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

Louisiana (Advocacy Center) - H240A120019 - FY2012

General Information

Designated Agency Identification

NameAdvocacy Center
Address8325 Oak St
Address Line 2
CityNew Orleans
StateLouisiana
Zip Code70118
E-mail Addressadvocacycenter@advocacyla.org
Website Addresshttp://www.advocacyla.org
Phone504-522-2337
TTY 855-861-3577
Toll-free Phone800-960-7705
Toll-free TTY855-861-3577
Fax504-522-5507
Name of P&A Executive DirectorLois V. Simpson
Name of PAIR Director/CoordinatorStephanie Patrick
Person to contact regarding reportStephanie Patrick
Contact Person phone504-522-2337
Ext.143

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 areas99
2. Individuals receiving I&R outside PAIR priority areas965
3. Total individuals receiving I&R (lines A1 + A2)1,064

B. Training Activities

1. Number of trainings presented by PAIR staff10
2. Number of individuals who attended training (approximate)458

• Legal Status at the Brain Injury Association of LA state conference, 50 participants • Legal issues for seniors, Folsom, 14 participants • Legal issues for seniors, Covington, 50 participants • Powers of attorney and living wills, Covington, 25 participants • Powers of attorney and living wills, Mandeville, 23 participants • Powers of attorney and living wills, Mandeville, 46 participants • Including Disability in Disaster Planning Louisiana Style, Webinar with participants from across the US, over 100 participants • Disability and Technology for Biomedical Engineering Students, New Orleans, 30 participants • Protective Services in Louisiana, New Orleans, 40 participants • Shelter Volunteer Caregiver Project Training, Webinar with participants from across the US, 80 participants

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff1
2. Newspaper/magazine/journal articles25
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website1,615,451
5. Publications/booklets/brochures disseminated15,639
6. Other (specify separately)0

Narrative

1. Radio and TV Appearances by PAIR Staff - 1 Proposed city ordinance aims for “Complete Streets” in NOLA, WWLTV, 11/10/11

2. Newspaper/magazine/journal articles - 25 Louisiana Coalition on Disaster Preparedness Receives National Recognition, Pushing the Envelope: AC News in Brief, 10/2/11

Accessible route open for bus transfers at food of Canal Street, Pushing the Envelope: AC News in Brief, 11/1/11

Affordable and Accessible Housing at Risk!, Pushing the Envelope: AC News in Brief, 11/9/11

Making New Orleans taxi cabs more accessible: Editorial, The Times-Picayune/Nola.com, 11/11/11

DHH, residents arguing over aid, The Advocate, 12/1/11

Public Affairs Research Council (PAR) Issues Report on Privatization of Medicaid, Pushing the Envelope: AC News in Brief, 1/11/12

Settlement Reached Regarding Wheelchair-Accessible Seating at Mahalia Jackson Theater, Pushing the Envelope: AC News in Brief, 1/13/12

Settlement Reached in Suit over Personal Care Services, Pushing the Envelope: AC News in Brief, 1/14/12

Al Judge to review, rule on state’s long-term care settlement, The News Star, 1/17/12

AC Helps More People with Disabilities Find Housing, Pushing the Envelope: AC News in Brief, 2/16/12

City of New Orleans Announces Major Accessibility Reforms to Taxicab Industry, Pushing the Envelope: AC News in Brief, 3/16/12

Proposed Taxi Regulations: Charles Maldonado on the city’s ambitious plan to overhaul cab service, The Gambit, 4/2/12

Public gets its turn to talk about La.’s budget, Washington Examiner, 4/16/12

New Orleans City Council Oks creating class of taxis geared towards disabled, The Times-Picayune/Nola.com, 5/3/12

Update: Accessing Nursing Services for Children on Medicaid, Pushing the Envelope: AC News in Brief, 5/11/12

Disabled residents, state reach preliminary deal, The Advocate, 5/17/12

Disabled in New Orleans continue to wait for taxi changes, New Orleans City Business, 5/30/12

Bayou Health to Include Waiver Recipients, Pushing the Envelope: AC News in Brief, 7/10/12

Medicaid Expansion Vital for Louisiana, Pushing the Envelope: AC News in Brief, 7/11/12

Update: Accessing Nursing Services for Children on Medicaid, Pushing the Envelope: AC News in Brief, 7/11/12

Take Action: Speak Up About the Needs of People with Disabilities After a Disaster, Pushing the Envelope: AC News in Brief, 7/13/12

Disability Coalition to Hold Seat at LA Emergency Operations Center, Pushing the Envelope: AC News in Brief, 8/17/12

Advocacy Center wants medical specialist access to Angola death-row inmates, records, The Republic, 8/21/12

Advocacy Center petitions for access to Angola inmates, records, The Times-Picayune/Nola.com, 8/21/12

Group petitions for access at Angola, The Advocate, 8/21/12

3. PSAs/Videos aired - 0

4. Hits on the PAIR/P&A Website - 1,615,451, Visitors - 72,032

5. Publications/booklets/brochures distributed - 15639

10 Steps to Being an Effective Advocate - 151 Abuse & Neglect of the Elderly - 123 Abuse & Neglect flyer - 221 Age Discrimination in Employment - 414 Bayou Health Basics - 2196 Bayou Health Eligibility - 399 Choosing a Contractor - 145 Choosing a Nursing Home - 320 Employment Rights Booklet - 431 Fair Housing Fact Sheet - 98 Fair Housing, People with Disabilities & Other Protected Classes…for landlords - 196 Fair Housing, People with Disabilities & Other Protected Classes…for landlords (Spanish) - 104 Fair Housing: Accommodations & Modifications of Private Rental Housing - 163 Investigations of Serious Abuse & Neglect - 107 Legal Status in Louisiana - 4750 Legislative Advocacy - 70 Living Wills - 729 Medicaid - 649 PAIR - 71 Representation: Procuration and Mandate: Power of Attorney - 923 Rights of Students with Disabilities in Special Education - 1413 Services for People with Physical Disabilities - 342 Students with Disabilities and Higher Education: Rights and Responsibilities - 267 Education Is For All Students - A Guide for Parents - 1357

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)55
2. Additional individuals served during the year74
3. Total individuals served (lines A1 + A2)129
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)5

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 48

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility9
2. Employment2
3. Program access4
4. Housing8
5. Government benefits/services5
6. Transportation2
7. Education7
8. Assistive technology0
9. Voting0
10. Health care83
11. Insurance0
12. Non-government services3
13. Privacy rights4
14. Access to records0
15. Abuse4
16. Neglect4
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor51
2. Other representation found0
3. Individual withdrew complaint7
4. Appeals unsuccessful2
5. PAIR Services not needed due to individual's death, relocation etc.6
6. PAIR withdrew from case5
7. PAIR unable to take case because of lack of resources1
8. Individual case lacks legal merit12
9. Other1

Please explain

Individual lacked capacity.

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-advocacy3
2. Short-term assistance33
3. Investigation/monitoring6
4. Negotiation13
5. Mediation/alternative dispute resolution0
6. Administrative hearings22
7. Litigation (including class actions)8
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 - 5978
4. 60 - 6410
5. 65 and over39

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females73
2. Males56

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race3
2. American Indian or Alaskan Native0
3. Asian2
4. Black or African American60
5. Native Hawaiian or Other Pacific Islander0
6. White62
7. Two or more races0
8. Race/ethnicity unknown2

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent90
2. Parental or other family home13
3. Community residential home1
4. Foster care0
5. Nursing home23
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center2
9. Homeless0
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 impairment15
2. Deaf/hard of hearing3
3. Deaf-blind0
4. Orthopedic impairment45
5. Mental illness1
6. Substance abuse1
7. Mental retardation0
8. Learning disability0
9. Neurological impairment18
10. Respiratory impairment5
11. Heart/other circulatory impairment18
12. Muscular/skeletal impairment16
13. Speech impairment0
14. AIDS/HIV4
15. Traumatic brain injury3
16. Other disability0

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities7

2. Number of individuals potentially impacted by policy changes96,000

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.

1. Objective: Ensure that fixed route and paratransit transportation in New Orleans is compliant with the ADA by periodically testing usage of the RTA and fixed route systems, by attending quarterly RTA Board meetings, and through participation on the RTA Special Transit Services Committee. Result: Advocacy Center staff regularly attended meetings of the Regional Transit Authority Board of Directors, and Special Transit Services committee. Staff advocated for additional funds for on-demand paratransit services, as increased demand led to delays for passengers. The city agreed to an additional $600,000 for this service.

AC staff continues to monitor fixed route and paratransit systems. Issues include failure to properly secure wheelchairs and failure to stop for passengers in wheelchairs. These issues are regularly reported to city officials. After one recent complaint, the driver was disciplined and re-trained.

AC staff continues to monitor removal of barriers on sidewalks that parallel the Loyola Streetcar Project. AC staff had several discussions with the City Office of Public Works concerning specific locations along the Loyola Streetcar route where uplifted sidewalk panels, the absence of sidewalk drainage grates and other barriers exist. This monitoring will continue in FY 2013.

Case Example: There were no individual cases related to this objective.

2. Objective: Pursue corridors of accessibility through the French Quarter.

Result: In preparation for the Superbowl in New Orleans, work on accessible corridors throughout the French Quarter has been progressing rapidly. In 2012, Advocacy Center staff met numerous times with the Vieux Carre commission, which governs historic preservation in the French Quarter. Vieux Carre commission members agreed to support the installation of curb cuts. The project has been expanded to 8 corridors of accessibility from the original 5. The project is expected to be completed in early 2013.

In addition, AC staff have been working to increase corridors of accessibility in other areas of New Orleans, especially near the museums and convention center.

Case Example: There were no individual cases related to this objective.

3. Objective: Monitor and provide input into new Medicaid managed care initiatives.

Result: Advocacy Center developed informational flyers on the new Medicaid managed care initiative and distributed them via mail, email, the Internet and to targeted disability groups. Staff also conducted targeted outreach via meetings with disability groups and individuals with disabilities. Staff met with representatives of several managed care agencies and attended public forums on the transition. Advocacy Center staff obtained a number of state records via a public records act request. Staff reviewed this information and identified several issues to further investigate including proper and understandable notices to individuals and providers and the prior authorization process.

Case Example: There were no individual cases related to this objective.

4. Objective: Pursue accessible taxicabs in the City of New Orleans.

Result: Accessible taxicabs disappeared from the New Orleans landscape after the floods of Hurricane Katrina. Finally, after years of effort, the city of New Orleans is poised to make accessible taxicabs once again available to residents and visitors with disabilities. Advocacy Center staff have been working with elected officials, regional transit authority and the Bureau of Taxicabs to ensure accessible taxicabs are part of a large-scale taxi reform effort. An AC staff member was involved in the evaluation of various accessible taxicabs to ensure the opinions of people with disabilities were included. Staff were also involved with the development of ordinances governing the use of accessible cabs and prioritization of people with disabilities. Despite numerous setbacks and opposition related to other parts of the taxicab reform efforts, accessible taxicabs should be available to New Orleans residents and visitors in early 2013.

Case Example: Potential visitors to New Orleans regularly contact the Advocacy Center to inquire about accessible transportation. Accessible taxicabs will increase the accessibility of the city for residents and visitors.

5. Objective: Monitor proposed cuts to Capitol Area Transit Services (CATS), which provides fixed route and paratransit services in Baton Rouge. Monitor services for people with disabilities in the fixed route and paratransit systems.

Result: Advocacy Center staff monitored efforts to pass the CATS tax (to designate a specific millage to fund CATS) and encouraged people with disabilities to become more involved in advocacy to protect and increase funding for this service. Staff also educated elected officials and the general public about the importance of CATS for people with disabilities.

An Advocacy Center staff member regularly monitored the CATS system and notified CATS and elected officials of the problems. These included operators failure to follow ADA requirements and properly use accessibility equipment. Other issues involved access to accessible bus shelter and general maintenance of accessibility features of buses, bus stops and shelters.

Case Example: There were no individual cases related to this objective.

6. Objective: Pursue additional protections for students with disabilities against bullying.

Result: The Advocacy Center, in conjunction with a number of groups representing people with disabilities, civil rights leaders and educators, pursued legislative changes to ensure all students are protected against bullying. SB 674 (now Act 861) passed in the 2012 legislative session. While not as expansive as hoped, this legislation offers additional protections for students with disabilities and requires schools to track and report on incidents of bullying.

Case Example: At the legislative hearing, one parent spoke very eloquently about her child’s experiences in school and the need for teachers to help keep him safe. When implemented, this legislation should offer additional protections to her child and all children with disabilities.

7. Objective: Oppose the authorization of additional nursing home beds, as the occupancy rate in nursing homes in Louisiana is significantly higher than the national average.

Result: Legislation to allow additional nursing home beds did not move forward.

Case example: There were no individual cases related to this objective.

8. Objective: Advocate for accessible streetcars on the St. Charles Streetcar line in New Orleans.

Result: Staff continues to advocate for accessible streetcars for the historic St. Charles Streetcar line. After many years of advocacy, it appears that this project is finally moving forward. Meetings were held with preservationist groups (such as the State Historic Preservation Office, the local Historic Landmark Commission and the president of the St. Charles Avenue Residents’ Association) and RTA Planning and Maintenance staff. Advocacy will continue in FY 2013.

Case example: There were no individual cases related to this objective.

9. Objective: Ensure people with disabilities have access to the emergency transportable housing, such as the FEMA trailers, that they need by outlining the need for such in the United States Access Board’s accessibility guidelines.

Result: The Advocacy Center submitted comments on the US Access Board’s proposed guidelines for emergency transportable housing, often used after a disaster. These comments outlined concerns regarding the minimum number of accessible units required and accessibility of kitchen sinks and faucets. The final regulations have not yet been issued.

Case Example: As Hurricane Katrina clearly demonstrated, people with disabilities can have difficulty accessing emergency transportable housing after a disaster. This activity seeks to prevent these issues in the future. There were no individual case examples related to this objective.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts46,000
2. Number of individuals named in class actions6

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.

1. Objective: Ensure the Mahalia Jackson Theater for the Performing Arts in New Orleans is compliant with accessibility laws. Result: As of 9/30/12, accessible seating areas were completed in accordance with the settlement agreement. Other modifications to remove barriers to accessibility (e.g., lowered ticket counters and improved access to back-stage areas) are in progress.

Case Example: Accessibility modifications to seating at the Mahalia Jackson Theater have been completed. Our client, a man who uses a wheelchair, is now able to access accessible seating at a variety of price points. Since this case was settled, we have received several emails from individuals with disabilities who are excited to attend the theater now that it is accessible.

2. Objective: Ensure that sidewalks in the City of Mansfield are accessible through monitoring of the settlement agreement in Rankin v. City of Mansfield.

Result: The Advocacy Center continues to negotiate with the City of Mansfield regarding sidewalk accessibility. As the city completes improvements to its water system, it adds curb cuts to sidewalks. Recent inspections have been positive. Though not all items have been corrected, the city appears to be making substantial progress, and is entering into a contract for sidewalk improvements with DOTD. The Advocacy Center will continue to monitor these improvements.

Case Example: An individual with physical disabilities who could not access the sidewalks in Mansfield is the plaintiff in this case.

3. Objective: Monitor cuts that DHH may impose on home and community based services and be prepared to challenge any cuts that violate consumers’ rights under the ADA and the Rehabilitation Act to receive services in the most integrated setting.

Result: Additional information on this objective is provided in Priority 2 below.

Case Example: See Priority 2 below.

4. Objective: Ensure people who are deaf receive necessary accommodations when seeking a commercial truck driver’s license.

Result: Attempts to negotiate with the Louisiana Department of Transportation were unsuccessful and AC staff are moving forward with discovery, in preparation for a possible trial.

Case Example: Our client is a 32-year-old man who is deaf and wants to work as a commercial truck driver. The Louisiana Department of Transportation has so far refused to provide him with an interpreter for the testing process.

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.

(1.1) Statement of Priority: Ensure that people with disabilities and seniors have access to government services, private businesses and other public accommodations and housing.

(1.2) Need Addressed: People with disabilities often face discriminatory practices by both public and private entities that deny them access to services and full use of buildings

(1.3) Description of Activities:

• Represent 25 individuals only where the issue is egregious, involves a critical need, has widespread impact, or involves access to government programs and services, access to places of public accommodation or housing The Advocacy Center represented 39 individuals in FY 2012.

• Provide training on access issues to at least five groups

The Advocacy Center provided training to two groups on access issues in FY 2012: Including Disability in Disaster Planning Louisiana Style, Webinar with participants from across the US with over 100 participants and Disability and Technology for Biomedical Engineering Students, New Orleans with 30 participants.

• Address systemic and policy issues through membership on the New Orleans Mayor’s Advisory Council on Disability Issues

Advocacy Center staff regularly attended meetings of the New Orleans Mayor’s Advisory Council. This year, the group addressed the city’s policy regarding parking meter fees for individuals with disabilities, accessible taxicabs, and the development of an ADA transition plan for the city.

• Ensure that fixed route and paratransit transportation in New Orleans is compliant with the ADA by periodically testing usage of the RTA and fixed route systems, by attending quarterly RTA Board meetings, and through participation on the RTA Special Transit Services Committee.

See the section on systemic activities above for additional information on this objective.

• Pursue corridors of accessibility through the French Quarter.

See the section on systemic activities above for additional information on this objective.

• Ensure the Mahalia Jackson Theater for the Performing Arts in New Orleans is compliant with accessibility laws via pursuit of Matthews case.

See the section on litigation activities above for additional information on this objective.

• Ensure that the athletic facilities at Southern University are complaint with accessibility laws via pursuit of Eames case.

This lawsuit was ended after our client decided he no longer wished to pursue the litigation. He had numerous and significant health problems and has since passed away.

• Ensure that sidewalks in the City of Mansfield are accessible through monitoring of the settlement agreement in Rankin v. City of Mansfield.

See the section on litigation activities above for additional information on this objective.

(1.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: As noted above, the Advocacy Center collaborated with the Vieux Carre commission, Regional Transit Authority, New Orleans Mayor’s Commission on Disability and local officials in efforts to increase accessibility. In addition, a number of disability groups including the Multiple Sclerosis Society, Louisiana Rehabilitation Services, Lighthouse for the Blind, Deaf Action Center and NO AIDS Task Force service on the New Orleans Mayor’s Commission on Disability.

(1.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: We handled 39 cases under this priority. Two were class actions.

(1.6) Provide at least one case summary that demonstrates the impact of the priority:

Ms. K, a young lady with Chron’s Disease, heart disease, and other disabilities, contacted the Advocacy Center for help with housing. Due to flare-ups in her symptoms over several months, the client was unable to keep appointments with the housing authority in order to be recertification for her Section 8 voucher. She informed the housing authority of the reasons she had been unable to make recertification meetings and provided ample medical documentation, but her voucher was terminated. The AC attorney intervened on her behalf, arguing for her need for accommodations. Ms. K’s voucher was reinstated and back payments made to her landlord, avoiding both the loss of the voucher and eviction.

(2.1) Statement of Priority: Insure that people with disabilities can live in the most integrated environment appropriate to their needs

(2.2) Need Addressed: People with disabilities continue to be discriminated against through the provision of services that are needlessly restrictive.

(2.3) Description of Activities:

• Train at least five groups about rights under the ADA and other state and federal laws that guarantee rights to people with disabilities

Due to funding cuts and the loss of two attorneys in FY 2012, Advocacy Center staff did not conduct any training in this area.

• Ensure that people with disabilities are able to live as independently as possible by advocating for increased hours under the LT·PCS program via the Pitts lawsuit.

In FY 2012, the Pitts lawsuit was settled. This lawsuit was brought on behalf of people with disabilities in the long-term personal care services (LTPCS) program who are at risk of nursing home placement. As part of the settlement negotiations, the Department of Health and Hospitals created a process for LT-PCS recipients receiving the maximum number of hours to request expedited access to the Community Choice Waiver Program. The Settlement Agreement extended that option to additional class members, were receiving more than 32 hours when the new cap was adopted, but were subsequently approved for less than 32 hours. DHH mailed written notices to all persons affected by the settlement that will explain how to request assistance.

Additionally, Advocacy Center attorneys negotiated changes to a problematic voicemail system that class members use to request expedited waiver slots and the right to appeal denials of expedited slots.

In the 2012 legislative session, 500 additional Community Choices waiver slots were funded, after compelling testimony from people on the waiting list, organized with support from Advocacy Center staff. This was reduced to 150 slots after an unexpected budget deficit. Advocacy Center staff will continue to encourage DHH and the legislature to fund the additional 350 slots in 2013.

(2.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: In the case involving long term personal care services described above, the Advocacy Center collaborated with Steven Gold and the AARP Foundation.

(2.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: The Advocacy Center handled one class action case under this priority.

(2.6) Provide at least one case summary that demonstrates the impact of the priority: EMS contacted the Advocacy Center to request assistance when her in-home services were threatened with a drastic reduction from 38 hours per week to 22 hours per week. Approximately six months prior to the client calling, the Advocacy Center had filed a class action lawsuit (Pitts v. Greenstein) for people similarly situated. With help from the Advocacy Center, using the remedy provided in the lawsuit, Ms. S was able to obtain an expedited HCBS Waiver. She is now is receiving approximately 50 hours per week in services and has a personal emergency response system available in case of an emergency.

(3.1) Statement of Priority: Ensure that people with disabilities and seniors receive the medical care, community supports and other public benefits to which they are entitled by law.

(3.2) Need Addressed: Medicaid and Medicare programs often fail to provide necessary services so that persons with disabilities who choose to do so can reside in home and community-based settings. Persons with disabilities are often denied needed medical services.

(3.3) Description of Activities:

• Represent 125 people in matters related to denial of Medicaid eligibility, reduction or termination of Home and Community Based Services (excluding health and safety or failure to cooperate) and issues around Managed Care.

The Advocacy Center represented 61 people in the areas denial of Medicaid eligibility, reduction or termination of Home and Community Based Services (excluding health and safety or failure to cooperate) and issues around Managed Care.

• Train at least five groups on issues related to Medicaid services

Due to funding cuts and the loss of two attorneys in FY 2012, Advocacy Center staff did not conduct any training in this area.

• Address policy issues through membership on the Home and Community Based Services Re-Design Group

The Home and Community Based Services Redesign Group did not meet in 2011-2012.

• Monitor cuts that DHH may impose on home-based and community-based services and be prepared to challenge any cuts that violate consumers’ rights under the ADA and the Rehabilitation Act to receive services in the most integrated setting.

The Advocacy Center continues to monitor the state’s budget process as it impacts home and community based services for people with physical disabilities. Except as outlined above in the Pitts lawsuit, the Department of Health and Hospitals has not implemented additional cuts in services for people with physical disabilities. Throughout the year, there have been discussions regarding adding service recipients to the Medicaid managed care initiative. The Advocacy Center has encouraged the state to allow the individuals to opt in to the Medicaid managed care program if they choose, rather that forcing them to enroll or requiring them to opt out. Monitoring will continue in FY 2013.

• Monitor and provide input into the implementation of the new Medicaid managed care initiative. Negotiate and take other appropriate action.

See the section on systemic activities above for additional information.

• Continue to monitor the Division of Administrative Law (DAL) and obtain procedures that grant reasonable accommodations, are compliant with federal Medicaid guidance, and deal appropriately with unrepresented appellants. Collaborate with other issue groups, as appropriate.

The Advocacy Center continues to monitor the DAL’s procedures for reasonable accommodations and provides individual representation to clients in the appeals process. Staff collaborated with other issues groups and are prepared to take action if an individual is unable to obtain reasonable accommodations as needed.

• Develop and begin to implement a plan to ensure that DHH adheres to a medical improvement standard so that benefits will not be reduced or terminated unless there is evidence that the individual has actually improved, (across the board cuts are excluded).

Advocacy Center staff continued to monitor the termination and reduction of benefits for individuals to ensure DHH is adhering to a medical improvement standard. The issue is being researched to insure staff is ready to take action on this issue when individual cases arise.

• Do preliminary research into a possible challenge of Medicaid’s physician visit limitation.

Advocacy Center staff researched the issue in preparation for filing a federal court case challenging a 15-visit limit on community physicians. Advocacy Center attorneys assisted one client with diabetes and a number of other medical problems in an institution. Because she had reached the limit, her staff and state official suggested that this limit might pose a barrier to community placement. After reviewing the law, it appeared to be a difficult, but possible, challenge under Medicaid, but the combination of filing the case as an ADA-Olmstead/ Medicaid case made the arguments even stronger. As it turned out, however, before the Advocacy Center took legal action, the client was able to move into the community. The 15-visit limit did not result in her being denied any services. At this point the issue is moot, although Advocacy Center staff are prepared to address this issue in the future.

• Challenge Medicaid’s failure to provide recipients with notice of payment denials and prior authorization denials.

The Advocacy Center had one case in FY 2012 where notice was an issue. Client did not get adequate notice that payment would be denied. However before the Advocacy Center took legal action, the case resolved when service plan was developed to provide necessary medical services and client was placed in the community. (3.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: The Advocacy Center shared information regarding Medicaid managed care with a number of disability groups across the state including Families Helping Families, Lighthouse for the Blind, and the Deaf Action Centers.

(3.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: The Advocacy Center represented 61 people under this priority. None were class actions.

(3.6) Provide at least one case summary that demonstrates the impact of the priority:

Ms. V.C. is a 58-year-old woman with Charcot-Marie-Tooth Muscular Dystrophy, who lives in her own home. Ms. C. contacted Advocacy Center because she needed in-home-based personal care services through Medicaid in order to avoid nursing home placement. Advocacy Center staff investigated this issue, negotiated on behalf of Ms. C. and Medicaid granted her the Medicaid Waiver. Because of Advocacy Center’s intervention, Ms. C. now receives additional hours of in-home personal care services each week and continues to live in her own home and not in an institution.

Ms. P.S. is a 49 year-old woman with multiple sclerosis who lives in her own home. She contacted Advocacy Center because she needed more home-based Medicaid waiver services in order to avoid nursing home placement. Her requests for more services were being denied by the Medicaid agency. The Advocacy Center attorney negotiated with the Medicaid agency for Ms. S. to receive the maximum number of hours under the waiver. Advocacy Center then negotiated for Ms. S. to be able to employ her service workers directly, without a provider agency. By directing her own services, Ms. S. was able to receive even more service hours. Because of Advocacy Center’s intervention, Ms. S. continues to live in her own home and not in an institution.

(4.1) Statement of Priority: Ensure the rights of people living in select Louisiana psychiatric hospitals, developmental centers, adult residential facilities, and other residential facilities by providing high quality individual advocacy on issues that stand as barriers to integration in the community, full enjoyment of human and civil rights, and to the development of the individual’s full potential.

(4.2) Need Addressed: People who live in congregate settings are vulnerable to abuse, neglect and denial or rights

(4.3) Description of Activities: • Represent 50 people in legal and civil rights violations, (privacy; medication; property; discharges), unlawful use of restraint and seclusion, denial of, or failure to provide, necessary and appropriate services, programs and benefits, and in involuntary discharges from ICF/MR facilities and nursing homes.

The Advocacy Center represented 17 individuals under this priority.

In addition to the above goal, the Advocacy Center began advocating for prisoners on death row at Angola prison in FY 2012. In the summer of 2012, the Advocacy Center received a complaint that temperatures on the death row unit at Angola prison were excessive, often rising to over 100 degrees during the day. There is no air conditioning on the unit. Many of the men take medications, which place them at greater risk of death or serious injury due to the excessive heat. The prison refused access to Advocacy Center attorneys. The Advocacy Center filed suit and was able to negotiate access to the death row unit to monitor the temperatures in September 2012. This case is ongoing. Advocacy Center attorneys are negotiating a settlement agreement intended to resolve the issues in the complaint and prevent any issues regarding its access to the facility in the future. They are also continuing to investigate complaints of excessive heat.

(4.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: The case involving prisoners on death row is in collaboration with the Capital Appeals Project in New Orleans.

(4.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: The Advocacy Center represented 17 individuals under this priority. None were class actions.

(4.6) Provide at least one case summary that demonstrates the impact of the priority: Mr. H was a resident at a nursing home who received a notice of involuntary discharge alleging that he was endangering residents and staff. The Advocacy Center discussed the case with him, investigated the discharge and filed an appeal on Mr. H’s behalf. At the hearing, the Advocacy Center attorney argued on behalf of Mr. H and the judge dismissed the discharge. Mr. H. was able to remain in the nursing home he preferred.

(5.1) Statement of Priority: Ensure that people with disabilities and seniors are enabled and empowered to exercise their right to self-determination to the fullest extent of the law.

(5.2) Need Addressed: People with disabilities are often deemed to be incompetent to make choices

(5.3) Description of Activities: • Represent 15 people in POAs, living wills, representative payee issues related to representation of clients on other issues.

The Advocacy Center represented 12 people in these areas in 2011-2012.

• Train five groups in matters related to legal status

The Advocacy Center conducted 6 trainings related to legal status in 2011-2012. • Legal Status at the Brain Injury Association of LA state conference, 50 participants • Legal issues for seniors, Folsom, 14 participants • Legal issues for seniors, Covington, 50 participants • Powers of attorney and living wills, Covington, 25 participants • Powers of attorney and living wills, Mandeville, 23 participants • Powers of attorney and living wills, Mandeville, 46 participants

• Determine the efficacy of EPS and APS by a concerted systems advocacy approach.

The Advocacy Center requested and reviewed extensive documents regarding policies, procedures, numbers of complaints, complaints substantiated, judicial actions, and reports relating to performance from both Elderly Protective Services (EPS) and Adult Protective Services (APS). In April 2012, the state introduced legislation to combine EPS and APS into one office under the Department of Health and Hospitals, Office of Aging and Adult Services. The Advocacy Center supported this legislation, as the consolidation would increase efficiency and consistency in these offices. This legislation did not pass but the state moved forward with combining the offices as the budgets were combined. AC continues to monitor this transition.

(5.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: In pursuing this priority, the Advocacy Center collaborated with the state Office of Aging and Adult Services, Louisiana Guardianship Services, and AARP.

(5.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: The Advocacy Center represented 12 people under this priority. None were class actions.

(5.6) Provide at least one case summary that demonstrates the impact of the priority: Ms. R woman with Multiple Sclerosis contacted the Advocacy Center for help after she misplaced a copy of her living will and wanted to make sure that her end of life wishes were known by her family and doctors. The Advocacy Center attorney discussed the legal issues related to living wills with Ms. S to ensure she fully understood the document. The attorney also helped Ms. S to determine who should receive copies of the documents. The AC attorney then sent multiple copies of Ms. S’s living will to her, along with detailed instructions on how to execute the documents. Ms. S was able to complete the living will and ensure her family and doctors understand her end of life wishes.

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.

(1.1) Statement of Priority: Priority 1, Goal 1 — Community Integration: People are able to remain in their homes, with the provision of Medicaid Home and Community Based Services.

(1.2) Need(s) Addressed: • Historically, Louisiana has devoted the majority of its long-term care budget to institutional services: nursing homes, ICF’s/DD, and State psychiatric hospitals. • Over the last decade, LA has increased community-based options, but these options remain inadequate. • The criteria for awarding services in existing programs are complex and often overly restrictive, resulting in problems for people who try to use the system without the help of an advocate. • In the past two years, the state has attempted to effect budget cuts by reducing individual services without due process.

(1.3) Description of Activities: • Through the provision of TA and Direct Representation, obtain or preserve Medicaid funded HCBS for 15 PAIR eligible clients. • Review and comment upon rules, policies and practices relative to the Medicaid HCBS program. • Monitor compliance with settlement agreement in Pitts v. Greenstein to insure that people on LT-PCS who need more services receive expedited waiver offers.

(2.1) Statement of Priority: Priority 1, Goal 3 — Community Integration: People with disabilities have access to required health care through Bayou Health and Louisiana Behavioral Health Partnership (Magellan) Managed Care Programs.

(2.2) Need(s) Addressed: • Louisiana is rolling out managed care systems for both physical and behavioral health. • The systems are untested. We need to monitor access to quality services and advocate with the State in order to insure that people get what they need.

(2.3) Description of Activities: • Update or create one set of informational materials about changes to and/or rights related to Bayou Health. • Disseminate at least three bulletins, alerts, or other general informational materials about rights under Bayou Health and/or the Louisiana Behavioral Health Partnership. • Comment on proposed regulations regarding bringing additional populations within Bayou Health. • Conduct outreach to target population. • Assist at least 1 PAIR eligible client who contacts Intake with complaints about access to services through TA and direct representation. • Bring systemic flaws in the system to the attention of DHH with the goal of improving the system.

(3.1) Statement of Priority: Priority 1, Goal 4 — Community Integration: Elimination of barriers to exercising autonomy and living independently in the community.

(3.2) Need Addressed: • Individuals with disabilities often encounter barriers to living independently and autonomously that can only be addressed with legal assistance. These include: a Continuing Tutorship law that deprives them of rights based on improper criteria and without due process; overly restrictive or unnecessary interdictions; and illegal discrimination in critical benefits, services, and programs.

(3.3) Description of Activities: • Pursue litigation against Louisiana Office of Motor Vehicles to redress discrimination against deaf individual who sought commercial drivers’ license. • Through provision of direct representation, eliminate barriers to independence and autonomy (such as overly restrictive or unnecessary interdictions and illegal discrimination in critical benefits, services, and programs) for 13 eligible PAIR clients.

(5.1) Statement of Priority: Priority 4, Goal 3 — Rights Protection: Correct egregious conditions of neglect or abuse in prisons.

(5.2) Need(s) Addressed: • Adequacy of Funding • Prison Administration incompetence • Public indifference • Lack of oversight • Use of prisons as holding facilities for persons with disabilities due to lack of available community resources • PLRA (legal barrier) • Deference to prison officials (legal barrier)

(5.3) Description of Activities: • Initiate an investigation in one parish jail involving the rights of a prisoner to adequate treatment or the denial of other important civil rights.

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:

The primary source of funding for the PAIR program comes from the federal Section 509 grant, including carryover from the prior year:

Sources of funding amount received and spent

Source of Funding Amount Received Amount Spent Federal Funds $ 129,026 $ 129,026 (includes carryover) State Funds $0 $0 Program Income $ 118,255 $ 118,255 Private $0 $0 All other funds $0 $0 Total $ 247,281 $ 247,281

B. Budget for the fiscal year covered by this report:

The chart below provides a breakdown of the PAIR program budget for FY 2012, the period covered in this report. In general, the Advocacy Center’s budget is driven by staff hours as charged to its various programs. When Administrative and Support staff salaries are not charged directly, they are allocated among programs in a pro-rata share of total agency staff hours worked.

Category Budget FY 2012 Wages & Salaries $ 153,486 Fringe Benefits $ 35,687 Travel $ 5,839 Bonding/ Insurance $ 530 Materials/ Supplies $ 2,343 Postage $ 1,747 Duplicating $ 1,435 Rent $ 11,681 Telephone/Cell Phone/Internet $ 2,800 Legal Services $ 1,500 Services & Service Contracts $ 4,914 Equipment $ 1,480 Indirect Costs $ 0 Miscellaneous $ 4,167 TOTAL $ 227,609

C: Description of PAIR staff (duties and person-years):

The majority of time allotted to PAIR services in FY 2012 was spent providing representation to individual clients, systems advocacy, impact litigation, outreach and training and other agency support activities, including intake and I&R for those clients whose issues did not fall under case selection priorities.

The Advocacy Center organizes its professional staff by legal issues groups, whose members specialize in areas of law across multiple programs. No staff members are assigned solely to the PAIR program. Rather, of the full-time professional staff, each person spends a percentage of his time serving PAIR clients. Established issue groups which provide services to PAIR include: Institutional Rights, Financial Entitlements, Self Determination, and Access. Each group’s individual representation services parallel one of the PAIR program’s priorities, already described in this report.

The annual plan for PAIR estimates how much of the time each individual staff member will spend providing services to PAIR eligible clients. Staff time is then budgeted accordingly. These estimates are based upon prior year records and are adjusted to reflect expected increases or decreases resulting from changes to case selection priorities or new initiatives. On a daily basis, staff members record how their time was spent, allotting it to the programs for which their services were performed. Thus, all time spent providing individual representation to PAIR eligible clients is allotted to PAIR. The information is reported bi-weekly, and is compiled monthly to monitor how closely actual time spent tracks staff time budgeted. If necessary, adjustments are made during the year to insure that the hours budgeted under PAIR are not used at a rate that is significantly higher or lower than anticipated.

Professional staff include the following positions: Compliance Specialist, Client Advocates, Systems Advocacy Specialist, Legislative Support Specialist, Intake Supervisor, Legal Interns, Paralegals, Staff Attorneys, Supervising Attorneys, Managing Attorney, Director of Litigation, Director of Legal Services, Executive Director, and Director of Policy & Planning. Their duties include planning, managing, supervising and performing outreach, training, individual client representation, systems advocacy, and litigation on behalf of PAIR clients. Administrative Support or Clerical staff include the following positions: Director of External Relations, Executive Assistant, Chief Financial Officer, Systems Administrator, and Intake Specialists.

The Person-Year chart below was prepared by combining staff time for all employees who performed services under PAIR during the fiscal year. Positions filled for any fraction of the year are expressed as full-time equivalents. Positions filled throughout the year are expressed as person-years.

PAIR staff in Person-Years

Type of Position FT equivalent % of year position filled Person-years Professional full-time 1.8704 100% 18 Professional part-time 1.6519 100% 7 Professional Vacant 0 0 0 Clerical full-time 0.0374 100% 5 Clerical part-time 0 0 0 Clerical vacant 0 0 0 TOTALS 3.5597 100% 30

D: Involvement with advisory boards (if any):

N/A

E. Grievance filed under the grievance procedure:

There are 2 grievances to report. Both cases involve a denial of representation, one on the grounds that the issue is in a non priority area and the second because, after research, we determined that the case lacked merit. Both cases ended at the supervisor level.

F. 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:

The Client Assistance Program (CAP) is part of the P&A. The Long-Term Care Ombudsman Program (LTCOP), while not a part of the P&A, has a formal relationship with one of the attorneys on our staff who provides legal backup to the ombudsmen, statewide.

Certification

Signed?Yes
Signed ByLois V. Simpson
TitleExecutive Director
Signed Date12/20/2012