECTION IS CONTINUED IN PART VI. NARRATIVE***

B. Priorities and Objectives for the Current Fiscal Year

Please include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:

  1. a statement of each prioirty;
  2. the need addressed by each priority; and;
  3. a description of the activities to be carried out under each priority.

DISABILITIES LAW PROGRAM FY 2012 P&A FOR INDIVIDUAL RIGHTS (PAIR) PRIORITIES INTRODUCTION The Disabilities Law Program (DLP) of the Community Legal Aid Society, Inc. (CLASI) provides services to individuals consistent with the following authorizing legislation:

1) Protection & Advocacy for Individual Rights (PAIR); 2) Protection & Advocacy for Individuals with Mental Illness (PAIMI); 3) Protection & Advocacy for Individuals with Developmental Disabilities (PADD); 4) Protection & Advocacy for Assistive Technology (PAAT); 5) Protection & Advocacy for Beneficiaries of Social Security (PABSS); 6) Protection & Advocacy for Individuals with Traumatic Brain Injury (PATBI); 7) Protection & Advocacy for Voting Access (PAVA).

This document defines the priorities for FY 2012 (October 1, 2011 - September 30, 2012) of the first component, PAIR.

INTERAGENCY COORDINATION

The focus of the PAIR program is to provide services to individuals with disabilities ineligible under traditional advocacy projects, i.e., PAIMI, PADD, and client assistance programs (CAPs). See 29 U.S.C. ’794e(f). However, federal law envisions that the PAIR will coordinate advocacy with such organizations as well as the Long-term Care Ombudsman.

In deference to this mandate, the PAIR program closely coordinates with the DLP’s PAIMI and PADD components as follows:

1) PAIMI, PADD, and PAIR program priorities are designed to be complementary; 2) intraoffice referrals among programs are routinely made to ensure that applicants are screened for eligibility by the appropriate DLP subdivision; 3) reference materials and training resources are routinely shared; and 4) the DLP Legal Advocacy Director coordinates advocacy across the three programs to minimize duplication of effort.

Likewise, the CAP director serves on the DLP’s PAIR advisory council and the DLP supplements CAP advocacy in the vocational rehabilitation context as follows:

1) DLP staff member serves as the Chair of the Dept. of Labor’s Division of Vocational Rehabilitation [DVR] advisory council; 2) DLP staff serve on the DVR Client Services Policy Committee; 3) DLP Director and CAP representative serve together on the State’s special education council, the Governor’s Advisory Council for Exceptional Citizens; 4) DLP Project Director and CAP Director serve together on the State Council for Persons with Disabilities Policy & Law Committee which acts on the DLP’s monthly critiques of legislative, regulatory, and policy initiatives; 5) DLP staff responds to CAP requests for technical information on matters within the DLP’s particular expertise; 6) DLP staff screens CAP referrals on matters outside the CAP’s mandate; and 7) DLP staff offers independent or collaborative training on the vocational rehabilitation system on request.

Finally, the Home and Community-based Services Ombudsman serves on the DLP’s PAIR advisory council and the DLP supports and supplements Ombudsman advocacy as follows:

1) DLP responds to Ombudsman requests for technical assistance; 2) DLP staff offers independent and collaborative training on abuse, neglect, and rights of constituents. 3) DLP staff and the Ombudsman serve together on the State Nursing Home Residents Quality Assurance Commission. 4) DLP Project Director and Ombudsman serve together on the State Council for Persons with Disabilities Housing Committee. 5) DLP Project Director and Ombudsman representative serve together on State Council for Persons with Disabilities Policy & Law Committee.

SCOPE OF ADVOCACY

The scope of PAIR program advocacy includes a broad array of activities, including information and referral, counseling and technical assistance, community education, negotiation, litigation, and legislative and regulatory analysis. Given relatively modest funding, the PAIR program is guided by these priorities in determining the type and scope of services provided to eligible constituents.

SPECIFIC PRIORITIES AND OBJECTIVES

I. ACCESSIBILITY GOAL: The PAIR program will promote and facilitate access to governmental programs and public accommodations.

OBJECTIVES:

0100 A. Provide direct advocacy services if an individual has been prevented from effectively accessing important governmental programs based on systemic policy or barrier(s) contrary to federal or state law.

0102 B. Provide direct advocacy services to individuals prevented from effectively accessing important public accommodations because of barriers or discrimination proscribed by federal or state law.

OUTCOME INDICATORS:

A. As a result of DLP intervention, 30 persons will secure equal or improved access to governmental services or public accommodations.

B. As a result of DLP intervention, 10 laws, regulations, policies or other barriers to government services or public accommodations will be eliminated or reduced.

RATIONALE: This priority is intended to promote access to important public income, health, and "safety net" support programs. This priority also encompasses enforcement of both Titles II and III of the ADA, as well as Delaware’s equal accommodations law, Title 6 Del.C. Ch. 45. Both public sector and private sector compliance with the ADA will be promoted. In the public sector, the DLP contemplates legal assistance to protect the rights of Medicaid beneficiaries, particularly those enrolled in the managed care system. Access to basic health care is a high priority among PAIR constituents and Delaware=s Medicaid MCOs have historically denied, in whole or part, valid claims for services. Planned transition to a DSHP Plus system in April, 2012 will significantly increase the number of Medicaid beneficiaries subject to MCO oversight. The DLP anticipates the provision of legal assistance to applicants for Medicaid waivers whose eligibility has been improperly denied. The DLP expects to support continued implementation of a Medicaid Buy-in program [a/k/a Medicaid for Workers with Disabilities (MWD) program] initiated October 1, 2009. The DLP will also support enhanced implementation of the Money Follows the Person program which has been extended until 2016. The DLP contemplates supporting the work of the Home and Community-based Services Ombudsman (HCBSO). The DLP anticipates continuing efforts to support State planning and implementation of federal health care reform legislation. Apart from health care, the DLP routinely receives requests for assistance with "safety-net" income-maintenance programs (e.g. preservation of SSI in State child support reimbursement context). The DLP expects to address constrictive enforcement of the Delaware Equal Accommodation law through multiple Superior Court appeals of dismissals of administrative complaints and collaboration with the SCPD. Recently enacted legislation (H.B. No. 237 in 145th General Assembly) incorporating DLP-drafted provisions mandates installation of automatic door openers or calling devices in public and private buildings constructed after January 1, 2011. The DLP will promote compliance. The DLP will support enactment of DLP-co-authored universal design legislation introduced on June 30, 2011. Finally, a DLP staff attorney will address accessibility of public buildings through participation in the Architectural Review Board and assist with implementation of recently enacted polling site accessibility legislation (S.B. No. 285 in 145th General Assembly) drafted by the DLP. In the private sector, the DLP anticipates addressing complaints regarding both policy and physical barriers to community integration. Selected long-term care concerns will be addressed in both public and private sector contexts.

II. TRANSPORTATION GOAL: The PAIR program will promote a consumer-friendly transportation system and reduction of barriers to constituent travel.

OBJECTIVES:

0200 A. Collaborate with advocacy organizations and councils [e.g. Elderly & Disabled Transportation Advisory Council (EDTAC); State Council for Persons with Disabilities (SCPD); [DAPT] to promote improvement in Delaware paratransit system through both systemic and individual constituent advocacy.

0201 B. Collaborate with the State Council for Persons with Disabilities (SCPD) to promote:

1. consumer-oriented motor vehicle license, operation and parking laws, regulations, and policies; and

2. safety-related transportation laws, regulations, and policies to prevent or reduce injuries resulting in disability.

0202 C. Provide direct advocacy services to individuals prevented from effectively accessing public and private vehicular transportation systems or otherwise experiencing significant barriers to travel contrary to Federal or State law.

OUTCOME INDICATORS:

A. As a result of DLP intervention, 5 persons will secure equal or improved access to transportation.

B. As a result of DLP intervention, 5 laws, regulations, or policies will be changed or barriers to transportation eliminated or reduced.

RATIONALE: This priority is intended to facilitate travel both within the State and to regional transportation centers. Advocacy contexts would include improving the public transportation system (including DelDOT paratransit capacity, policies, and practices); promoting the availability of accessible parking; and enhancing pedestrian travel through barrier removal (e.g. curb cuts). The DLP anticipates continued participation in Logisticare advisory committee to facilitate consumer-oriented access to Medicaid-funded transportation. Since many long-term injuries are transportation-related, the DLP also envisions supporting safety related laws and regulations, including implementation of recently enacted legislation banning handheld cell phone use by drivers effective January 2, 2011 and supporting laws promoting helmet use. The Governor vetoed legislation diluting motorcycle helmet usage on July 14, 2011. Transportation affects access to employment, medical services, shopping, and recreation.

III. HOUSING; INDEPENDENT LIVING

GOAL: The PAIR program will promote freedom from disability-based discrimination in housing and the reduction of barriers to independent living.

OBJECTIVES:

0300 A. Provide direct advocacy services to constituents aggrieved by significant violations of fair housing laws.

0301 B. Collaborate with the SCPD to promote the availability of independent living supports (e.g. attendant services; home health services; private duty nursing services; home modifications; caregiver services, and public financial incentives).

OUTCOME INDICATORS:

A. As a result of DLP intervention, 20 persons with disabilities will secure equal access to or maintain housing or independent living supports.

B. As a result of DLP intervention, 10 laws, regulations, or policies will be changed or other barriers to housing eliminated or reduced.

RATIONALE: This priority addresses both enforcement of fair housing laws and promotion of the availability of community-based housing options. For example, the DLP envisions addressing both individual housing discrimination complaints and, in conjunction with the State Council for Persons with Disabilities, systemic barriers to independent living. For example, the DLP anticipates collaboration with the State Council for Persons with Disabilities to influence proposed adoption of a DSHP PlusMedicaid program. The DLP typically protects client rights to reasonable accommodations by landlords and freedom from discrimination in the housing application context. Clients in institutions (e.g. DHCI) also benefit from advocacy support to facilitate discharge to community-based settings. The DLP envisions continued supprt of DSAAPD screening of residents of State-operated long-term care facilities to assess prospects for discharge to community settings with appropriate services. The DLP anticipates implementation of DLP-authored legislation (H.B. No. 36 in the 145th General Assembly) which enhances protection of rights of long-term care facility residents. Lack of access to community-based housing results in homelessness, resort to substandard living arrangements, and over-institutionalization. The DLP contemplates advocacy to deter adoption of restrictive zoning laws and practices by local governments. The DLP also envisions continued participation in the Governor’s Commission on Community-based Alternatives for Individuals with Disabilities and the Commission’s Housing Committee. Finally, the DLP plans to continue participation in Delaware Nursing Home Residents Quality Assurance Commission meetings which address both nursing home regulation and civil rights of residents.

IV. AUTONOMY

GOAL: The PAIR program will promote constituent autonomy and self-assurance through training, information dissemination, and assistance with substitute or advance consent documents.

OBJECTIVES:

0400 A. Offer individual technical assistance and information and referral services on substantive disability law (e.g. employment, housing, public benefits) and enforcement options.

0401 B. Offer group training on substantive disability law, enforcement options, and self- advocacy.

0402 C. If not readily available through other agencies, assist with preparation of a limited number of routine advance directives, powers of attorney, and similar authorizing documents.

OUTCOME INDICATORS:

A. The DLP will provide information and referral services to 150 individuals and agencies.

B. The DLP will provide training to 10,000 individuals through articles, seminars, training events, and dissemination of training materials.

C. The DLP will prepare a minimum of 20 powers of attorney, advance directives, and similar authorizing documents.

RATIONALE: This priority encompasses the provision of individual technical assistance as well as group training activities. For example, the DLP anticipates presentation of seminars, drafting articles, enhancing its Website, and other information dissemination activities to promote informed constituent decision-making and empowerment. An informed constituency is confident, self-reliant, and enabled to engage in proactive advocacy. The DLP leverages resources through wide dissemination of information and advice to consumers.

GENERAL STANDARDS FOR DETERMINATION OF LEVEL AND TYPE OF SERVICES

Recognizing that the demand for assistance has historically outstripped available resources, the following factors will be considered in determining the level and type of services to be offered to an eligible applicant:

(1) potential impact on client; (2) merits of case (both factually and legally); (3) realistic alternate sources for referral and assistance; (4) applicant’s ability to self advocate; and (5) potential impact on other constituents or systems.

Part VI. Narrative

At a minimum, you must include all of the information requested. You may include any other information, not otherwise collected on this reporting form that would be helpful in describing the extent of PAIR activities during the prior fiscal year. Please limit the narrative portion of this report, including attachments, to 20 pages or less.

The narrative should contain the following information. The instructions for this form outline the information that should be contained in each section.

  1. Sources of funds received and expended
  2. Budget for the fiscal year covered by this report
  3. Description of PAIR staff (duties and person-years)
  4. Involvement with advisory boards (if any)
  5. Grievances filed under the grievance procedure
  6. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency

A. Sources of Funds Received and Expended - October, 2010 - September, 2011

Amount Received $175,632 Amount Spent $175,632

B. Budget for FY 11

Wages/salaries $104,785

Fringe benefits (medical, dental ,FICA, unemployment, etc. $50,590

Materials/supplies $1,492

Postage $552

Telephone $2,046

Occupancy (Rent, Utilities, Bldg & Grounds Maintenance) $8,719

Travel $1,233

Membership dues $753

Bonding/insurance $1,647

Equipment (rental/purchase) $1,472

Litigation Costs $368

Contractual (Payroll, Audit, Law Library on-line) $1,932

Miscellaneous $43

Total Budget $175,632

C. Description of PAIR staff - October 2010 - September 2011

Type of Position Professional Full-time FTE 1.42 % of Year Filled 100% Person-years 1.42

Part-time FTE .20 % of Year Filled 100% Person-years .20

Clerical

Full-time FTE .21 % of Year Filled 100% Person-years .21 The PAIR positions for Fiscal Year 2011, October 2010 - September 2011, included the Project Director and the Legal Advocacy Director, 5 attorneys, 6 paralegals, 4 administrative and 4 support staff required to provide PAIR services in each of Delaware=s three counties. The staff positions, of which 2 were part-time, included the following:

Professional Staff Disabilities Law Program Project Director 2.67% Disabilities Law Program Legal Advocacy Director 2.04% Executive Director 2.0% Financial Director 2.0% Accountant 2.0% Network Administrator 2.0%

Attorneys New Castle County 1 Senior Attorney 27.31% 2 Attorneys 1.26%

Kent County 1 Attorney 8.20%

Sussex County 1 Senior Attorney 19.23%

Paralegal New Castle County 4 Paralegals 9.21%

Kent County 1 Paralegal 11.95%

Sussex County 1 Paralegal 12.39%

Clerical Staff Administrative Assistant 7.65%

Legal Secretary New Castle County 1 Legal Secretary 3.0%

Kent Count 1 Legal Secretary 3.0%

Sussex County 1 Office Manager/Legal Secretary 3.0%

The Executive Director, Chief Financial Officer, Accountant, Administrative Assistant, Network Administrator and Legal Secretary positions are representative of the administrative and clerical positions that provided support to the legal staff. In addition to these positions, the intake receptionists and additional secretaries worked with the program in each county.

D. Involvement with Advisory Board

The DLP maintains a separate PAIR Advisory Council. The Council meets quarterly. In FY 11 the Council met on November 10, 2010; February 9, 2011; May 11, 2011; July 20, 2011. The membership includes both consumer and agency representatives, including the following: CAP Director, Delaware Paralyzed Veterans representative, Center for Disabilities Studies representative, Division of Services for Aging & Adults with Physical Disabilities representative, Division of Vocational Rehabilitation Administrator, Delaware Assistive Technology Initiative director, and State Council for Persons with Disabilities Administrator.

The Council reviews and approves priorities and the annual report. At each meeting, DLP staff provided a written and oral statistical update, advocacy update, and Project Director’s report. The Council provides input and advice on current issues affecting persons with disabilities.

E. Grievances Filed

There were no grievances filed during the fiscal year.

F. Coordinating with the CAP & Long-term Care Ombudsman

1) DLP staff member serves as the Chair of the Dept. of Labor’s Division of Vocational Rehabilitation advisory council; 2) DLP staff serve on the DVR Client Services Policy Committee; 3) DLP Director and CAP representative serve together on the State’s special education council, the Governor’s Advisory Council for Exceptional Citizens; 4)DLP Project Director and CAP Director serve together on the State Council for Persons with Disabilities Policy & Law Committee which acts on the DLP’s monthly critiques of legislative, regulatory, and policy initiatives; 5)DLP staff responds to CAP requests for technical information on matters within the DLP’s particular expertise; 6)DLP staff screens CAP referrals on matters outside the CAP’s mandate; and 7)DLP staff offers independent or collaborative training on the vocational rehabilitation system on request.

Finally, the Office of the Long-term Care Ombudsman includes a Home and Community Based Services Ombudsman who serves on the DLP’s PAIR advisory council and the DLP supports and supplements Ombudsman advocacy as follows:

1) DLP responds to Ombudsman requests for technical assistance; 2) DLP staff offers independent and collaborative training on abuse, neglect, and rights of constituents. 3) DLP staff and the Ombudsman serve together on the State Nursing Home Residents Quality Assurance Commission. 4) DLP Project Director and Ombudsman serve together on the State Council for Persons with Disabilities Housing Committee. 5) DLP Project Director and Ombudsman representative serve together on State Council for Persons with Disabilities Policy & Law Committee.

**PRIORITIES & OBJECTIVES CONTINUED**

5. Number of Cases

Consistent with the PPR, Part I, Sections A. and B, 150 individuals received technical assistance and 2,615 individuals received direct training. Twenty (20) “other” (e.g. POAs; advance directives) were open during the fiscal year. Published journal and newsletter articles reached 20,000 persons. Other articles and training materials reached 2,302 individuals.

6. Case Summaries

Fifty-three year old with visual impairments solicited advance health care directive (AHCD) prior to surgery. The DLP prepared documents which client executed. [10-1029394]

Fifty-eight year old with throat and esophageal cancer requested AHCD and power of attorney (POA). The DLP prepared documents which client executed. [10-2029255]

Fifty-six year old with orthopedic impairments requested AHCD and POA. The DLP prepared documents which client executed. [11-2031281]

Fifty-nine year old State nursing home resident requested AHCD. DLP prepared document and coordinated execution with Long-term Care Ombudsman representative and facility social worker. [10-1027569]

Forty-eight year old private nursing home resident requested POA and AHCD. DLP prepared document and coordinated execution with Long-term Care Ombudsman representative and facility social worker. [10-1028252]

Fifty-six year old SSDI beneficiary based on acquired brain jury resulting in memory loss requested POA. The DLP prepared document which client executed. [11-2030708]

Fifty-eight year old SSI beneficiary in rehabilitation facility requested POA. DLP prepared document which client executed. [11-1031797]

Fifty-five year old SSDI beneficiary with cardiovascular disease, orthopedic impairments, and hearing disability (Deaf) requested POA naming brother as agent since he was undergoing divorce from spouse with existing POA. The DLP advised client of procedure to revoke existing POA and prepared new POA which client executed. [11-2030747]

Thirty year old with intellectual disability had been determined ineligible for Division of Developmental Disabilities Services. DLP provided information on availability of desired job training services available through non-profit agency. [11-1031410]

Certification

Signed?Yes
Signed ByBrian Hartman
TitleProject Director
Signed Date11/30/2011