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

Delaware (COMMUNITY LEGAL AID SOCIETY,) - H240A130008 - FY2013

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 DirectorWilliam Dunne, 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 areas108
2. Individuals receiving I&R outside PAIR priority areas0
3. Total individuals receiving I&R (lines A1 + A2)108

B. Training Activities

1. Number of trainings presented by PAIR staff21
2. Number of individuals who attended training (approximate)2,051

Community Education Events FY13

The DLP Legal Advocacy Director gave a seminar at Widener University on October 18, 2012. The Advocacy Director trained attendees on monitoring poll sites on Election Day. There were 17 persons in attendance. Staff distributed 17 sets of materials. [12-1036768]

DLP staff gave a presentation at Horizon House Echo Center on October 31, 2012. Staff spoke to attendees about the ADA and voting rights. There were 10 persons in attendance and staff distributed 10 brochures containing information related to the PAIR program. [12-1037125]

DLP staff exhibited at the 2012 Community Mental Health Conference on November 17, 2012. Staff spoke to attendees about all DLP programs and services. There were approximately 250 persons in attendance. The DLP distributed an assortment of 190 brochures and pamphlets which contained information related to the PAIR program. [11-1033211]

The DLP Legal Advocacy Director gave a presentation for the Delaware State Bar Association (DSBA) on December 12, 2012. The Legal Advocacy Director spoke to attendees about Social Security Disability, disability law for disabled veterans, ethical issues when representing PWDs, and prohibiting discrimination on the basis of disability. There were 26 persons in attendance and the presentation was recorded for additional viewings. Staff distributed 26 sets of materials that contained information related to the PAIR program. [12-1036078]

The DLP served on the design team and exhibited at the LIFE Conference on January 17, 2013. Staff gave an overview of all DLP services. There were approximately 477 persons in attendance. Staff distributed an assortment of 327 brochures, pamphlets and booklets that included information related the PAIR program. [13-104526]

The DLP Project Director co-presented a seminar at the LIFE Conference on January 17, 2013. The Project Director presented on recently enacted state legislation in which he described legislation affecting parking, assistive technology, universal design in housing, employment and health insurance. There were 70 persons in attendance. There were 70 sets of materials distributed. [13-1045526]

DLP Senior Attorney co-presented a seminar at the LIFE Conference on January 17, 2013. The member presented on Medicaid Fair Hearing rights. There were 40 persons in attendance. There were 40 sets of materials distributed. [13-1036397]

The P&A and DATI co-sponsored the 6th annual “Disability Day in Legislative Hall” on January 16, 2013. The were approximately 200 persons in attendance and 200 sets of educational materials disseminated on several priority initiatives, including the following: family support waiver; seclusion and restraint legislation; accessible taxi service; TBI trust fund legislation; equal accommodations law reform; and accessible medical equipment.

DLP staff exhibited at the 2013 NAMI Conference on January 24, 2013. Staff spoke to attendees about all DLP programs and services including the PAIR program. There were 180 persons in attendance. Staff distributed an assortment of 102 brochures, pamphlets and booklets that contained PAIR related information. [13-1045499]

The DLP Legal Advocacy Director gave a presentation about disability rights at the Temple University School of Social Work on February 23, 2013. The Legal Advocacy Director spoke to attendees about the ADA and its impact for persons with disabilities in the areas of employment, fair housing and gaining access to appropriate services. There were 18 persons in attendance. There were 18 sets of materials distributed. [13-1045824]

DLP staff gave a presentation at the Parent Information Center on March 12, 2013. Staff spoke to attendees about all DLP programs and services including PAIR. There were 20 persons in attendance. No materials were distributed. [13-1046047]

The DLP Legal Advocacy Director gave a presentation at Widener University School of Law on March 20, 2013. The Advocacy Director spoke to attendees about disability law, institutionalization, and all DLP programs and services including the PAIR program. There were 15 persons in attendance. There were 15 sets of materials distributed. [13-1046112]

DLP staff gave a CLE at the Delaware State Bar Association on March 21, 2013. Staff spoke to attendees about education advocacy for students with disabilities and ethical issues. There were 30 persons in attendance. Staff distributed 30 sets of materials. [12-1045057]

The DLP Legal Advocacy Director gave a presentation at the NCMLP Summit on April 15, 2013. The Legal Advocacy Director spoke to attendees about medical-legal partnerships in social services context and gave an overview of all DLP programs. There were 100 persons in attendance. Staff distributed 100 sets of materials. [12-1045065]

The DLP exhibited at the 2013 Brain Injury Conference on April 5, 2013. There were approximately 200 persons in attendance. The DLP distributed an assortment of 140 brochures and pamphlets which contained PAIR related information. [13-1046478]

DLP staff presented a seminar at the 2013 Brain Injury Conference on April 5, 2013. The seminar covered Medicaid and the Medicaid DSHP+ program. There were 8 persons in attendance. The DLP distributed 8 sets of materials which contained PAIR related information. [13-1046361]

The DLP Legal Advocacy Director gave a presentation to the Widener University Disability Law class on April 17, 2013. Staff spoke to attendees about education law and public benefits. There were 15 persons in attendance. There were 15 sets of materials distributed. [13-1046180]

The DLP Legal Advocacy Director gave a presentation at CHIMES Delaware on April 26, 2013. The Legal Advocacy Director spoke to attendees about guardianship and gave an overview of DLP programs and services. There were 15 persons in attendance. Staff distributed 15 brochures. [13-1046099]

DLP staff exhibited at the PEER Empowerment Conference on May 10, 2013. Staff spoke to attendees about all DLP programs and services. There were approximately 250 persons in attendance. There was an assortment of 303 brochures distributed to attendees which contained information about the PAIR program. [13-1046875]

The DLP Project Director gave a legislative update presentation at the Center for Disabilities Study on June 16, 2013. The Project Director spoke to attendees about recent State legislation affecting persons with disabilities. There were 35 persons in attendance. There were 35 sets of materials distributed. [13-1047385]

DLP staff exhibited at the Independent Resources Incorporated Emergency Preparedness event on September 5, 2013. Staff spoke to attendees about DLP programs and services including the PABSS project. There were 75 persons in attendance. There was an assortment of 60 brochures distributed that contained information about the PAIR project.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles3
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website103,000
5. Publications/booklets/brochures disseminated1,721
6. Other (specify separately)0

Narrative

N/A

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 year50
3. Total individuals served (lines A1 + A2)96
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 46

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility9
2. Employment3
3. Program access1
4. Housing3
5. Government benefits/services47
6. Transportation4
7. Education1
8. Assistive technology0
9. Voting0
10. Health care9
11. Insurance5
12. Non-government services12
13. Privacy rights0
14. Access to records0
15. Abuse0
16. Neglect0
17. Other2

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor49
2. Other representation found1
3. Individual withdrew complaint0
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 merit0
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-advocacy5
2. Short-term assistance25
3. Investigation/monitoring4
4. Negotiation2
5. Mediation/alternative dispute resolution0
6. Administrative hearings14
7. Litigation (including class actions)0
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 - 221
3. 23 - 5973
4. 60 - 6411
5. 65 and over11

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females55
2. Males41

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American31
5. Native Hawaiian or Other Pacific Islander0
6. White63
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent78
2. Parental or other family home7
3. Community residential home2
4. Foster care0
5. Nursing home3
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center1
9. Homeless2
10. Other living arrangements3
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 impairment4
2. Deaf/hard of hearing4
3. Deaf-blind0
4. Orthopedic impairment44
5. Mental illness3
6. Substance abuse0
7. Mental retardation0
8. Learning disability1
9. Neurological impairment13
10. Respiratory impairment4
11. Heart/other circulatory impairment8
12. Muscular/skeletal impairment2
13. Speech impairment0
14. AIDS/HIV3
15. Traumatic brain injury1
16. Other disability9

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities165

2. Number of individuals potentially impacted by policy changes30,600

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 efforts0
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.

The DLP did not close any cases involving judicial level litigation in FY13 but did close several cases involving administrative hearings and conferences. The following are examples.

Administrative Agency Level Advocacy

Fifty six year old with terminal kidney disease was transferred from private nursing home to hospital. Nursing home then refused to allow return of patient when patient no longer needed acute care. Department of Health & Social Services solicited assistance from DLP. DLP represented patient in administrative hearing which was obviated on day of hearing when Department offered alternative long-term care setting. Patient resided in that setting until his death. [12-1037181]

Sixty-one year old with HIV and aspestosis had applied for long-term care Medicaid. His application had been denied in January but approved in April. DLP requested administrative hearing to contest January denial since client had amassed medical bills between January and April. Hearing officer acknowledged conflicting standards but ultimately upheld January denial of eligibility. [13-3045943]

Fifty-two year old was SSDI beneficiary based on orthopedic disability. The Social Security Administration (SSA) issued a termination notice based on earnings as "greeter" at Walmart and requested repayment of $26,956 in overpaid benefits. The DLP represented in conference with SSA representatives and prompted review of SSA decision. SSA recalculated earnings and reversed its earlier decision. SSA reinstated SSDI benefits and eliminated the entire $26,956 overpayment. [12-3036641]

Sixty-seven year old with cardiac impairment received $8,595 check from SSA during conversion from SSDI to retirement benefits. Client had questioned but received assurances from SSA staff that she could spend. Later, SSA determined issuance of check was in error and requested repayment. DLP represented in conference with SSA and secured waiver of entire overpayment. [12-1036339]

Fifty-three year old SSDI beneficiary based on orthopedic disability received notice of proposed SSDI termination and overpayment due to excess earnings. DLP assisted with appeal; represented in multiple conferences with SSA; and secured continuation of benefits, reduction of overpayment to $1,335, and benign repayment schedule of $50/month. [12-1035744]

Thirty-seven year old SSDI beneficiary had $4,653 overpayment due to excess earnings. DLP represented in multiple Social Security Administration conferences and secured a reduction in repayment schedule from $150/month to $30/month. [13-1046002]

Sixty year old with orthopedic impairments received notice of termination of SSI benefits and overpayment based on discovery of resources over SSI limit. DLP assessed and determined that client had received large sums from estate when parent died which justified termination and overpayment determination. SSA agreed to deduct $46/month from SSDI benefits to be applied to SSI overpayment. [12-1034547]

Fifty year old blind beneficiariy received notice of large ($72,252) SSDI overpayment due to earnings and withholding of entire check to pay for overpayment. DLP represented in SSA conference and prompted reduction of overpayment to $57,000 and reinstatement of pay status subject to $100/month repayment arrangement. [11-1032111]

DLP assisted sixty-six year old beneficiary with SSDI overpayment. DLP represented in multiple conferences with SSA and prompted suspension of $384/month repayment schedule pending consideration of waiver request. [13-1046280]

DLP assisted sixty-two year old SSDI beneficiary who had received notice of $19,000 overpayment due to earnings. DLP represented in SSA conference and benefits were reinstated pending review of complete earnings record. [11-1033369]

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, adoption of State standards conforming to federal law, and securing effective access to governmental programs and places of public accommodation by people with disabilities. As reflected in the PAIR FY13 Priorities, the outcome indicators for this objective were as follows:

a. As a result of DLP intervention, 40 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, Access Wilmington Committee, Victim Rights Task Force Disability Subcommittee, and Victims Compensation Assistance Program Council. A DLP senior paralegal served as chair of the State Rehabilitation Council. DLP staff were members of the other organizations.

Delaware utilizes a managed care system with MCOs to implement its Medicaid program. Most of the State’s 212,000 Medicaid enrollees participate in this system. Consumer organizations (Delaware Managed Care Panel; Delaware Family Voices) sponsor regular teleconferences to address issues arising within the system. A DLP attorney participates in the calls and provides on-going technical assistance.

The DLP routinely collaborated with the State Council for Persons with Disabilities (SCPD); Governor’s Advisory Council for Exceptional Citizens (GACEC), 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

Physical Access

Legislation (H.B. No. 129) was introduced to require DHSS to adopt regulations to ensure hospital staff have ready access to a locked hospital bathroom in the event of an emergency. The bill was prompted by the death of a 14 year old teen who experienced a medical emergency in a locked bathroom and died. The bill passed the House in June, 2013 and awaited action by the Senate. The DLP issued a critique in July, 2013 recommending endorsement of the concept underlying the bill. Further action on the legislation is expected in 2014.

Access to Health Care

Legislation (H.B. No. 89) was introduced to facilitate development of a rehabilitation hospital which had been delayed due to litigation. The DLP issued a critique recommending support for the initiative. The legislation was enacted and signed by the Governor on June 25, 2013.

Legislation (S.B. No. 35) was introduced to impose restrictions on private health insurers to facilitate access to "specialty-tier" drugs by policyholders. Such drugs are typically used to treat hemophilia, AIDS/HIV, cancer, and multiple sclerosis. The DLP issued a critique recommending endorsement. Multiple councils adopted the critique which was shared with policymakers. A substitute bill was enacted and signed by the Governor in July, 2013.

Legislation (S.B. No. 56) was introduced to expand the Medicaid program to cover adult dental services. The DLP issued a favorable critique which was adopted by multiple councils and shared with policymakers. The legislation was approved by a Senate Committee in June, 2013. Further action is impeded by a $6.2 million fiscal note.

Legislation (H.B. No. 42) was introduced to amend the list of relatives authorized to consent to medical care on behalf of some individuals without an advance health care directive. The DLP issued a lengthy analysis identifying several conflicts in the statutory scheme and recommending comprehensive legislation to resolve the conflicts. Multiple councils adopted the analysis which was shared with policymakers. The legislation was enacted and signed by the Governor on May 29, 2013. Leiglsation (H.B. No. 154) was introduced to facilitate training of healthcare providers in controlled substances and recognition of dependency. The legislation passed the House in June, 2013. The DLP issued a critique in July, 2013 identifying two (2) significant concerns. Further action on the legislation is expected in 2014.

The Division of Professional Regulation prepared draft legislation and regulations authorizing a new licensure category, speech language pathology assistants. The DLP issued a critique of the pre-publication bill and regulations which was shared with the Division in August, 2013. The critique identified six (6) concerns with the draft standards. A revised bill and set of regulations had not been issued by the end of FY13.

Delaware’s Victims Compensation Assistance Program (VCAP) funds remedial services (medical care; dental care) for victims of violent crime. The Attorney General’s Office proposed legislation to remove the authority of the VCAP Council to issue program regulations. The DLP negotiated amendments requiring advance review of proposed regulations by the Council and establishing the authority of the Council to issue its own annual report. The amendments were incorporated in the final legislation (H.B. No. 166) which was enacted and signed by the Governor on July 18, 2013.

Access to Adult Education

Legislation (S.B. No. 20) was introduced to address funding for an adult Department of Correction education program and authorize the State special education council (GACEC) to inspect and audit the program. The DLP issued a critique which identified several defects. Multiple councils adopted the critique which was shared with policymakers. The Legislature approved a lengthy amendment which corrected approximately six (6) defects identified by the DLP. The legislation, as amended, passed the Senate in June, 2013. House action is expected in 2014.

Access to Voting Process

Legislation (H.B. No. 20) was introduced to provide more flexibility in standards for voting with an absentee ballot. For example, the current statute allows use of an absentee ballot based on "sickness or physical disability" but omits any reference to "mental disability". The DLP issued a favorable analysis which was adopted by multiple councils and shared with policymakers. Unfortunately, the bill required a 2/3 vote for enactment and an April 16, 2013 House vote (27 "yes"; 14 "no") was one vote short of the standard.

Legislation (H.B. No. 18) was introduced to update Delaware statutory provisions regarding the confirmation of election results, including absentee ballots. The DLP issued a favorable analysis which was adopted by multiple councils and shared with policymakers. The bill was enacted and signed by the Governor on May 28, 2013.

Legislation (H.B. No. 105) was introduced to make Delaware the 12th state to allow Election Day registration. The change would facilitate voting by individuals with disabilities who face obstacles to registration due to institutionalization, lack of transportation, and variable health. The DLP issued a favorable analysis which was adopted by multiple councils and shared with policymakers. The bill was approved by the House Administration Committee in May, 2013. Further action on the bill is anticipated in 2014.

Legislation (H.B. No. 10) was introduced to eliminate a 5-year waiting period before eligible felons who have discharged their sentences can vote. Delaware law was more restrictive than laws in 38 other states. Many individuals with disabilities, particularly those with addictions correlated with drug possession convictions, would be affected. The DLP authored a favorable critique which was adopted by multiple councils and shared with policymakers. The legislation was enacted in May, 2013.

Legislation (SCR No. 20) was introduced to establish a task force to comprehensively review Delaware’s election code (which contains 32 chapters) and issue recommendations. The DLP prepared a favorable analysis which was adopted by multiple councils and shared with policymakers. The legislation was enacted in June, 2013.

Regulations and Policies

Physical Access & Accommodations

The Division of Long-term Care Residents Protection published a proposed regulation covering rest (residential) facilities. The DLP issued a critique which included recommendations on physical accessibility features. Multiple councils adopted the critique which was shared with the Division. The Division adopted a final regulation which incorporated changes prompted by the DLP commentary, including standards on the accessibility of doors and medicine cabinets and accommodations for individuals using wheelchairs. [16 DE Reg. 376 (October 1, 2012) (proposed); 16 DE Reg. 637 (December 1, 2012) (fnal)]

The Division of Social Services published a proposed regulation changing its case administration standards. The DLP issued a critique which identified several concerns, including a provision limiting access to policy manuals to physical sites despite a statute contemplating access through the Web. Web access is important to individuals with physical impairments for whom travel to a "bricks and mortar" site could be a hardship. Multiple councils adopted the critique which was shared with the Division. The Division adopted a final regulation incorporating five (5) amendments prompted by the commentary, including inclusion of a reference to a Web address to access policy information. [16 DE Reg. 927 (March 1, 2013) (proposed); 16 DE Reg. 1191 (May 1, 2013) (final)]

The Division of Social Services published a proposed regulation revising its standards for provision of interpreter services for non-English speaking individuals and persons with hearing impairments. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation incorporating seven (7) amendments prompted by the commentary. The most significant changes were expansion of the scope of eligible individuals beyond "clients" and explicit adoption of the ADA’s "effective communication" standard. [16 DE Reg. 605 (December 1, 2012) (proposed); 16 DE Reg. 869 (February 1 2013) (final)]

Access to Health Care

In FY12 the DLP had issued a critique of a proposed DMMA regulation covering expedited fair hearings to contest decisions in the Medicaid program. The DLP recommended two amendments to ensure prompt access to case records prior to hearing. In FY 13, the Division adopted a final regulation incorporating amendments to conform to both DLP recommendations. [16 DE Reg. 30 (July 1, 2012) (proposed); 16 DE Reg. 419 (October 1, 2012) (final)]

The Division of Medicaid and Medical Assistance published a proposed regulation to revise Medicaid payment rates for certain primary care services to conform to requirements in the Affordable Care Act. The DLP issued a favorable analysis which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation which conformed to the proposed version. [16 DE Reg. 921 (March 1, 2013) (proposed); 16 DE Reg. 1176 (May 1 2013) (final)]

The Division of Medicaid and Medical Assistance published a proposed regulation amending its Medicaid drug standards. The DLP issued a critique which questioned a 70% reduction in the annual doses of opioid analgesics available under the Medicaid program, particularly as applied to patients with certain forms of cancer. Multiple councils adopted the critique which was shared with the Division. The Division adopted a final regulation which conformed to the proposed version. The Division noted that the cap in opioids could be exceeded through an exceptions procedure. [16 DE Reg. 1028 (April 1, 2013) (proposed); 16 DE Reg. 1270 (June 1, 2013) (final)]

The Division of Medicaid and Medical Assistance published a proposed 61-page regulation renewing its Diamond State Health Program, its managed care system covering most Medicaid beneficiaries. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division. The DLP strongly objected to discontinuation of a public MCO and DMMA’s decision to not include the DLP as a source of free legal assistance in MCO notices. The Division adopted a final regulation with few changes. The Councils followed up with a letter to the Secretary of the Department of Health & Social Services criticizing the lack of information about free legal assistance in MCO notices. A response had not been received by the end of FY13. [16 DE Reg. 1140 (May 1, 2013) (proposed); 17 DE Reg. 225 (August 1, 2013) (final)]

The Division of Medicaid and Medical Assistance published a proposed regulation to conform to CMS standards implementing the Affordable Care Act. The DLP issued an analysis which identified two (2) contexts in which the proposed regulation were ostensibly inconsistent with CMS guidance. Multiple councils adopted the analysis which was shared with the Division. The Division had not adopted a final regulation by the end of FY13. [17 DE Reg. 282 (September 1, 2013) (proposed)]

The Division of Medicaid and Medical Assistance proposed to amend the Medicaid State Plan to conform to CMS guidance on drug manufacturer rebates. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. The Division had not adopted a final regulation by the end of FY13. [17 DE Reg. 285 (September 1, 2013) (proposed)]

The Division of Public Health published a proposed regulation covering medical facilities where invasive medical procedures are utilized. The DLP issued a critique which identified several defects. Multiple councils adopted the critique which was shared with the Division. Given the extent of defects, the Division did not adopt a final regulation. Instead, it published a revised proposed regulation in FY14. [16 DE Reg. 1033 (April 1, 2013) (proposed)]

The Division of Public Health published a proposed regulation amending the regulations covering Delaware’s medical trauma system. The DLP issued a critique which identified three (3) concerns. Multiple councils adopted the critique which was shared with the Division. The Division had not adopted a final regulation by the end of FY13. [17 DE Reg. 288 (September 1, 2013) (proposed)]

Access to Financial Benefits

In FY12, the DLP had issued a critique of a Division of Social Services proposed regulation modifying its emergency assistance program. The DLP critique had been adopted by multiple councils and shared with DSS. In FY13, the Division adopted a final regulation incorporating three (3) amendments prompted by the critique. However, the Division declined to add a recommended amendment to authorize home repairs to provide "accessibility". [16 DE Reg. 173 (August 1, 2012) (proposed); 16 DE Reg. 426 (October 1, 2012) (final)]

In FY12, the DLP had strongly opposed a plan to reduce participation in the General Assistance (GA) program. The program pays qualified individuals $95 per month and provides automatic Medicaid coverage to many unemployable adults with disabilities. The plan was deferred given opposition from the Legislature. In FY13, the Division proposed to repeal a 24-month cap on participation in GA. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation which eliminated the 24-month cap. [16 DE Reg. 378 (October 1, 2012) (proposed); 16 DE Reg. 642 (December 1, 2012) (final)]

A high percentage of adults with disabilities participate in the Food Supplement Program. See http://www.ehow.com/info_7956104_disabled veterans food stamps.html . Indeed, SSI beneficiaries are categorically eligible for the Food Supplement Program. See http://www.ssa.gov/policy/docs/ssb/v67n4/67n4p71.html . The Division of Social Services published a proposed regulation in the context of Food Supplement Program participant time limits for certain individuals. The DLP issued an analysis which included one recommended amendment. Multiple councils adopted the analysis which was shared with the Division. The Division adopted a final regulation which incorporated the amendment recommended by the DLP. [16 DE Reg. 1143 (May 1, 2013) (proposed); 17 DE Reg. 66 (July 1, 2013) (final)]

The DLP issued a negative critique of a proposed DSS regulation contemplating the elimination of a DSS identification card for participants in the Food Supplement Program. The DLP noted that the change could have a negative effect on some participants who have no other form of identification. Multiple councils adopted the DLP critique which was shared with the Division. The Division adopted a final regulation eliminating the identification card based on the rationale that it was never intended to be used as verification of identity. [16 DE Reg. 607 (December 1, 2012) (proposed); 16 DE Reg. 874 (February 1, 2013) (final)]

Access to Employment and Vocational Programs

The Division of Social Services published a proposed regulation to reduce penalties for non-compliance with TANF and Transitional Work Program (TWP) employment standards. Historically, a high percentage of individuals enrolled in TANF are persons with disabilities. See http://www.ssa.gov/policy/docs/ssb/v65n3/v65n3p14.html and http://www.urban.org/publications/411883.html . The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. DSS adopted a final regulation which conformed to the proposed version. [16 DE Reg. 379 (October 1, 2012) (proposed); 16 DE Reg. 643 (December 1, 2012) (final)]

The Division of Social Services maintains a child care subsidy program which facilitates the employment of individuals enrolled in the TANF program. The Division published a proposed regulation amending financial eligibility standards. The DLP issued a favorable critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation which conformed to the proposed version. [16 DE Reg. 609 (December, 1, 2012) (proposed); 16 DE Reg. 876 (February 1, 2013) (final)]

The Division of Social Services published a proposed regulation to eliminate its child care subsidy Purchase of Care Plus program. The DLP issued a critique which identified significant concerns with elimination of the program. Multiple councils shared the concerns with DSS which, in deference to the concerns, formally withdrew the regulatory initiative. [16 DE Reg. 603 (December 1, 2012) (proposed); 16 DE Reg. 987 (March 1, 2013) (final)]

The Division of Social Services published a proposed regulation modifying its child care subsidy program standards. The DLP issued a negative critique. For example, the amendments ostensibly eliminated eligibility of individuals with an Associates degree and deleted a provision confirming that the program is an entitlement for qualifying individuals. Multiple councils shared the negative critique with the Division. DSS adopted a final regulation which struck the Associates degree limit. [16 DE Reg. 717 (January 1, 2013) (proposed); 16 DE Reg. 990 (March 1, 2013) (final)]

The Division of Social Services published a proposed regulation modifying its child care subsidy program standards. The DLP issued a analysis which recommended two (2) amendments. Multiple councils adopted the analysis which was shared with the Division. The Division adopted a final regulation incorporating amendments conforming to both of the DLP’s recommendations. [16 DE Reg. 1043 (April 1, 2013) (proposed); 16 DE Reg. 1276 (June 1, 2013) (final)]

The Division of Social Services published a proposed regulation modifying key definitions in its child care subsidy program standards. The DLP issued a critique which identified several concerns. Multiple councils adopted the critique which was shared with the Division. A final regulation had not been adopted as of the end of FY13. [17 DE Reg. 289 (September 1, 2013) (proposed)]

County Park Accessibility

In FY12, the DLP had prompted New Castle County to install accessible portalavs in a large (300 acre) park to comply with ADA standards. In December, 2012, the DLP noted that two (2) of the accessible portalavs had been removed and submitted a complaint to the County. The contractor for the portalavs was replaced and accessible units were installed by the new contractor which remained in place throughout the balance of FY13.

Architectural Accessibility Board Reviews

A DLP Senior 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. The DLP participated in formal reviews of 117 sites. The AAB disapproved 44 sets of plans, prompting revision to ensure conformity with accessibility standards. Based on DLP referrals, the AAB had also notified the New Castle County Election Department of accessibility deficiencies at 5 polling sites at the end of FY12. In FY13 the DLP monitored corrective action at the sites.

5. Number of Cases - (75)

6. Case Summaries

a. Government Benefits

Fifty-two year old was SSDI beneficiary based on orthopedic disability. The Social Security Administration (SSA) issued a termination notice based on earnings as "greeter" at Walmart and requested repayment of $26,956 in overpaid benefits. The DLP represented in meeting with SSA representatives and prompted review of SSA decision. SSA recalculated earnings and reversed its earlier decision. SSA reinstated SSDI benefits and eliminated the entire $26,956 overpayment. [12-3036641]

Sixty-seven year old with cardiac impairment received $8,595 check from SSA during conversion from SSDI to retirement benefits. Client had questioned but received assurances from SSA staff that she could spend. Later, SSA determined issuance of check was in error and requested repayment. DLP represented in conference with SSA and secured waiver of entire overpayment. [12-1036339]

Fifty-three year old SSDI beneficiary based on orthopedic disability received notice of proposed SSDI termination and overpayment due to excess earnings. DLP assisted with appeal; represented in multiple conferences with SSA; and secured continuation of benefits, reduction of overpayment to $1,335, and benign repayment schedule of $50/month. [12-1035744]

Sixty-one year old with orthopedic impairments received notice of $1,499 SSI overpayment due to fluctuations in earnings. DLP had previously represented in context of other overpayments and stressed need to report earnings on monthly basis. Client had not reported earnings consistently. Given lack of eligibility for waiver, DLP provided technical assistance and client agreed to $10/month repayment arrangement. [12-1036485]

Fifty-three year old with orthopedic impairments received notice of SSI overpayment of $668 when client was hospitalized and in coma. DLP filed for waiver of entire overpayment which was approved. [12-1036890]

Forty-nine year old with cardiac impairments received notice of $63,677 SSDI overpyament attributable to excess earnings over a period of several years. The DLP represented in multiple conferences with the SSA but was ultimately unsuccessful in obtaining a waiver of the overpayment, in whole or in part. [06-1018770]

Sixty-three year old with orthopedic impairments received notice of $1,963 SSDI overpayment based on earnings in past. DLP represented in conferences with SSA, demonstrated that attribution of self-employment earnings was based on an IRS error, and secured a waiver of the entire overpayment. [12-1035358]

Fifty-three year old with orthopedic impairments received notice of $345 SSI overpayment based on deeming of spouse’s income. Client spoke only Spanish. DLP filed for administrative waiver which was granted. Entire overpayment was waived. [10-1030004]

DLP had previously secured reduction in claimed SSDI overpayment amount and low, $10/month repayment arrangement for sixty-two year old beneficiary. Later, SSA repayment center prompted notice of reduced benefits and increased monthly repayment amount. DLP represented in conference with SSA and obtained restoration of $10/month repayment arrangement. [12-1036024]

Forty-seven year old SSDI beneficiary with AIDS had $4,000 overpayment due to past earnings. The SSA was recouping from benefits at rate of $100/month resulting in financial hardship. The DLP represented in SSA conference, secured $10/month repayment arrangement, and obtained additional benefits for daughter. [12-1036291] Thirty-seven year old SSDI beneficiary had $4,653 overpayment due to excess earnings. DLP represented in multiple SA conferences and secured a reduction in repayment schedule from $150/month to $30/month. [13-1046002]

Sixty year old with orthopedic impairments received notice of termination of SSI benefits and overpayment based on discovery of resources over SSI limit. DLP assessed and determined that client had received large sums from estate when parent died which justified termination and overpayment determination. SSA agreed to deduct $46/month from SSDI benefits to be applied to SSI overpayment. [12-1034547]

Fifty year old blind beneficiariy received notice of large ($72,252) SSDI overpayment due to earnings and withholding of entire check to pay for overpayment. DLP represented in SSA conference and prompted reduction of overpayment to $57,000 and reinstatement of pay status subject to $100/month repayment arrangement. [11-1032111]

Fifty-one year old with mental disability had previously been advised by DLP to limit employment at current wages to 25 hours/week to maintain eligibility for SSDI. Beneficiary did not follow advice resulting in potential termination and overpayment. DLP assisted with reporting updated wages to facilitate decision by Social Security Administration. [12-1035146]

Forty-three year old who was Deaf received notice of $14,937 SSI overpayment. DLP assisted with submission of waiver request and represented in initial conference with SSA. However, client failed to maintain contact and $71/month repayment arrangement was implemented by SSA. [10-1028024]

Fifty-three year old SSDI/SSI beneficiary received notice of $2,455 SSI overpayment. DLP negotiated a benign $10/month repayment schedule. [12-1034498]

DLP assisted sixty-six year old beneficiary with SSDI overpayment. DLP represented in multiple conferences with SSA and prompted suspension of $384/month repayment schedule pending consideration of waiver request. [13-1046280]

DLP assisted sixty-two year old SSDI beneficiary who had received notice of $19,000 overpayment due to earnings. DLP represented in SSA conference and benefits were reinstated pending review of complete earnings record. [11-1033369]

Sixty year old with orthopedic impairments had amassed $39,051 overpayment of SSDI benefits due to unreported earnings. SSA had already denied waiver request and former beneficiary requested administrative hearing. DLP assessed merits and determined that there was an insufficient legal basis to justify representation in hearing. [13-1045155]

Fifty-four year old with orthopedic impairments wished to contest SSDI overpayment based on receipt of $8,890 check in 2000. Client claimed he never received check. The DLP acquired copy of cancelled check from SSA archives confirming client’s endorsement. The DLP also provided technical assistance on standards for requesting a waiver. [13-1046011]

Sixty year old SSDI beneficiary had also been representative payee of brother who died. The DLP assisted with submission of forms with SSA to request payment of balance of deceased brother’s benefits. [13-1046207]

Fifty-three year old with orthopedic impairments was SSDI beneficiary and representative payee for daughter turning 18. The DLP provided technical assistance on standards to continue as representative payee and payee eligibility for back benefit award earned while daughter was still minor. [13-1047407]

Fifty-three year old SSDI beneficiary questioned accuracy of benefit calculation. DLP assessed, determined that benefits were being reduced due to Workers Compensation offset, and confirmed accuracy of benefit calculation. [13-1045442]

Fifty year old with orthopedic impairments had been denied SSI based on deeming of wife’s income and resources. Client claimed that he and wife were separated, justifying disregard of her income. DLP represented in SSA conference and determined that client had been inconsistent in reporting co-habitation with spouse. DLP provided technical assistance, based on SSA guidance, that client could either submit proof of filing of divorce or notarized statement from spouse confirming separation and different address. [12-1045019]

Sixty-two year old beneficiary received SSI termination and overpayment notice from SSA. DLP assessed and determined that SSA decision was justified based on beneficiary’s transfer of assets for less than market value. DLP provided technical assistance and advice. [12-3034494]

Fifty year old with Lupus and orthopedic impairments received notice of termination of SSDI based on medical improvement. The DLP represented in administrative hearing resulting in reinstatement of eligibility. [12-2034091]

Forty year old with progressive multifocal leukoencephalopathy received Medicaid termination notice when her application for SSDI was approved and she became over-income for Medicaid. The DLP disagreed with determination, contacted administrator within Division of Medicaid & Medical Assistance, and prompted reinstatement of Medicaid under the Medical Transition to Medicare (MAT) program. [13-1046812]

Medicaid enrollment of fifty year old with brain tumor had been discontinued. DLP determined that client was elligiible under Medicaid Transition to Medicare (MAT) program and contacted Medicaid Director who prompted reinstatement under MAT. [11-1032520]

Sixty-one year old with HIV and aspestosis had applied for long-term care Medicaid. His application had been denied in January but approved in April. DLP requested administrative hearing to contest January denial since client had amassed medical bills between January and April. Hearing officer acknowledged conflicting standards but ultimately upheld January denial of eligibility. [13-3045943] Sixty nine year old with quadriplegia was receiving occupational and physical therapy. Therapy provider advised that coverage under Medicare and Medicaid was under review. The DLP provided technical assistance on eligibility for coverage of OT and PT under Medicare and Medicaid and offered assistance if client received actual notice of termination or reduction of services. [13-1047766]

Fifty-five year old SSDI beneficiary was subject to $87/month withholding for child support arrears. DLP assessed and determined that beneficiary had amassed $26,855 in arrears over a period of years when he made no payments despite court orders. The DLP advised beneficiary of limited options. [13-1046732]

Sixty-three year old Medicaid beneficiary with orthopedic impairments alleged that provider was fraudulently billing Medicaid for services she never received. DLP assessed and provider conceded that billing was due to error. DLP notified the State Division of Medicaid & Medical Assistance. [13-1045870]

Veterans Administration reduced the number of hours of private duty nursing provided to a fifty-six year old with quadriplegia who was ventilator dependent. DLP researched and determined that reduction conformed to applicable statutory standards. However, DLP also advised client of availability of exemption authorized by V.A Handbook. The DLP offered to pursue exemption but client did not opt to pursue further. [09-1026832]

Prison inmate with visual impairment requested information on categorical right to own cell based on disability and adapted eyeglasses. DLP assessed and provided technical assistance confirming no right to individual cell. Inmate was provided with adapted eyeglasses. [13-1047720]

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

Persons 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 FY13 Priorities, the outcome indicators for this objective were as follows:

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.

4. Collaborative Efforts

The DLP addressed transportation-related concerns through active participation in a DART paratransit advisory committee (EDTAC). The DLP also addressed transportation matters through participation in the State Council for Persons with Disabilities. The Council includes both a DLP representative and DART paratransit representative. Finally, the DLP is a member of the advisory committee to the State Medicaid transportation broker, Logisticare.

Legislation

The State Transition Task Force for Emerging Adults with Disabilities and Special Health Care Needs was established in June, 2012 through SCR 34. The legislation required the appointment of a DLP representative to the Task Force. The Task Force was divided into four committees, including one addressing transportation. A DLP staff attorney served on the Task Force during FY13 and facilitated preparation of a report to the Legislature. A draft of the report was completed in FY13 in anticipation of publication of the final version in October, 2013. Transportation recommendations included the following: fixed route and paratransit routes need to be better coordinated; transportation providers should be required to have a percentage of their fleet include accessible taxis and vans; fixed route bus stops and the pedestrian walkways to those bus stops should be accessible; and an impartial committee should be formed to monitor the implementation of the DelDOT Transition Plan.

In 2003, legislation (H.B. No. 172) had been enacted requiring local governments to adopt ordinances regarding signage on designated parking spaces for person with disabilities along with enforcement and penalty provisions. However, compliance was not uniform. The DLP supported an SCPD initiative to compile implementing ordinances. The SCPD solicited and acquired ordinances from 2 of 3 counties and 3 municipalities. A meeting with key legislators is planned in FY14 to assess options to enhance compliance with the State law.

Legislation (H.B. No. 155) was introduced in May, 2013 to ban operation of a motor vehicle while using "Google Glass", a wearable multi-function computer which is worn like eyeglasses with access to the Internet. The DLP prepared a critique which focused on the potential for distracted driving resulting in accident-related injuries. The critique was adopted by multiple councils and submitted to policymakers. The bill was approved by the House Public Safety and Homeland Security Committee on June 12, 2013 in anticipation of further action in FY14.

Regulations and Policies

At the end of FY12, the DLP prepared a lengthy critique of a draft DelDOT ADA Self-Assessment and Transition Plan which was adopted by the SCPD and shared with DelDOT. In FY13, DelDOT issued a revised draft plan which incorporated some changes prompted by the DLP critique. On September 3, 20013, the SCPD consulted the DLP and submitted conforming comments on the revised plan to DelDOT.

In FY12, the Delaware Dept. of Transportation (DelDOT) had proposed adoption of a new regulation covering its grievance system for external complaints involving the ADA and ’504. The DLP had issued a lengthy critique which identified some inconsistencies between the proposed regulation and Federal Highway Administration guidance. Multiple councils adopted the critique which was shared with DelDOT. In FY13, the DLP monitored developments but DelDOT failed to issue a final regulation. [16 DE Reg. 270 (9/1/12)(proposed)]

In September, 2013, DelDOT initiated a public relations campaign promoting an overhaul of the paratransit system. Public hearings were convened and a legislative hearing was scheduled for October 3, 2013 to review options. In September, 2013, the DLP prepared comments and recommendations for submission to DelDOT at the inception of FY14.

The Division of Medicaid and Medical Assistance (DMMA) contracts with a private firm, Logisticare, to serve as the broker/manager of transportation for the Medicaid program. However, no information was published on the availability of a grievance or complaint process involving the firm. The DLP filed multiple complaints with the DMMA customer relations unit in 2013 and followed up with a letter to the Medicaid Director in September, 2013 requesting the formal protocol for complaints. A response had not yet been received at the end of FY13.

As part of an NDRN nationwide assessment of the accessibility of the AMTRAK rail system, the DLP inspected the Newark, Delaware station and documented the lack of an accessible route between platforms. Results were included in NDRN report published in October, 2013. [13-1047748]

5. Number of Cases (4)

6. Case Summaries

Fifty-four year old with orthopedic impairments requested municipality to designate a dedicated accessible parking space near her home. Municipality declined to create space in front of residence but offered to create space on street next to residence. DLP negotiated with municipality to promote designation of space in front of residence. This effort was ultimately unsuccessful since municipality justified decision based on insufficient corner clearance in front of residence. Moreover, the side street space complied with the authorizing ordinance. [10-1028433]

Sixty-two year old with cardiac and pulmonary function impairments presented multiple concerns about past services from a Medicaid-funded transportation broker. The DLP obtained her records from the broker and assisted client with submission of complaint to Division of Medicaid & Medical Assistance customer relations unit. [12-1036929]

Forty-six year old with orthopedic and mobility impairments contacted DLP regarding transportation options. DLP provided guidance on paratransit eligiblity standards and application procedure. [13-1046829]

Trailer park had installed ramp for 47 year old mobile home tenant. Ramp was presently usable but tenant alleged that it was deteriorating. DLP agreed to assess but tenant failed to respond to subsequent DLP letters. [12-1037156]

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, persons 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 disabiilty 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 living settings; and acquisition of supports to facilitate successful community living. As reflected in the FY13 Priorities, the outcome indicators for this objective were as follows:

a. As a result of DLP intervention, 15 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

The DLP Project Director served on the State Council for Persons with Disabilities Housing Committee. However, the Committee convened no formal meetings during FY13.

The DLP addressed several bills, regulations, and policies affecting housing or reducing barriers to independent living. The following is a partial list. In most cases, the DLP collaborated with the State Council for Persons with Disabilities (SCPD); and the Governor’s Advisory Council for Exceptional Citizens (GACEC). The list also includes examples of collaboration with the AARP on some initiatives. Finally, the DLP participated in a State Transition Task Force (described below) which included 24 representatives from a wide variety of public and private agencies.

Legislation

Legislation (S.B. No. 143) was introduced which would affect patient rights in the context of long-term care facility transfer, discharge, and readmission. The DLP participated in a small legislative hearing with the prime sponsor and representatives from DHSS, multiple councils, and the nursing home industry. The DLP assisted with preparation of an amendment which was added to the bill. The amendment expanded protection for residents who leave a long-term care facility (including group home; foster home, and assisted living settings) for specialized care and wish to return to the long-term care facility. The amendment requires the facility to permit return or offer the next available opening. The legislation unanimously passed the Senate on June 27, 2013. House action is expected in 2014.

Legislation (S.B. No. 13) was introduced to address the transfer of the State’s Long-term Care Ombudsman to the Office of the DHSS Secretary. The DLP issued a critique which identified three (3) concerns, including an incorrect reference to witnessing of advance health care directives. Multiple councils shared the critique with policymakers resulting in introduction of a substitute bill (SS No. 1 for S.B. No. 13) which corrected two of the three concerns identified by the DLP. The legislation passed the Senate in April, 2013 and was approved by a House committee in May, 2013. A vote by the full House is expected in 2014.

State Transition Task Force for Emerging Adults with Disabilities and Special Health Care Needs was established in June, 2012 through SCR 34. The legislation required the appointment of a DLP representative to the Task Force. The Task Force was divided into four committees, including one addressing housing. A DLP staff attorney served on the Task Force during FY13 and facilitated preparation of a report to the Legislature. A draft of the report was completed in FY13 in anticipation of publication of the final version in October, 2013. Housing recommendations included the following: enactment of legislation to include "source of income" as a protected class under Delaware’s fair housing law; enactment of legislation to standardize building codes; and enactment of legislation to provide developer incentives to produce accessible units.

Regulations and Policies

In FY12, the Division of Medicaid and Medical Assistance (DMMA) initiated a new Program of All Inclusive Care for the Elderly (PACE). Eligibility was open to individuals at least 55 years of age with income below 25% of the SSDI Federal Benefit level. A combination of Medicaid and Medicare funds are used to pay a provider to cover all preventative, primary, acute, and long-term care services. CMS national statistics indicate that 7% of PACE enrollees live in nursing homes with the vast majority living in the community with supports. In August, 2012, the DLP had prepared a critique of proposed enrollment standards for the PACE program. The critique identified several concerns, including conflicting standards concerning eligibility, authorization to terminate participation for conduct that could be symptomatic of disability, and lack of appeal rights. Multiple councils had endorsed the critique and forwarded conforming comments to the Division with a copy to AARP. In FY13, the Division adopted a final regulation incorporating 3 amendments prompted by the commentary. The most important changes were clarification that an individual’s eligibility does not terminate upon admission to a long-term care facility and that the DMMA appeal regulation applies to the PACE program. [16 DE Reg. 170 (August 1, 2012) (proposed); 16 DE Reg. November 1, 2012 (final)]

The Division of Long-term Care Residents Protection (DLTCRP) solicited DLP input on draft amendments to regulations covering discharges and readmission to long-term care facilities. Long-term care facilities include group homes, foster homes, and assisted living settings. The DLP submitted an analysis which prompted several amendments to the prepublication draft. The Division then formally published a proposed regulation. The DLP issued a favorable critique recommending endorsement subject to 2 minor revisions. Multiple councils adopted the critique and submitted conforming commentary to the Division. However, the Division did not adopt a final regulation. Instead, it issued a second set of proposed regulations which would effect a complete revision of the existing standards as described below. [16 DE Reg. 710 (January 1, 2013) (proposed)]

The Division of Long-term Care Residents Protection issued a proposed regulation representing a complete revision of its standards covering long-term care facility transfers, discharges, and readmission. The DLP issued a critique identifying eleven concerns. Multiple councils adopted the critique and submitted conforming comments to the Division. In the meantime, the DLP, Division, and councils became involved with pending legislation (S.B. No. 143) which would affect the regulations. The Division therefore deferred action on the final regulations pending action on the legislation which passed the Senate but awaited House action at the end of FY13. [16 DE Reg. 1130 (May 1, 2013) (proposed)]

DMMA proposed an amendment to its Medicaid reimbursement standards for long-term care facilities. The DLP issued a favorable analysis of the standards which were intended to result in increased leveraging of federal funds and enhanced quality of care in affected facilities. Multiple councils adopted the DLP analysis and submitted an endorsement to DMMA. The Division acknowledged the endorsements and adopted a final regulation with no further changes. [16 DE Reg. 517 (November 1, 2012) (proposed); 16 DE Reg. 781 (January 1, 2013) (final)] In September, 2012, the Public Service Commission (PSC) solicited public input on a draft regulation to allow termination of residential electric service without an in-person visit to the residence. On September 20, 2012, the DLP had issued a highly negative critique of the proposal which would have placed individuals with disabilities at risk, especially those reliant on electricity for health reasons (e.g. oxygen dependent; electronic lift dependent; nebulizer dependent) and those with intellectual disabilities. Multiple councils endorsed the DLP critique and submitted conforming commentary to the PSC. The AARP also submitted a negative critique. In the face of the opposition, the PSC ostensibly abandoned the planned initiative. A formal proposed regulation was not issued during FY13.

Home health aides are an important support facilitating successful community living. The Division of Long-term Care Residents Protection issued proposed regulations covering background checks for home health agency employees. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation incorporating approximately 14 amendments prompted by the commentary. [16 DE Reg. 717 (January 1, 2013) (proposed); 16 DE Reg. 978 (March 1, 2013) (final)]

Private duty nursing (PDN) is an important support facilitating successful community living. In a prior reporting period, the DLP and councils had successfully negotiated with DMMA to adopt a less rigid approach to caps on PDN service hours. In FY13, DMMA responded to a DLP critique and proffered a new draft policy. In July, 2013, the DLP issued an analysis of the draft policy which included several recommendations. As of the end of FY13, the Division had not issued a revised draft.

The Division of Long-term Care Residents Protection published a proposed regulation amending its standards for certified nursing assistants (CNAs). CNAs provide important support services in long-term care facilities and are commonly employed as home health aides in the community. The DLP issued a critique identifying many technical defects in the proposed regulation. Multiple councils adopted the critique which was shared with the Division. The Division adopted a final regulation incorporating twenty-eight (28) amendments prompted by the critique. [16 DE Reg. 371 (October 1, 2012) (proposed); 16 DE Reg. 632 (December 1, 2012) (fjnal)]

The Division of Long-term Care Residents Protection issued proposed regulations covering background checks for long-term care facility employees. Long-term care facilities include group homes, foster homes, and assisted living settings. The DLP issued a lengthy critique which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation incorporating approximately 12 amendments prompted by the commentary. [16 DE Reg. 716 (January 1, 2013) (proposed); 16 DE Reg. 974 (March 1, 2013) (final)]

The Division of Long-term Care Residents Protection published a proposed regulation overhauling its standards for rest (residential) homes. The DLP issued a lengthy analysis which was adopted by multiple councils and shared with the Division. The Division adopted a final regulation incorporating ten (10) amendments prompted by the DLP analysis. [16 DE Reg. 376 (October 1, 2012) (proposed); 16 DE Reg. 637 (December 1, 2012) (final)]

The Division of Long-term Care Residents Protection published a proposed regulation to address emergency preparedness in assisted living settings. The DLP issued a critique recommending two (2) amendments. Multiple councils adopted the DLP’s critique which was shared with the Division. The Division adopted a final regulation incorporating both amendments suggested by the DLP. [16 DE Reg. 595 (December 1, 2012) (proposed); 16 DE Reg. 965 (February 1, 2013) (final]

The Division of Long-term Care Residents Protection published a proposed regulation to address emergency preparedness in nursing homes. The DLP issued a critique recommending two (2) amendments. Multiple councils adopted the DLP’s critique which was shared with the Division. The Division adopted a final regulation incorporating both amendments suggested by the DLP. [16 DE Reg. 592 (December 1, 2012) (proposed); 16 DE Reg. 861 (February 1, 2013) (final]

The Division of Medicaid and Medical Assistance proposed a "housekeeping" amendment to its long-term care Medicaid resource regulations to address an expired "disregard" of income tax refunds. The DLP issued a critique recommending endorsement which was adopted by multiple councils and shared with the Division. The Division acknowledged the endorsements and adopted a final regulation with no further changes. [16 DE Reg. 825 (February 1, 2013) (proposed); 16 DE Reg. 1077 (April 1, 2013) (final)]

The Division of Medicaid and Medical Assistance published a proposed regulation modifying the financial eligibility cap for long-term care eligibility. The DLP issued a critique recommending endorsement subject to amending the standard for equity value in a home. Multiple councils adopted the critique which was shared with the Division. The Division adopted a final regulation which incorporated the DLP’s suggested revision of equity value of a home verbatim. [16 DE Reg. 377 (October 1, 2012) (proposed); 16 DE Reg. 639 (December 1, 2012) (final)]

Legislation (H.B. No. 403) was enacted in 2012 to expand the role of the Division of Public Health in disease control and reporting to include long-term care facilities. The DLP issued a critique of proposed implementing regulations published by the Division. Multiple councils adopted the critique and submitted conforming comments to the Division. The Division adopted a final regulation incorporating six (6) amendments prompted by the commentary. [17 DE Reg. 1255 (June 1, 2013) (proposed); 17 DE Reg. 320 (September 1, 2013) (final)]

5. Number of Cases (3)

6. Case Summaries

Fifty-six year old SSI beneficiary received notice from landlord of rent and utility arrears. Representative payee was responsible for these payments. DLP assessed and representative payee brought account up-to-date and landlord waived late charges. Housing was preserved. [13-1047473]

Hospital planned to discharge twenty-two year old with paraplegia due to gunshot to shelter. Client had no wheelchair or support system. DLP facilitated discharge to rehabilitation facility as more appropriate setting to prepare client for transition back to community. [13-1047599] Fifty six year old with terminal kidney disease was transferred from private nursing home to hospital. Nursing home then refused to allow return of patient when patient no longer needed acute care. Department of Health & Social Services solicited assistance from DLP. DLP represented patient in administrative hearing which was obviated on day of hearing when Department offered alternative long-term care setting. Patient resided in that setting until his death. [12-1037181]

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 FY13 Priorities, the outcome indicators fo this objective were as follows:

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 15 powers of attorney, advance directives, and similar authorizing documents.

4. Collaborative Efforts

Consistent with PPR, Part 1, Section B, the DLP conducted 20 group training events. Collaborating agencies included the State Council for Persons with Disabilities, Department of Health & Social Services, and Center for Disabilities Studies.

Since State law requires the Long-term Care Ombudsman to witness execution of advance health care directives (AHCDS) by residents of long-term care facilities, the DLP often collaborated with the Ombudsman in finalizing such documents.

Finally, the DLP collaborated with multiple councils to promote autonomy in the context of maintenance and restoration of parental rights. Parents with disabilities are disproportionately subject to termination of parental rights (TPR). See University of Minnesota, "The Inclusion of Disability as Grounds for Termination of Parental Rights" in State Codes (2006), published at http://ici2.umn.edu/products/prb/172/default.html. Indeed , Delaware law includes a "mental incompetence" ground in its TPR statute. See Title 13 Del.C. ’1101. Legislation (H.B. No. 125) was introduced to authorize reinstatement of parental rights subsequent to termination. 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 August 6, 2013.

5. Number of Cases (12)

6. Case Summaries

DLP prepared power of attorney (POA) and advance health care directive for fifty-four year old with Parkinson’s Disease. Primary language was Spanish. Paralegal translated documents for client prior to execution. [13-1045653]

Fifty-eight year old with cancer contacted DLP regarding health care POA prior to imminent surgery. DLP recommended health care surrogacy as more appropriate option and provided information to request be included in medical record. [13-2047125]

DLP prepared a power of attorney (POA) and advance health care directive (AHCD) at request of fifty-five year old with AIDS. However, client did not respond to subsequent calls and letter to sign documents so case was closed. [13-1047036]

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 2014 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); and 7) Protection & Advocacy for Voting Access (PAVA)

This document defines the priorities for FY 2014 (October 1, 2013 - September 30, 2014) 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. ยง794e(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, 45 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 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. This priority also extends to promotion of effective constituent access to “safety-net” public benefit programs.

In the public sector, the DLP contemplates legal assistance to protect the rights of Medicaid beneficiaries, particularly those enrolled in the DSHP 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. The transition to a DSHP Plus system effective April, 2012 has significantly increased the number of Medicaid beneficiaries subject to MCO oversight. The DLP anticipates the provision of legal assistance to DSHP and DSHP Plus participants whose eligibility for services 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] characterized by low statewide enrollment (36 participants in May, 2013). The DLP will support legislation (S.B. No. 56) expanding access of adult Medicaid beneficiaries to acute and preventative dental services. 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; preservation of SSI/SSDI benefits through overpayment waivers or incremental repayment agreements). The DLP expects to deter constrictive enforcement of the Delaware Equal Accommodation law through both on-going litigation and collaboration with the SCPD on remedial legislation. The DLP will support implementation of recently enacted universal design legislation (H.S. No. 1 for H.B. No. 227) signed by the Governor in July, 2012. The DLP anticipates on-going advocacy to promote the accessibility of public parks and outdoor recreation sites. The DLP envisions support for pending legislation (H.B. No. 129) covering hospital bathroom access. Finally, a DLP senior staff attorney will address accessibility of public buildings through participation in the Architectural Review Board and assist with implementation of polling site accessibility legislation drafted by the DLP and enacted in 2011.

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); ADAPT] 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; supporting legislative initiative to promote availability of accessible taxi service; and enhancing pedestrian travel through barrier removal (e.g. curb cuts). The DLP envisions collaborating with the DelDOT ADA Coordinator to promote conformity with the ADA in DelDOT programs. Since many long-term injuries are transportation-related, the DLP also envisions supporting safety related legislation and regulations, including pending H.B. No. 155 deterring distracted driving. 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, 10 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 educate policymakers on the merits of pending legislation (H.B. No. 196) barring discrimination in housing based on source of income. 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 support of DHSS efforts to offer community-based options to residents of long-term care facilities. 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. In concert with the SCPD, the DLP anticipates continuing advocacy to promote development and implementation of procedural safeguards for residents of long-term care facilities facing involuntary discharge, including enactment of DLP co-authored S.B. No. 143. In conjunction with the Delaware Guardianship Commission, the DLP will assess options to reduce a prevalent bias towards institutional placement of wards. 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 15 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, 2012 - September, 2013

Federal (section 509) Amount Received $166,132— FY 2013 funds Amount Spent $164,588.91 —FY 2013 funds

State 0 Program Income 0 Private 0 All other funds 0 Total (from all sources) $166,132 Total Spent S164,588.91

B. Budget for FY 13

Category Current Fiscal Year Budget

Wages/salaries $99,356.98

Fringe benefits (medical, dental ,FICA, unemployment, etc. $48,332.76

Materials/supplies $1,345.74

Postage $473.85

Telephone $2,748.33

Occupancy (Rent, Utilities, Bldg & Grounds Maintenance)$6,633.91

Travel/Training $616.01

Membership dues $796.07

Bonding/Insurance $1,326.78

Equipment (rental/purchase) $1,421.55

Litigation Costs $284.31 Contractual (Payroll, Audit, Law Library on-line) $2,700.95

Miscellaneous $94.77

Total Budget $164,588.91

C. Description of PAIR staff - October 2012 - September 2013

Type of Position

Professional Full-time 1.48 % of year filled 100% Persons-years 1.48

Part-time 0 Vacant 0 Clerical Full-time .29 % of year filled 100% Person-years .29

Part-time 0 Vacant 0

The PAIR positions for Fiscal Year 2013, October 2012 - September 2013, included the Sr. Project Director and the Deputy Legal Advocacy Director, 9 attorneys, 5 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 FTE Disabilities Law Program Sr. Project Director 4.86% Disabilities Law Program Legal Adv Director 3.91% Executive Director 4.00% C.F.O 4.00% Accountant 4.00% Network Administrator 4.00%

Attorneys New Castle County 1 Senior Attorney 43.61% New Castle County 3 Attorneys 0.96% Kent County 2 Attorney 0.26% Sussex County 1 Senior Attorney 11.07% Sussex County 1 Managing Attorney 0.21%

Paralegal New Castle County 3 Paralegals 41.15% Kent County Paralegal 12.89% Sussex County Paralegal 13.06%

Clerical Staff Administrative Assistant 12.85% Legal Secretary New Castle County 1 Legal Secretary 4.00% 1Intake Receptionist 4.00% Kent Count 1 Legal Secretary 4.00% Sussex County 1 Office Manager/Legal Secretary 4.00%

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 FY13 the Council met on November 7, 2012; January 30, 2013; May 1, 2013; and July 17, 2013. The membership includes both consumer and agency representative, 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.

E. Grievances Filed

There were no grievances filed during the fiscal year.

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

The DLP maintains a positive relationship with both the CAP and Long-term Care Ombudsman. 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.

The State’s HCBS 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.

Certification

Signed?Yes
Signed ByBrian Hartman
TitleProject Director
Signed Date12/11/2013