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

Idaho (DisAbility Rights Idaho, Inc.) - H240A140013 - FY2014

General Information

Designated Agency Identification

NameDisability Rights Idaho, Inc.
Address4477 Emerald Street
Address Line 2Suite B-100
CityBoise
StateIdaho
Zip Code83706
E-mail Addressinfo@disabilityrightsidaho.org
Website Addresshttp://disabilityrightsidaho.org
Phone208-336-5353
TTY 208-336-5353
Toll-free Phone866-262-3462
Toll-free TTY866-262-3462
Fax208-336-5396
Name of P&A Executive DirectorJames R Baugh
Name of PAIR Director/CoordinatorAngela Eandi
Person to contact regarding reportAngela Eandi
Contact Person phone208-336-5353
Ext.113

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 areas64
2. Individuals receiving I&R outside PAIR priority areas340
3. Total individuals receiving I&R (lines A1 + A2)404

B. Training Activities

1. Number of trainings presented by PAIR staff37
2. Number of individuals who attended training (approximate)864

A Power Point presentation was developed by the P&A Executive Director (E.D.) explaining the impact of Medicaid expansion (renamed Idaho Medicaid redesign) would have in Idaho. This presentation explained how this proposal will result in major changes in Idaho’s health care financing system for people who cannot address the cost of health care, including mental health care. The presentation reviewed the five components for Medicaid redesign/expansion; and provided statistics on the money that Idaho would save within the next ten (10) years and educates about the current Medicaid eligibility standards showing that, contrary to popular belief, is not available to all low-income families. Information on the impact that it would have for Idahoans with disabilities, especially the 10,000 Idahoans with serious and persistent mental illness who currently having no access to mental health services due to Idaho’s broken mental health system was also provided. Eleven variations of this training were presented to two (2) legislative committees, the Governor’s Medicaid Redesign Committee and at eight (8) public forums and workshops statewide reaching approximately 300 people.

The P&A provided a three (3) hour self-advocacy 101 trainings titled Awareness Becoming Action at the Treasure Valley Deaf Forum to 66 attendees, more than half of whom were deaf or hard of hearing and to family members of people who are deaf or hard of hearing. Purpose of the training was to teach people in the deaf and hard of hearing community about their rights under the ADA and how to speak up for what they need in their personal, professional and civic life which included how to advocate for accommodations, including Communication Access Real-time Translation CART and Video Relay Service (VRS) under the Americans with Disabilities Act with doctors’ and lawyers offices. Evaluation forms were disseminated and collected requesting input on information provided and suggestions for training improvement.

The P&A provided (4) trainings at the Tools for Life conference: Self-Advocacy Guide to Guardianships to students, parents, an attorney, a Vocational Rehabilitation counselor and a special education teacher providing information on guardianship processes, less restrictive alternatives and information on changing or removing guardianships/conservatorships. Packets were provided to 17 students which included the P&A developed Self-Advocacy Manual providing information on the DD guardianship processes, court hearing processes, important definitions and an Idaho DD Act guardianship petition form to request a change or termination: Voting rights training providing rights protections information, accessible voting options and hands on training on the AutoMARK ballot marking device to 23 students parents and providers; Transition from School to Work giving information to parents and students moving from school to post-school activities, with focus on obtaining and maintaining employment through coordinated services and fostering interagency collaboration to approximately 65 students and parents; and Social Security Work Incentives training providing information about this program and how you can work and retain or maintain some benefits while working and/or becoming self-sufficient to 12 parents and 22 students. PP were developed for each training given in lecture format. Evaluations were provided and collected requesting input and suggestions for improvement.

The Transition from School to Work training was also provided at a high school to 34 students. Evaluations for input and suggestion of improvement were provided and collected.

The P&A facilitated three (3) IDVOTE 2014 Community Voter Training for Trainers workshops providing hands-on training to 30 community members in Moscow, Boise and Pocatello. The primary goals of these workshops were to teach people with disabilities and the general electorate how to help others through the election process. Participants committed to provide at least one (1) training within their organization or community regarding voter rights and access. Participants were trained how to use the information received to train others within their own agencies and communities. Participants gained real life experience related to voting rights and access with an emphasis on hands on training related to accessible voting technologies. Participating agencies/organizations: Idaho Council on Developmental Disabilities (ICDD), two (2) centers for independent living (CILs), University of Idaho Center on Disabilities and Human Development/Idaho Assistive Technology Project (CDHD/IATP), Pocatello League of Women Voters (LWV), Idaho Catholic Charities, the Idaho Self-Advocate Leadership Network (SALN), Disability Action Center-Northwest, the Community Council of Idaho and the Northwest ADA Training Center-Idaho. More than two-thirds of participants identified as having a disability.

Thirteen Voter Rights trainings were provided to I97 persons with disabilities, on voter rights and accessible options, including hands-on training of the AutoMARK ballot marking device), 87 of those trained were transition aged students/adults who also received information about P&A CAP, PABSS and WIPA services as well as brochures with P&A contact information. Trainings were provided at schools, developmental disabilities centers and facilities. Participants were told to contact the P&A if any barriers to accessing needed services, benefits or barriers to employment arose. The previous power point (PP) training was revised with current updates and given in lecture format. Packets of information including registration forms, important election dates and copies of the PP presentation and evaluation forms were provided and collected requesting input and suggestions for improvement.

Employment discrimination training was provided in lecture format to Approximately 50 members of a multiple sclerosis society support group. Information about the ADA, Section 504 and the Idaho Human Rights Act legal protections against disability discrimination were explained. Information about the P&A and its services was also provided. Evaluations were provided for input and suggestions.

The P&A Executive Director, Legal Director and Advocacy Director conducted orientation training to 16 members of the PAIMI Advisory Council and the P&A Board of Directors. This training provided information about the grants that the P&A operates including PAIMI, the role of the Council and the Board and their advisory capacities as well as the P&A’s roles and responsibilities. Information on its current fiscal priorities, its priority development process and how it determines assistance was also explained. At the Spring Board meeting, the Advocacy Director presented a report on the number and types of service requests that had been received so far in FY2014, informing members about current disability issues and emerging systemic issues. She also reported on the progress that has been made on the FY2014 objectives.

The P&A provided a training to six members of a regional Keeping Children Safe Child Protection Services (CPS) Citizen’s Panel providing information on the P&A and its services and how it can assist children in foster care. Training on services available for children with disabilities accessing Medicaid, special education, children’s mental health, assistive technology (AT) devices, and social security benefits were also provided.

P&A advocates and attorneys developed Power Point presentations and conducted internal staff training to 17 P&A staff on the following topics: ADA/504 and the Idaho Human Rights Act on federal and state law protections for individuals with service animals; P&A standards; Social Security eligibility and emerging FY 2014 issues; Client Assistance Program (CAP) services and FY2014 emerging issues; Social Security Work Incentives; Specific Lethal Available Proximity (SLAP) Assessments training to better identify persons who may be at risk of suicide to determine when appropriate to contact authorities to conduct wellness checks; Senior services; Legal Case Building for non-attorneys and new legal staff; Idaho Medicaid, Medicaid Expansion legislative advocacy and emerging issues for FY 2014; Abuse and Neglect investigation training including P&A access authority review, when P&A can and can’t disclose requested client records; monitoring in facilities strategies; Sheltered Workshop P&A outreach strategies; Advocacy strategies addressing rights violations in facilities; employment disability discrimination rights; and Assistive Technology Advocacy.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles0
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website7,204
5. Publications/booklets/brochures disseminated9,070
6. Other (specify separately)4,265

Narrative

1) Facebook-total audience reached on Page "likes"661. Additionally, the P&A blog, written by our Executive Director and linked from our website, had 2, 3014 hits.

Blog articles posted:

Idaho Medicaid Redesign: Promoting Independence for People with Disabilities-The P&A Executive Director (E.D.) drafted and posted on his blog an article advocating for Medicaid expansion legislation which explained the changes that wold result in Idaho’s health care financing system for people who cannot afford the cost of health care, including mental health care.

Community Supported Employment - H476- The E.D. drafted and posted on his blog an article discussing the benefits of this bill which would allow HCBS waiver recipients to increase their service budget if the modification is needed to obtain or maintain employment by accessing Community Supported Employment HCBS Waiver Services.

Supported Employment Opportunities Open Up for People with Disabilities in Idaho- After H476 was passed, E.D. drafted an article and posted on his blog discussing the class action court decision, the recent State law change, and informing that this waiver service is also available to Aged and Disabled (A&D) Waiver recipients as well as those on the Developmental Disabilities Waiver.

E.D. posted an article from the National Disabilities Rights Network (NDRN) entitled "Shocking Behavioral Therapy - The Safety and Effectiveness of Using Electric Shock Devices for Behavior Management" and requested comments for those that have experienced this awful practice.

2) The P&A distributed 1300 ID Vote newsletters (10 were provided in plain text versions & forwarded through the Idaho Commission for the Blind and Visually Impaired); and Two (2) Braille copies were provided).

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)8
2. Additional individuals served during the year86
3. Total individuals served (lines A1 + A2)94
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)2

B. Individuals served as of September 30

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

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment1
3. Program access2
4. Housing0
5. Government benefits/services73
6. Transportation1
7. Education0
8. Assistive technology2
9. Voting1
10. Health care9
11. Insurance0
12. Non-government services2
13. Privacy rights0
14. Access to records0
15. Abuse1
16. Neglect3
17. Other1

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor0
2. Other representation found80
3. Individual withdrew complaint1
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case5
7. PAIR unable to take case because of lack of resources4
8. Individual case lacks legal merit3
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-advocacy79
2. Short-term assistance9
3. Investigation/monitoring0
4. Negotiation2
5. Mediation/alternative dispute resolution0
6. Administrative hearings3
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 - 223
3. 23 - 5977
4. 60 - 6410
5. 65 and over4

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females49
2. Males45

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race12
2. American Indian or Alaskan Native2
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White78
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent72
2. Parental or other family home11
3. Community residential home1
4. Foster care0
5. Nursing home1
6. Public institutional living arrangement0
7. Private institutional living arrangement1
8. Jail/prison/detention center3
9. Homeless5
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment5
2. Deaf/hard of hearing3
3. Deaf-blind0
4. Orthopedic impairment26
5. Mental illness7
6. Substance abuse0
7. Mental retardation1
8. Learning disability2
9. Neurological impairment9
10. Respiratory impairment6
11. Heart/other circulatory impairment2
12. Muscular/skeletal impairment24
13. Speech impairment0
14. AIDS/HIV1
15. Traumatic brain injury0
16. Other disability8

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities6

2. Number of individuals potentially impacted by policy changes99,901

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

1) During FY2013, the P&A advocated for a bill to restore dental care for adults receiving enhanced Medicaid services which includes all HCBS waiver recipients. Even though the bill was held by the House committee chair in 2013, he promised to introduce and support a similar bill during the 2014 legislative session. The bill was introduced and the P&A E.D. provided information to the legislative committees on the serious harmful effects of a lack of dental coverage for Idahoans with disabilities, especially people taking prescription drugs, including psychotropic medications, which increase the risk of dental diseases. OUTCOME: The Legislature passed a bill restoring Medicaid dental coverage for adults with disabilities and chronic health conditions. This legislation potentially impacts 11,358 HCBS waiver recipients receiving enhanced Medicaid services, according to statistics received from the IDHW Public Records Coordinator.

2) Limits previously set on individual adult developmental disabilities (DD) service budgets have significantly decreased access to community supported employment (CSE) Waiver services. The P&A Executive Director (E.D.) developed a position paper on the problem and provided information about it to legislators and other policy makers. He provided information to the legislators on this issue in the Joint Finance Committee "listening sessions" and in committee hearings. OUTCOME: The Legislature passed a bill removing the budget limitation for CSE. This legislation potentially impacts approximately 3,500 DD waiver recipients. This data was reported by the Art Evans, the IDHW Developmental Disabilities Bureau Chief to the Idaho Council on Developmental Disabilities (ICDD).

3) Even though CSE waiver services are available under both the Idaho DD waiver and A&D waiver, the P&A identified systemic issues for A&D waiver recipients trying to access CSE while providing individual case work during FY2014. While assisting an A&D waiver recipient in accessing CSE so he could work, IDHW informed the P&A that not only have they never approved anyone for CSE on the A&D waiver since they had been added several years ago, they didn’t even have a Medicaid billing code. The P&A contacted appropriate IDHW administrative heads with this concern. A billing code has now been assigned so Medicaid can be billed by providers for this service. IDHW informed the advocate that they will provide training to its regional Medicaid offices so they will process requests for CSE waiver services. The P&A has also informed several community CSE providers that not only can these waiver services be accessed under the DD waiver, but also can be provided under the A&D waiver. The P&A is monitoring this issue to determine if access is occurring as indicated by IDHW. The P&A E.D. also published an article and disseminated on the P&As blog about CSE services, the bill that removed budget limits, and that CSE can be accessed under both waivers. This can potentially impact 7,858 A&D waiver participants. This data was provided from the DHW Public Records Coordinator.

4) The P&A E.D. collaborated with the Partners in Crisis Coalition and CID to support funding for mental health crisis centers which is a the only resource for persons experiencing a mental health crisis to access services if uninsured. These coalitions also were successful in opposing bills limiting indigent county medical care which is the only funding source that pays for persons experiencing mental health crises that result in mental holds. NAMI of Idaho 2010 state statistics reports that there are nearly 10,000 Idahoans with a serious mental illness that are uninsured and who also don’t qualify for mental health services from IDHW Division of Mental Health.

5) After a bill was introduced requiring a physician’s order to use handcuffs or shackles when law enforcement personnel transport people with mental illness from one treatment center to another, the P&A E.D. was the only person to testify in support of the bill. The Restraint of People with Mental Illness bill passed the House committee without dissent, and passed the House overwhelmingly. The P&A E.D. and others testified in support of the bill in the Senate H&W committee. There were 5,096 people placed on mental holds during 2014 according to data from the IDHW Division of Behavioral Health.

6) The P&A was successful in getting the two largest school districts in Idaho to formally revise their service animal policies so they are in accordance with the Americans with Disabilities Act (ADA) while representing two clients:

P&A staff attorney represented a 12 year old boy with autism and anxiety disorder denied access to his service animal from the Boise School District, the 2nd largest district in Idaho. During this representation, the P&A also determined that the district’s service animal policy was not in compliance with the Americans with Disabilities Act (ADA) as it allowed for school employees to demand documentation such as vaccination records, and required individuals, such as the client, to make a written request to the superintendent’s office ten business days before bringing the animal to school or a school function. P&A staff attorney represented the client in meetings and negotiations resulting in the school agreeing that he could be accompanied by his service animal at West Junior High during the 2014-2015 school year. In addition to representing the client, the P&A attorney also addressed the out of compliance service animal policies by filing complaints with both the Office of Civil Rights (OCR) and the Department of Justice (DOJ) alleging violations of Title II of the ADA; and a complaint with the State Dept of Education, alleging violations of Individuals with Disabilities Education Act (IDEA). As a result of client’s OCR and DOJ complaints, the Boise School District agreed to modify its service animal policy so that it would be in accordance with the ADA. The policy was officially approved and passed by the school board of trustees on August 11, 2014, creating positive policy change in the second largest school district within the State of Idaho.

The P&A staff attorney also represented an 18 year old female with anxiety and PTSD, who had just completed her senior year of high school at Meridian High School, the largest district in the state, in response to the school’s denial of her right to be accompanied by her service animal during her graduation ceremony. The district told her that in order for her to be accompanied by her service animal for graduation ceremonies she would need to have the dog officially certified. During this representation the P&A determined that this district’s service animal policy also violated ADA requirements. Initially, the P&A provided information and guidance on her right to be accompanied by a service animal under Title II of the ADA as well as information on how to file complaints with the State Dept. of Education and the Office for Civil Rights for the US Dept of Education (OCR). Client filed both complaints on her own resulting in an OCR investigation. OCR also contacted the P&A requesting help with the investigation, which was provided. The P&A represented the client at meetings with the district resulting in her being allowed to attend all school-sponsored graduation events and activities with her service animal, including the ceremony itself. As a result of client’s OCR complaint and the P&As collaboration with OCR, the school district also agreed to modify its service animal policy so that it would be in accordance with the ADA. The policy was officially approved and passed by the school board of trustees on May 13, 2014.

These systemic policy changes potentially impacts 36,111 students enrolled in Meridian (west Ada) Joint District and 25,978 students enrolled in the Boise School District. Enrollment statistics for these two districts were located from the SED 2013-2014 enrollment data.

7) The P&A opened a case on behalf of the man, aged 62, diagnosed with dementia and mental illness and funded under PAIMI to investigate allegations that he had been beaten with a pipe by his certified family home (CFH) provider who had been criminally charged. During its investigation, the P&A determined that there was probable cause suspecting abuse and neglect (A&N) of all of the residents, seven in addition to its client: three men and four women, all diagnosed with dementia and physical impairments and ranging in age from 60 to 90. They were residing in two CFHS on the same property operated by two owners. The eight residents had been removed temporarily pending investigations and criminal proceedings. Due to a lack of PAIR funding, the P&A has been unable to open individual cases for the other residents, but opened a systemic PAIR Abuse case and continued its investigation in addition to the investigation for its PAIMI client. The State Licensing and Certification (L&C) agency informed the P&A that since the owners appealed its revocation of their certifications and because the abuse for the residents had not yet been substantiated by L&C , the residents may be returned to these two homes. During its investigation, the P&A has learned that L&C had previously revoked then reinstated these CFHs certifications. The P&A also discovered that the owners operated without a certification for almost a year.

The P&A has collaborated with the county prosecutor and coroner and Adult Protection Services (APS). Unfortunately the criminal charges of abuse and assault were dismissed because the client with dementia and mental illness was not allowed to testify. To prevent the return of the residents to these CFHs, the P&A sent a letter to L&C regarding its investigation stating that probable cause of abuse and neglect had been established on behalf of the eight residents from reports received from the residents and staff. This abuse includes sexual assault, physical injury, being forced to work “at the farm”, financial exploitation and theft by the providers also acting as SSA representative payees. Presently none of the residents have been returned, the owner’s certification has been revoked and these two CFHs are not in operation. Even though one owner was acquitted of charges of abuse, further charges of financial exploitation of a vulnerable adult for an amount over $1,000.00 and grand theft has been recently filed due to the P&A involvement. A hearing has since been set on the new charges. The P&A is now focusing on further establishing abuse and neglect of the residents that were removed in its efforts to ensure that these CFHs are not allowed to operate again and to bring about systemic change with the state L&C Agency so the CFH residents are more adequately protected from A&N. This systemic case has been carried over to FY2015. This case is discussed in further detail in the Part V of this report.

8) The P&A worked extensively in getting a Medicaid expansion (renamed Medicaid redesign) bill passed in Idaho so that more low income families and persons with disabilities have access to health care coverage and needed Medicaid paid services. The E.D. provided information and drafted a presentation at the request of the "Governor’s Work Group on Medicaid Redesign" regarding disability related issues in their work on Medicaid expansion. He participated with the health care provider and “Close the Gap" coalitions, providing information to include disability related issues in their work on Medicaid expansion, especially the 10,000 people with serious and persistent mental illness who currently have no coverage and few state services. He participated with the Consortium for Idahoans with Disabilities (CID) and ICDD in formulating a position on Medicaid expansion. The E.D. testified at the Legislative Joint Finance Committee "listening session” informing how Medicaid redesign will impact Idahoans that need adequate health care access as well as save Idaho almost a half a billion dollars over the next ten years. He prepared and delivered a PowerPoint presentation on the impact of Medicaid expansion on Idahoans with disabilities throughout the state and posted a blog to educate on this need. OUTCOME: A bill implementing Medicaid expansion was introduced, but the committee voted not to print it. Efforts for promoting Medicaid expansion and educating law makers will continue through the FY 2015.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts7,668
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 P&A has four current cases (but no class actions) involving litigation, all carry over cases to FY2015. Summaries provided below:

1) The P&A has been appointed to act as guardian on behalf of a 59 year old woman with mental and developmental disabilities who currently resides in her own home in Boise, Idaho. After her father passed away, a guardianship and conservatorship proceeding was initiated pursuant to the wishes of his will. As a result of these proceedings, a P&A attorney was appointed as GAL for client. A conservatorship for the client was established, appointing a local bank to become her conservator, later replaced by a local trust company. Her father’s friend, M.D., and client’s sister, became co-guardians of client. Client’s sister (Co-Guardian) expressed concerns that both the co-guardian/M.D. and the trust company were charging too many “fees” such as “trustee” fees or “conservator fees” and “guardian reimbursement fees,” without any justification for how those fees were incurred. As a result, client’s Special Needs Trust no longer had any funds in it and the trust company had suggested placing a lien against client’s home or selling it in order to “fund the trust.” P&A requested documentation from the trust company and M.D. in order investigate and received little to no documentation from M.D. and was eventually told by the trust company that no further records would be shared with DRI staff without a court order. P&A is assisting client with getting MD removed as co-guardian and substitute her nephew in his place. P&A has reported concerns to the court regarding not receiving requested documentation and has informed court that M.D. and trust company is contemplating selling client’s home or placing a lien on her home to pay themselves. P&A is waiting for a response from the court and this case is carried over to FY2015.

2) P&A is representing a 19 year old woman with autism and mental illness with removing or modifying her guardianship. The client wants to work, however her guardian will not allow her to and is making her continue going to school. The P&A attorney, while gathering evidence on client’s capacity, has discovered that documentation does not support that she currently meets the definition of incapacity. The P&A has filed a petition to either modify or terminate the guardianship. The P&A will argue that the young woman no longer needs a guardianship and has a supported decision making team that can provide her any assistance she needs to make decisions and to assist her in pursuing her employment goals. This case is carried over to FY2015.

Both of these cases assist the P&A in its systemic efforts to protect clients from abusive guardianships and conservatorships; to educate the courts and the community on alternatives to full guardianships; and to encourage the implementation of supported decision making model in guardianship proceedings. The Idaho Supreme Court Guardianship and Monitoring Coordinator reported that as of the end of 2014, there are presently 2669 adults with disabilities that have guardianships and conservatorships appointed in Idaho.

3) The P&A has been working on a carry-over litigation case filed on behalf of a client who is a deaf inmate at the Idaho State Correctional Institution (ISCI) whose primary language is American Sign Language. He has been repeatedly denied access to a videophone which would allow him to effectively communicate by telephone to family and friends outside of the prison. Client is currently provided the use of a TTY, but none of his contacts outside the prison who are deaf utilize TTY as they have upgraded to videophones. P&A staff filed a complaint in the Federal District Court for the District of Idaho on January 23, 2012, alleging that defendants, Idaho Department of Corrections Officials, have violated the Americans with Disabilities Act of 1990 as well as the Rehabilitation Act of 1973 by failing to ensure that the client was provided an opportunity to effectively communicate with persons outside the prison that was equal to that provided to hearing inmates. Since that time, the parties have participated in three judicial settlement conferences, the most recent of which occurred on August 21, 2014. None of these settlement conferences resulted in a settlement of this case. In the spring of 2014, P&A staff attorneys filed a Motion to Strike Defendants’ Jury Demand which was opposed by the defendants, but ultimately granted by the court. As a result, this case will be heard in front of a judge instead of a jury. In September of 2014, defendants moved to have the trial continued until the spring of 2015 as they had a change in legal counsel. P&A staff attorneys opposed this motion, which was ultimately denied by the court. A pre-trial status conference is scheduled for January 6, 2015. The parties are set to go to trial on January 20, 2015 and ending on January 26, 2015. Therefore, this case is carried over to FY2015. If this case is settled in the client’s favor, it will be used as precedence for other inmates in Idaho needing video phone access. IDOC has reported to the P&A that there are two inmates identified within in the client’s prison that are deaf.

4) When conducting an abuse and neglect investigation on behalf of a woman who committed suicide while placed on a mental hold in a local hospital’s behavioral health unit, the P&A encountered records access denials by both the hospital (regarding requested peer records) and by the county coroner’s office (regarding requested autopsy records). Not only did the coroner’s office deny the P&A’s request for records, but the county on the coroner’s office behalf filed a lawsuit in state court against the P&A in order to determine whether it has to provide the P&A with the requested records. The P&A removed the action to federal court and has filed a counterclaim for access to the requested records. The county has challenged the P&A request to remove the case to federal court. Currently, the case is pending in federal court waiting for a determination on the removal issue. This death investigation and resulting litigation has been carried over to FY2015. Remedies to address the barriers to accessing needed records from the hospital are pending while the P&A proceeds with the litigation that has arisen regarding the coroner’s office lawsuit. This litigation is necessary to ensure that the federal access authority mandated to the P&As is maintained, since it allows the P&A to effectively investigate alleged abuse and deaths in facilities. This death investigation and the litigation with the county coroner’s office potentially effects approximately 5,000 Idahoans who are placed on mental holds each year, supposedly to ensure their safety. According to a Boise State University PBS radio investigation, data collected from the IDHW Division of Behavioral Health shows that there were 5,095 persons in Idaho that were put on mental holds during 2014 and 5,056 during 2013.

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.

Fiscal Year 2014 PAIR Priorities and Objectives Report

DISABILITY DISCRIMINATION

1. Public or private services will not discriminate on the basis of disability in violation of the Americans with Disabilities Act, Section 504 and HAVA.

2. Accessibility

3. Address selected cases of alleged illegal discrimination by state or local government entities.

4. None. 5. There were 11 cases handled under this priority, but no class actions. One ligation case carried over to FY 2015.

6. 1) Client was a 66 year old Caucasian woman with multiple sclerosis and neuropathy contacted P&A requesting information on how to resolve issues related to non-emergency medical transportation services paid for by Idaho Medicaid. Client complained that she is a Medicaid participant who uses non-emergency medical transportation services to get to and from medical appointments. Idaho Medicaid has contracted with AMR to administer/coordinate these services. AMR then contracts with private transportation providers (TP). Client reported that her TP has not been providing accessible transportation for her electric wheelchair and requires all clients who use electric chairs to leave their chairs at home and use a manual wheelchair the TP provides, which resulted in orthopedic issues for the client. Complaints filed with AMR had not resolved the issue and the client requested appropriate complaint information. Client also reported that TP may be committing Medicaid fraud in its billing practices and that its employees may be violating HIPAA privacy laws. P&A SERVICES: Technical assistance (TA): P&A conducted research confirming DHW is obligated under Title II of the ADA and Section 504 to ensure its contractors are providing accessible services. This information was provided to the client as well as procedures for filing complaints with AMR, Idaho Medicaid, the State ADA Coordinator, DOJ, and the Dept of Health and Human Services Office for Civil Rights (OCR). Client was also provided with information regarding her right to file a lawsuit under Title II of the ADA and 504 and on the statute of limitations, as well as a referral to the Idaho State Bar for legal representation assistance. Finally, client was provided with information on how to file a Medicaid fraud complaint as well as how to file a Health Information Privacy complaint with OCR. OUTCOME: As a result of P&A assistance, client was provided with rights and complaint information and resources to better advocate for self. Client stated she planned to share this information with other Medicaid participants to encourage them to advocate for themselves as well.

2) Client was a 50 year old white female residing in urban location and who is blind. She contacted P&A on the day of a municipal election requesting assistance because her polling site didn’t have the auto mark-ballot device available as it was during the last federal election. P&A SERVICES: Short-term assistance (STA): PAVA advocate explained that accessible voting options guaranteed under the Help America Vote Act (HAVA) did not apply to county/municipal elections. Email referral to her county election officer was provided with the suggestion that she present her concerns of not being able to vote in private with use of a ballot marking device. Client forwarded the email she drafted and sent to her elections office and the Secretary of State (SoS) ADA Coordinator. The P&A PAVA Coordinator was also sent the letter since she has established contacts within the SoS office. A case was then opened under PAIR addressing concerns of possible ADA Title II violations. P&A contacted the Northwest ADA consultant, the Idaho Attorney General’s (AG) office and the SoS office regarding client concerns. The ID AG office filed a complaint with the Department of Justice (DOJ) on client’s behalf but unfortunately not under the ADA and the DOJ did not review her issue. The client was provided with additional suggestions and strategies to use for future county and municipal elections, such as contacting the election officer prior to municipal elections requesting that they have a ballot marking device available in her polling place or a centralized location within her precinct. OUTCOME: Since PAAT & PAIR not funded to further examine the merits of this case, it was closed but the client was provided with information and strategies to advocate on her own behalf.

Systemic Change: Due to the compelling nature of client’s letter it was disseminated throughout the state by SoS office and discussed during election officer training by P&A, with client’s approval. County election officers were asked to consider using the ballot marking device for county and municipal elections. Several counties informed the PAVA Coordinator that they plan to use the machines next year for county and municipal elections even though they are not required to under HAVA. However, the county in which the client in the above case summary resides decided not to make the AutoMARK available in all county and municipal elections. The P&A has included an objective for 2015 that allows them to further address this issue on behalf of this client, if PAIR funding permits.

3) P&A has an ongoing litigation case filed with the Idaho Department of Corrections on behalf of a inmate that is discussed in Section B. Litigation/Class Actions.

EDUCATION

1. Students with disabilities will not be subjected to unnecessary restraint or seclusion in Idaho public schools.

2. Abuse.

3. Educate parents and policy makers about the practice of unnecessary restraint and seclusion of students with disabilities

4. Idaho Council on Developmental Disabilities (ICDD) to develop a Restraint and Seclusion (R&S) Fact Sheet and Idaho Special Education Advisory Panel (SEAP) to advocate for R&S data collection from the State Department of Education (SED).

5. 0

6. No calls from PAIR students regarding concerns with restraint and seclusion were received during FY 2014 but cases were opened under other funding sources.

A summary of systemic work is provided:

The P&A is developing a White Paper to submit to the Idaho Legislature on the pervasive use of restraint and seclusion (R&S) in Idaho schools and to advocate for legislation regulating the use of R&S. National research has been done and data collected showing the harmful effects related to its use. Next, the P&A needed to collect statistics on its use in Idaho and requested data from the (SED). However, SED informed the P&A that they do not collect and track this information. Therefore, since the P&A is a member of the Idaho Special Education Advisory Panel (SEAP), it focused its efforts on educating the panel on the need for the SED to track R&S usage in Idaho Schools. The P&A was successful, and the panel has agreed to advise the SED to begin collecting this data during FY2015.

The P&A has completed its draft of a Section 504 Manual that includes suggestions and strategies for parents when addressing concerns regarding the use R&S. It is undergoing its final draft prior to dissemination during FY2015. The Supervising Advocate sitting on SEAP is conducting its final review.

Additionally, the P&A collaborated with the Idaho Council on Developmental Disabilities ICDD) by providing information collected on R&S for the development of a R&S Fact Sheet to be presented to the Idaho Legislature and SED encouraging regulation of the use of restraint and seclusion in Idaho schools.

1. Students with disabilities will have access to transition services.

2. Access to appropriate transition services.

3. Ensure students have access to transition age services.

4. P&A is a member of the Idaho Interagency Council on Secondary Transition, which is a state sponsored collaboration with the State Department of Education (SED), Idaho Vocational Rehabilitation (IDVR), the Idaho Council on Developmental Disabilities (IDCC), the Idaho Department of Juvenile Corrections (IDJC), the Idaho Assistive Technology Project (IATP), the Small Business Development Center, and the Professional Technical Training Center, and meets quarterly to ensure that Idaho students receive appropriate transition services and assists with planning for the annual Tools For Life Transition conference.

5. 0

6. No calls for PAIR students encountering difficulties with transition services were received during FY 2014. However, cases were opened under other funding sources.

A summary of systemic work is provided: The P&A is a member of the Idaho Interagency Council on Secondary Transition which met four times this year. Presentations and information exchange on various projects occurred, including transition fairs in the Blaine County School District as well as discussion on and planning for the annual Disability Mentoring day and the annual state-wide transition Tools for Life conference. The P&A has been asked to participate on a pilot project for FY2015 specifically aimed at improving transition outcomes for students who are deaf and, if successful, will branch out to other populations.

The P&A was a member of the Tools for Life planning committee and participated at the annual transition conference by having a display booth and providing four trainings on the topics of self advocacy skill training during guardianship proceedings, transition services, voting rights, and Social Security work incentives. Two other transition trainings were provided at a southeastern high school.

The P&A sits on the Idaho State Rehab Council. Improvement of transition services has been identified as a top priority for this council and efforts for improvement has been discussed. The Council invited transition aged students to talk about services that were the most helpful when transitioning from secondary education.

By collaborating with state agencies, educators, providers and disability agencies, conducting outreach and providing trainings, the P&A has been successful in ensuring that students state-wide in Idaho are aware of, and have access to, services that can assist them when transitioning from school to work and/or college or vocational training

INDIVIDUAL RIGHTS

1. People with disabilities will not be subjected to unnecessary or abusive guardianships or conservatorships.

2. Free from abusive or unnecessary guardianships or conservatorships.

3. Increase public awareness as to the rights of people with disabilities who are, or may be subject to, a guardianship or conservatorship.

4. The Idaho Supreme Court Committee on Guardianships and Conservatorships in efforts to improve guardianship statutory protections in Idaho.

5. 0 cases were handled under this priority since not case driven.

6. A summary of systemic work is provided:

The new P&A Legal Director (LD) was appointed to the Legislative Committee on Guardianships and Conservatorships and a subcommittee headed by judges formed to review and propose rule changes to the guardianship and conservatorship statutes.

Previous work accomplished by the former P&A LD’s participation included a recommendation to the Idaho Supreme Court for a state wide monitoring system to be funded by filing fees. This recommendation was accepted and put in place during FY2014 and now wards, or persons interested on their behalf, can file a complaint about concerns with their guardians directly to the court in which the guardianship was appointed. Also currently in place is required guardianship training accessed through the Idaho Supreme Court webpage for any guardian petitioner prior to appointment as well as background checks for any prospective guardian prior to appointment also enacted from collaborative efforts of the P&A.

The P&As new LD attended three meetings of this committee introducing the concept of supported decision-making as an alternative to guardianships and to encourage the courts to look at the practice of initially considering limited guardianships; and to only use full guardianships when the person truly lacks the legal capacity to make any decision or is completely unable to participate or make their desires known. The P&A LD was asked to provide a presentation on supported decision making. She developed a Power Point presentation about supported decision making during FY2014 to be presented at the committee’s meeting in November of FY2015.

The P&A developed and presented a Power Point presentation to transition students, VR counselors, special education teachers, parents and providers at the Tools for Life transition conference on Self Advocacy for Guardianships. This training educates about guardianships, court proceedings, provides guidance and suggestions for advocating for the least restrictive forms of guardianship or no guardianship. Information on how to remove or modify guardianships also was discussed. Packets of information were assembled including copies of the training, copies of the Self-Advocacy for Guardianship manual and a petition for filing for removal or modification of guardianship.

1. People with disabilities will have access to Social Security benefits.

2. Access to Social Security benefits.

3. People with disabilities who are entitled to Social Security Disability Insurance or Supplemental Security Income will receive their benefits.

4. None.

5. 71 cases were opened under this priority, one case carried over to FY2015 but no class actions.

6. 1) A 61 year old Caucasian female with orthopedic impairments, severe osteoporosis, diabetes, and problems with confusion/organization possibly from neurological deficits, and residing in urban location contacted P&A requesting assistance with accessing Social Security disability benefits. Client was unable to do her job despite multiple accommodations, and resigned in June due to her health. Client needed assistance with applying for SSDI benefits and Medicaid to obtain services to allow her to remain in the community due to her confusion and inability to apply independently. P&A Services: P&A staff assisted client with completing the SS application and disability report forms, obtaining medical justification since she hadn’t previously informed her physician of her declining health, and explaining the SS disability benefits process, including Medicare access. Due to her rapidly declining health, the P&A also assisted with explaining the Home and Community Based Services (HCBS) Medicaid programs since she would need Medicaid paid services to remain in a community placemat. OUTCOME: Client was quickly determined eligible for SSDI benefits without appealing an unfavorable decision. Another case was opened to help secure HCBS Medicaid services.

2) A 44 year old, Hispanic male with degenerative disc disease, migraines and mental illness and residing in an urban location, contacted DRI requesting assistance with a denial of SS benefits. P&A SERVICES: TA- Advocate interviewed client to gather information regarding severity of his disabilities and how they impair his ability to work. Provided information on the Social Security eligibility process, information on preserving appeal rights and where to access the needed forms on-line. Since he was being treated by a physician, he was given an appropriate doctor’s questionnaire and directed to ask physician to complete and to submit with his appeal. Also provided a guide for family and friends on how to prepare a letter of support. In case his request for reconsideration also denied, information on next step of the appeal process was provided with information on where to access a Request for Administrative Law Judge Hearing. Referred to P&A to access forms, if needed. Information when attorneys take cases also provided with a referral to Idaho Legal Aid and the Idaho State Bar for appropriate attorney referrals. All information was given to him in Spanish. OUTCOME: Client received rights information and resources secured in his primary language to assist with advocating for SS disability benefits eligibility.

1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities.

2. Protect and promote rights.

3. Participate with stakeholders and disability groups on task forces, workgroups and councils that provide the opportunity to advocate on behalf of people with disabilities.

4. See of collaboration discussed in systemic work summary below in 6.

5. 0 since not case driven.

6. A summary is provided of this systemic work:

The P&A Executive Director (E.D.) is a leading member of the Consortium of Idahoans with Disabilities (CID) and served as President of its Board of Directors during FY2014 guiding its public policy agenda which included efforts in getting Medicaid expansion legislation passed and helped create the “Close the Gap, Idaho” initiative which is an additional coalition of groups working together to promote Medicaid expansion and coverage of mental health services for people in the Medicare waiting period. Other CID efforts resulted in successfully restricting the use of shackles when transporting persons experiencing mental health crisis, and opposing bills limiting indigent medical care access. He is on the Idaho Council of Developmental Disabilities sub-committee for Public Policy successfully getting legislation passed reinstating Medicaid paid dental coverage for adults with disabilities. He has continued his membership on the Partners in Crisis which is a mental health policy group addressing and monitoring Idaho’s recent coordinated care system for accessing Medicaid paid mental health services. He remained on the Governor’s Children at Risk Task Force making recommendations to the Governor on policies affecting children in the child welfare system. He continues his membership on the Idaho Medicaid Care Advisory Council reviewing state Medicaid policy and providing comments on proposed rules and implementation. He participates on the committee on access addressing issues in the children’s developmental disabilities redesign of services. He is on the Center on Disability and Human Development’s (CDHD) Consumer Advisory Council helping to develop its five year plan.

The PAIR Coordinator remains as a member of the statutorily mandated Community Care Advisory Council advocating for quality care and rights protections for persons with disabilities residing in certified family homes (CFHs) and residential assisted living facilities (RALFs). This year she led the formation of a work group for this council of the advocates from the ICDD, the State Ombudsman and the advocate for the mentally ill in efforts to increase the focus towards quality of life improvements for the residents and to combat the influence of this predominately provider council. She was also asked by members of the Idaho Certified Family Home Association to participate on a work group with the Idaho Department of Health and Welfare Bureau heads, successfully addressing the need to create a more accurate listing of available CFH providers to more efficiently assist with the placement of persons in a CFH, especially when in crisis. The PAIR/PATBI Coordinator is on the Board of Directors of the Brain Injury Alliance (BIA) in efforts to improve access to information and resources for persons with TBI and their families, as well as educating the community on preventive measures. She is also on the TBI Advisory Council which allows collaboration with the TBI state grantee, the Institute of Rural Health at Idaho State University advocating for improved delivery systems for persons with TBI in Idaho. During FY2014, she was also asked to participate on a work group led by the Federal Emergency Management Administration (FEMA) representatives primarily comprised of Idaho Homeland Security heads and staff, IDHW Public Health Preparedness Program staff, representatives from the Red Cross and the State Independent Living Council (SILC) to identify how to better meet the needs of persons with disabilities in emergency preparedness planning in Idaho. She was also asked to speak at the IDHW Bureau of Emergency Medical Services & Public Health Preparedness Program’s annual conference for all of its regional heath district staff providing information on disability entities to be included when drafting regional emergency plans. The Public Health Emergency Preparedness Program Coordinator asked her to complete a comprehensive listing of disability agencies and organizations throughout the state. This listing was developed and disseminated to the health district administrators statewide for Emergency Preparedness guidance.

P&A Legal Department attorneys are all members of the Idaho State Bar Diversity Section addressing increasing diversity in the bar and issues addressing minority populations and a P&A staff attorney acts as the secretary/treasurer. P&A staff attorney also serves on the Idaho State Bar Delivery of Legal Services Committee which is comprised of representatives from Idaho Legal Aid Services, Idaho Supreme Court sponsored county court assistance offices, the Pro-Bono Commission, the Idaho Volunteer Lawyers Program, IDHW Child Support Enforcement, and the Intermountain Fair Housing Council for the purpose of exchanging information about legal services provided to low-income clients so that appropriate referrals are provided. The Advocacy Director (A.D.) continues membership on the Women of Color Alliance providing support and education on voting rights, systemic issues and recruitment to the P&A board. This Alliance has several hundred members throughout Idaho and surrounding states including many Idaho Native American tribal members. The A.D. also serves on the U.S. Commission on Civil Rights Idaho State Advisory Panel pursuing the advancement of civil rights in Idaho. During FY2014, priorities were set this year to focus on education and immigration concerns.

The new P&A Legal Director (L.D.) was appointed to the Idaho Supreme Court authorized Guardianship Committee evaluating the strengths and weaknesses of the Idaho guardianship statutes. She is also on the Guardianship Legislative sub-committee providing her the opportunity to advocate for more appropriate and less restrictive guardianships and to educate about supported decision making initiatives.

The P&A Supervising Advocate is on the State Department of Education Advisory Panel (SEAP) assisting the State Department of Education (SED) on ensuring that students in Idaho have access to a free and appropriate public education (FAPE). The panel’s primary focus during FY2014 was to continue its revision of the Idaho Special Education manual and its review of new core testing standards for education. She has presented concerns about the lack of any collection of data on the use of restraint and seclusion in the public school system by the State Department of Education (SED). The panel will be addressing this issue during FY2015. The P&A is also on the SED sponsored Idaho Interagency Council on Secondary Transition, improving the transition of Idaho students with disabilities from high school to work and/or college. The P&A collaborates with the Idaho Assistive Technology Project (IATP) and sponsored the Tools for Life annual conference as presenters and a member of the conference organizing committee.

The P&A supports and advocates for self determination initiatives as a member of the Self Advocacy Leadership Network’s Executive Committee this year, helping establish guidelines for hiring a new coordinator. The P&A also participated on the deaf forum planning committee for this event held during FY 2014, as well as providing support and training for the event.

The P&A Advocacy Director (A.D.) and CAP Coordinator continued her membership on the State Rehabilitation Advisory Council as the CAP representative reviewing IDVR service reports, client outcomes, and budget data to provide input for improvement. Focus for 2014 has been on upcoming regulatory changes for Vocational Rehabilitation (VR) due to the Workforce Innovation Opportunity Act (WIOA) with an increased focus on improving outcomes for transition-aged students. She continued on the Idaho Employment First Consortium organized by the IDCC. This initiative is a collaboration of self-advocates, providers, state agency staff and others working to ensure that employment is the first outcome considered for people with disabilities, with the focus on public policy, systems (such as Medicaid, IDVR and education), and educating the general public. This consortium also has a work incentives work group that is working to make a state-wide work incentives system to provide consistent information services based on the P&A’s WIPA model. Issues and initiatives covered this year included getting the Governor’s office to announce an Executive Order promoting employment first, collaborating with Idaho Division of Medicaid to ensure community supported employment is being provided to both DD and A&D Medicaid waiver recipients, and monitoring issues with IDVR that create barriers to employment.

The A.D. also participated on a regional Keeping Children Safe Child Protection Services (CPS) Citizens Panel providing input on how to improve the child protection system. This year she provided training on resources and supports available to children with disabilities for both biological and foster parents. This regional panel recommended to the state-wide panel to collaborate with the SED to reduce/eliminate the use of restraint and seclusion of foster children when contraindicated by the child’s mental health professional. Even though the state-wide panel didn’t submit this recommendation to the SED, this regional panel will continue its efforts to the state panel during 2015 due to the importance of the issue.

The A.D. continues to sit as President of the Board of Directors for the Intermountain Fair Housing Council. The Board reviews all complaints received regarding allegations of violations of the Fair Housing Act (FHA). 40% of all complaints are received from persons with disabilities, making them the largest of all protected classes The majority of these complaints are regarding denials of service animals and design and construction issues. She assisted with the recruitment of “ambassadors” in four regions state-wide to help recruit testers and monitor newly constructed subsidized housing units.

This participation allows the P&A to identify and monitor systemic issues which need to be addressed and those that are emerging, many times preventing the need for litigation or adversarial remedies, as well as resource costly measures. It has allowed the P&A to effectively advocate for disability legislation and comment on proposed rules that affect the disability community, address client’s choice and rights issues, the desire for meaningful integration, and access to affordable FHA compliant housing; address abuse and neglect in facilities, schools and the community; address whether persons with disabilities are receiving appropriate VR services and employment barriers, all factors that greatly improve the quality of life for persons with disabilities in Idaho. Through this involvement, the P&A is able to address the ever changing issues of Medicaid and of budget cuts that greatly affect the access to and quality of health care. It allows the P&A to advocate for special education services that meet the needs of students in Idaho schools. It allows the P&A the opportunity to advocate on behalf of persons with all types of disabilities including those with DD, TBI, MI, the elderly, hard of hearing/deaf and blind/sight impaired, and those with physical and neurological impairments. It allows the P&A to constantly remind agencies and others of the protections under the Americans with Disabilities and Rehabilitation Acts and the need for prevention of disability discrimination.

MEDICAID

1. People with disabilities will have increased access to Medicaid services.

2. Access to appropriate medical services.

3. Investigate and seek remedies for violations of federal EPSDT rules regarding providing evidenced based rehabilitative services or other required services for children with disabilities.

4. Meetings with private council to determine feasibility of case analysis development.

5. 0 cases since objective not case driven.

6. A summary of systemic work completed is provided: P&A L.D. facilitated several meetings during the year with different private counsels in attempts to gather evidence and supporting cases. This was needed to develop a case analysis exploring legal claims regarding violations of federal EPSDT requirements to provide rehabilitative services for children with disabilities that are Medicaid beneficiaries. Unfortunately, limited resources prevented further work on this case analysis. Therefore, the LD created two technical assistance (TA) letters to help parents in advocating for needed services and treatment provided under EPSDT if medically necessary: a TA letter with suggestions and strategies to assist families addressing denied Medicaid mental health services from the state coordinated care contractor, Optum; and a TA letter regarding denied DD services through the redesign process to provide guidance with appeals and to provide other strategies for accessing comparable medically necessary services through EPSDT Medicaid services. These TA letters were provided to several families under other funding sources.

1. People with disabilities will have increased access to Medicaid services.

2. Access to appropriate medical services.

3. Advocate for changes to community based waivers.

4. None.

5. Two cases were opened under this priority during FY 2014, one a carry-over case from FY 2013, but no class actions.

6. 1) A 63 year old Caucasian woman with physical and cognitive disabilities related to a stroke contacted P&A asking for help with her Medicaid A&D waiver share of cost determination. She was not being approved for the total 16 hours weekly under personal care services state plan, which does not require a share of cost. Her remaining PCS hours were approved as attendant care services which require a share of cost. While working on this systemic issue, the client received an A&D Medicaid waiver eligibility denial due to increased unearned income. The P&A needed to address this issue in order to proceed with addressing the share of cost issue. The P&A coordinated with Idaho Legal Aid Services in setting up a Miller’s Trust and appealed the Medicaid denial and requested a hearing. P&A negotiated with the Department and obtained resolution in which she retained her A&D waiver eligibility with the original eligibility date maintained, allowing the P&A to proceed with the share of cost issue. OUTCOME: Client retained her Medicaid waiver eligibility but she passed away the day after the hearing was vacated and the P&A had to close this case.

2) A 53 year old man with multiple sclerosis was assessed a share of cost in the amount of $2,258 by the Idaho Department of Health and Welfare, Division of Medicaid during FY2013 that was in violation of federal HCBS waiver rules and was jeopardizing his community placement. P&A SERVICES: The P&A represented the client for his Administrative Procedural Hearing maintaining that IDHW was not considering Federal and state laws requiring that a Medicaid program allow a person on the waiver to deduct “incurred medical and remedial expenses” that are not paid for by Medicaid or another third party from the amount they are required to pay for their Medicaid services. The law does not define the terms “medical” or “remedial” for this purpose. The P&A located a Medicaid policy document that stated that remedial expenses are “costs for services or goods that are provided for the purpose of relieving, remedying, or reducing a medical or health condition. The P&A also negotiated with IDHW to increase his personal needs allowance to reflect current and actual costs for any housing and living expenses included in the calculations and to include an additional amount for other living expenses in the amount of $361.00 per month. This amount represented an adjustment to the PNA to equalize the amount an individual who does not pay rent or have a mortgage has to spend on food and clothing, i.e., $710.00, when compared to the amount an individual who pays rent or a mortgage has remaining to spend for the rent or mortgage when a similar living expenses is deducted from the PNA, i.e., $1082.00 minus $721.00. OUTCOME: A partial favorable decision was agreed upon lowering his share of cost contribution to a more affordable amount since IDHW did approve some additional deductions for incurred medical and remedial expenses as well as increasing the amount of his PNA previously determined. Since all of the deductions being sought to further lower his cost of share determination were not approved, the P&A provided Office of Civil Rights (OCR) violations of ADA Title II complaint information. P&A also informed client of recent Centers for Medicare/Medicaid Services (CMS) Home and Community Based Services (HCBS) rule changes requiring states, including Idaho, to make changes to its HCBS waiver programs, to comply with the rule and suggested that he provide public comment since it will be required by states. Web-pages to access HCBS rule change meetings/webinars and dates for public comment were provided.

A summary of the systemic work completed under this priority is also provided: After the P&A successfully settled two Medicaid hearings decreasing the clients share of cost determination due to allowing an increased personal needs allowance, it was determined that a rule change needs to occur so others can benefit from this precedent. The P&A determined that the most expeditious remedy was to negotiate with the department to propose its own rule change instead of filing a petition for one. P&A E.D. began meeting with the Division of Medicaid Bureau Chief and administrative staff proposing a rule change that will raise the personal needs allowance for A&D waiver recipients to 180% of the SSI benefits rate resulting in an increase of $217 monthly. As of the end of FY2014, this proposal was not officially agreed upon but a meeting is scheduled to occur during FY2015. The P&A included an objective for this issue in its FY2015 priorities.

The P&A developed a TA letter with suggestions and strategies for pursuing additional deductions and to request for a higher PNA to decrease IDHW’s cost of share determinations until the rule change can been formally completed.

1. People with disabilities will have increased access to Medicaid services.

2. Access to appropriate medical services.

3. Provide technical assistance and short term assistance according to protocol.

4. None.

5. 5 but no class actions.

6. 1) A 40 year old white male living in urban area diagnosed with ocular herpes, Crohn’s disease, nerve leg damage and with visual and mobility impairments, contacted P&A requesting assistance with appealing his A&D waiver application denial. P&A SERVICES: Interviewed client and reviewed denial letter to determine appeal timeline status of his application. The advocate clarified timelines for requesting appeal. She identified his primary concern to his A&D waiver application which was that the regional Medicaid nurse did not allow him to answer questions on the Uniform Assessment Instrument (UAI) in a manner that explained his functional limitations and that he was unable to submit new medical evidence for consideration. Since his appeal timeline expired the next day, the advocate expedited a legal consultation to clarify the process for getting another UAI which was to request that his case be remanded, thus postponing the appeal and also allowing him to submit new medical evidence. She located necessary contact information to the Administrative Medicaid Procedural Unit so he could contact them by phone directly to meet timelines. Since the rules allow for a facilitator to be present when the UAI is conducted, she also provided a referral to the center for independent living (CIL) to request that an advocate act as a UAI facilitator. Client was also provided IDAPAs (rules) explaining the criteria used to determine if the applicant meets nursing facility level of care. OUTCOME: Client received rights information, resources and strategies so he could advocate for getting his case remanded allowing him to receive another UAI assessment. In case his application was again denied, he was provided with the legally based TA letter providing information and specific strategies to appeal. All written materials were printed on green paper to accommodate his visual impairment, as requested.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities.

2. Access to Medicaid paid community bases services and treatment.

3. Address systemic public policy issues in the Idaho Medicaid or managed care programs.

4. The P&A collaborates with the Consortium of Idahoans with Disabilities (CID) , a network of disability agencies, providers and organizations in various public policy initiatives including the Idaho Council on Developmental Disabilities, Idaho Vocational Rehabilitation (IDVR) centers for independent living, the Idaho Assistive Technology Project, the Centers on Disabilities and Human Development (CCHD), the Brain Injury Alliance of Idaho, Idaho Parents Unlimited; the P&A collaborated with the National Alliance of Mental Illness (NAMI) of Idaho and mental health (MH) work groups and with home health providers in efforts to reduce effects of proposed legislation that would reduce access to Medicaid paid MH and community services and supports. The P&A is a close collaborative partner with the Idaho Council on Developmental Disabilities.

5. None since objective not case driven.

6. A summary of systemic work provided since objective not case driven:

1) Limits previously set on individual adult developmental disabilities (DD) service budgets have significantly decreased access to community supported employment (CSE) waiver services. The P&A Executive Director (E.D.) developed a position paper on the problem and provided information about it to legislators and other policy makers. He provided information to the legislators on the issue in the Joint Finance Committee "Listening Sessions" and in committee hearings. OUTCOME: The Legislature passed a bill removing the budget limitation for CSE.

2) During FY2013, the P&A continued its systemic efforts advocating for the restoration of dental coverage for enhanced Medicaid recipients. During FY2014, the P&A E.D. provided information to legislative committees on the serious harmful effects of a lack of dental coverage on Idahoans with disabilities, especially people taking prescription drugs, including psychotropic medications, which increase the risk of dental diseases. OUTCOME: The legislature passed a bill restoring Medicaid dental coverage for adults with disabilities and chronic health conditions. This will potentially affect 11,358 HCBS waiver recipients receiving enhanced Medicaid services, according to statistics received from a IDHW public records request.

3) The P&A has diligently advocated for a Medicaid expansion bill in Idaho. The P&A E.D. provided information and drafted a Power Point presentation at the request of the "Governor’s Work Group on Medicaid Expansion" on disability related issues in their work on Medicaid expansion. This presentation was also presented and given for its use to a health care provider coalition and the “Close the Gap” Coalition in their collaborative efforts. He delivered PP presentation throughout the state reaching approximately 300 people. He assisted the Consortium for Idahoans with Disabilities (CID) in formulating a position on Medicaid expansion. E.D. testified at the Legislative Joint Finance Committee "Listening Session" on the impact that Medicaid expansion would have on Idahoans with disabilities, especially the 10,000 people with serious and persistent mental illness who currently have no coverage and few state services. OUTCOME: A bill implementing Medicaid expansion was introduced, but the committee voted not to print it. Collaboration and efforts for providing information to policy makers will continue through the 2015 legislative session in efforts to get a Medicaid Expansion bill passed.

1. Eligible individuals will receive Medicaid for Worker’s with Disabilities

2. Access to appropriate medical services.

3. Reduce barriers for access MWD program.

4. None.

5. 2 cases were handled during FY 2014 under this objective.

6. 1) A 62 year old Caucasian female with back and hip impairments residing in rural location contacted P&A as she had been denied Medicaid for Worker’s with Disabilities (MWD) program eligibility (Medicaid Buy-in). Client was working and wanted to continue to work however she needed surgery for back and hip issues and she was not covered by health insurance. P&A SERVICES: P&A attorney provided representation on client’s behalf at an administrative procedural hearing for a denial of MWD. P&A attorney filed a notice of appearance, requested a remand to submit additional information and discussed the case with the attorney general (AG) to ensure that the DDU properly evaluated client’s case. P&A collected additional medical evidence and presented it to the MWD program for consideration. P&A requested that Medicaid approved retroactive eligibility. OUTCOME: Client was approved for MWD four months prior to the application date ensuring coverage of client’s surgery and ability to continue employment.

OUTREACH/TRAINING

1. People with disabilities will have increased access to the services offered by DisAbility Rights Idaho.

2. Access to P&A advocacy.

3. Conduct outreach to transition age youth.

4. P&A staff attorney is a member of the Idaho State Bar Diversity Section of the Love the Law sub-committee encouraging transition aged students of diverse backgrounds to pursue a career in law. P&A collaborated with the State Department of Education (SED), Idaho Vocational Rehabilitation (IDVR) , the Idaho Council on Developmental Disabilities (IDCC), and the Idaho Assistive Technology Project (IATP) as a member of the Tools for Life planning committee.

5. 0 since not case driven

6. A summary of systemic work is provided since not case driven: The P&A participated at the annual Tools for Life conference. Initially the P&A was on the planning committee focusing on the employment elements related to the event. This included selecting break-out topics and seeking out presenters for employment forums, and coordinating the displays of individuals with disabilities who presented their business materials and products at the Business Exposition and offering four (4) trainings on various topics. The P&A participated at this conference by having an agency display booth, disseminating P&A brochures and discussing its services and how the P&A helps people with disabilities and transition aged students to approximately 175 students with disabilities, providers, disability agency staff, parents, educators and attorneys. P&A also provided trainings at this conference on the following topics to the following audiences: Self-Advocacy Guide to Guardianships - to students, parents, an attorney, a Vocational Rehabilitation counselor and a special education teacher providing information on guardianship processes, less restrictive alternatives and information on changing or removing guardianships/conservatorships. Packets were provided to 17 students which included the P&A developed Self-Advocacy Manual providing information on the DD guardianship processes, court hearing processes, important definitions and an Idaho DD Act Guardianship Petition form to request a change or termination; Voting rights training providing rights protections information, accessible voting options and hands on training on the autoMARK ballot marking devise to 23 students, parents and providers; Transition from School to Work giving information to parents and students moving from school to post-school activities, with focus on obtaining and maintaining employment through coordinated services and fostering interagency collaboration; and Social Security Work Incentives training to provide information about this program and how you can work and retain or maintain some benefits while working and/or becoming self-sufficient to 12 parents and 22 students. Power Point presentations were developed for each training.

The P&A outreached to a high school providing transition to work training to 34 students, including information about Social Security benefits, Vocational Rehabilitation services, community supports and services and how the P&A can help in accessing these services.

The P&A participated at a county transition fair by having a display booth discussing P&A services, how they help people with disabilities and transition students access needed transition planning and services to 55 students, parents and educators and providers.

P&A staff attorney is the secretary for the Idaho State Bar Diversity Section’s Love the Law! Committee. This committee encourages students of diverse backgrounds, including students with disabilities, to consider a career in the legal profession. Its activities are aimed primarily at high school students but college students are also invited. This committee sponsored a fall event titled Law & Motion Day held at the Ada County Courthouse in Boise in which students received an overview of the courtroom and a presentation by county courthouse employees from the prosecutor’s and public defender’s offices, the sheriff’s department and a court clerk. The 2nd event was entitled Courtroom Skills and was held at the Concordia Law School. Students were provided with an overview of the trial experience, then divided into plaintiffs and defendants and participated in a mock trial experience. These events were attended by 98 transition students.

In addition to these outreach activities, Voter Rights trainings were provided to 87 transition aged students and youth. Information on P&A CAP services, PABSS and WIPA was also provided with referrals to P&A if barriers to accessing needed services arose.

1. People with disabilities will have increased access to the services offered by Disability Rights Idaho.

2. Access to P&A advocacy.

3. Conduct outreach to individuals employment networks and sheltered workshops.

4. None.

5. 0 since not case driven.

6. A summary of systemic work is provided: P&A staff attorney researched prior to outreaching to the employment networks and sheltered workshops to determine its access authority and what records it may have access to at sheltered workshops. It was determined that the P&A would focus outreaching to the participants and providers, meet with administrators to clarify the various work and contracts for labor conducted, request information on its funding sources and request a copy of its 14 (c) certificate to determine if it is current. The P&A also developed a listing of all of the 14 (c) certificate holders indicating if it is a sheltered workshop that can pay sub-minimum pay to its participants.

The P&A conducted three outreaches to approximately 65 participants, administrators and staff:

Outreached to WITCO, which is a sheltered workshop also providing employment network (EN) services and located in southwestern Idaho. Met with the administrator and identified concern that ID Vocational Rehabilitation (IDVR) is not providing work evaluations prior to placing at the sheltered workshop. The CAP Coordinator was going to look into this issue with the IDVR Program Specialist. Visited its sheltered workshop but was unable to meet with any clients since they were working during outreach.

Outreached to the ARC located in Boise which is a sheltered workshop and a developmental disabilities center. P&A met with the administrator, requested a copy of the 14 (c) certificate, but was told that she would provide at a later date since she couldn’t locate it. Advocate provided information regarding accessing A&D ESE services since administrator was only aware that these services could be received under the DD waiver. Confirmed that there were 89 participants at this sheltered workshop and most never moved into community employment. During break the advocate met with 25 participants and disseminated P&A work incentive flyers and P&A brochures. Administrator was asked and agreed that the P&A could provide a training to its participants on work incentives, IDVR services and becoming employed in community settings in the future. The P&A will follow up on denied certificate since it has still not received during FY 2015. The discussed presentation will be scheduled during FY2015 if funding permits.

Outreached to the Panhandle Special Needs (PSN) in northern Idaho and met with the Employment Services Administrator, who introduced advocate to staff and many participants. Was provided with a copy of the 14 (c) certificate. This sheltered workshop has a nursery where workers are employed at minimum wage or greater, learn horticulture, money handling, answers telephones, and make public contact. Some of these participants transition to community employment. Advocate met with approximately 30 employees and one reported that he not only received vocational skills training but that he was also helped with accessing SSI and independent living skills training and now lives on his own. This provider also works with transition aged youth. The administrator provided information on some barriers for transition aged students receiving IDVR services prior to graduation and a referral to P&A was provided if this happens again. Twenty-five each of PABSS and CAP brochures provided to administrator to disseminate to participants.

1. People with disabilities will have increased access to the services offered by Disability Rights Idaho.

2. Access to P&A advocacy.

3. Conduct outreach in the community to increase awareness of DRI services.

4. None.

5. 0 since not case driven.

6. A summary of additional outreach other than those listed above is provided: P&A met with the Boise Veteran’s Affairs Medical Center’s Suicide Prevention Coordinator providing information about P&A Services, and copies of its current priorities explaining how the P&A can assist veterans and military personnel and their families. Brochures discussing P&A services, as well as CAP, WIPA and PABSS services were provided.

PAIR/PATBI Coordinator assisted the Brain Injury Alliance of Idaho with its display booth outreaching to veterans and military families at the annual Welcome Home Event. Information on the P&A and its services and how it can help were provided to 55 vets, military personnel and their families.

Outreached to 22 people while conducting two focus groups at a psychiatric facility. One focus group was to given to five staff, including the administrator, treatment director, and clinicians, and gathered information regarding their clients with mental illness barriers to accessing appropriate mental health services since Idaho switched to the Medicaid mental health coordinated plan and specific concerns with its contracted provider/Optim. They also discussed discharge placement and people who are homeless and have no medical coverage or benefits. The second focus group was given to 17 patients discussing concerns with Optim and discharge planning. Information on P&A services and contact information provided.

The P&A sponsored a meeting inviting the Northwest Social Justice Fund and other non-profit agencies that were not aware of the P&A and its services. Fifteen persons from ten agencies attended as well as two Social Justice Fund staff receiving information about the P&A and its services.

The P&A participated at a Deaf and Hard of Hearing Forum providing outreach to 66 people who were informed about the P&A and its services while also providing self-advocacy and community advocacy training.

The P&A provided an agency display booth at an Americans with Disabilities Act (ADA) Celebration and CIL building dedication, outreaching to approximately 100 people, including state legislators and providing information about the P&A and its services. Also provided hands on training on the accessible AutoMark ballot marking device.

The P&A participated at a refugee conference held at Boise State University by providing an agency display booth outreaching to approximately 60 people providing information about the P&A and its services with primary focus on how the P&A can assist refugees accessing appropriate and needed IDVR services.

The P&A participated at Advocacy Day at the Capitol by providing an agency display booth providing information about the P&A and its services to approximately 80 people with disabilities, providers, and legislators. Also provided hands-on training on the accessible AutoMark ballot marking device.

RIGHTS IN FACILITIES

1. People with disabilities will live free from abuse.

2. Abuse in facilities.

3. Address issues of restraints and/or seclusion in facilities.

4. None

5. 0

6. The P&A didn’t receive any reports of inappropriate restraints on behalf of PAIR client during FY 2014.

1. People with disabilities will live free from abuse.

2. Abuse in facilities.

3. Affect changes in policy or practice by investigating instances of death at facilities.

4. None

5. 0

6. The P&A didn’t receive any reports of deaths at facilities on behalf of PAIR client during FY 2014.

1. People with disabilities will live free from abuse.

2. Abuse in facilities.

3. Address issues of abuse in facilities.

4. None

5. One systemic case was opened to address abuse issues at two certified family homes (CFHs) assisting seven elderly PAIR clients with dementia and physical impairments.

6. P&A was made aware by the local media of the possible abuse of 62 year old man, living in a CFH, who was alleging he had been beaten by its owner with a pipe. The P&A contacted IDHW Licensing and Certification (L&C) Division and learned that there were two CFHs owned by two different people on the same property in which a total of eight residents lived. The P&A requested the name of the reported abused male resident and the other seven residents. The P&A opened a case on behalf of 62 year old man, diagnosed with dementia and mental illness, and funded under PAIMI. During its investigation, the P&A determined that there was probable cause to suspect abuse and neglect (A&N) of all of the residents, three men and four women, all diagnosed with dementia and physical impairments ranging from age 60-90. L&C informed that since the owners appealed its revocation of their certifications and since the abuse of the other residents had not yet been substantiated, they may be returned to these two homes. Due to a lack of PAIR funding, the P&A has been unable to open individual cases on behalf of all of the residents, but opened a systemic PAIR case in order to keep all residents safe and to continue its investigation under PAIMI and PAIR funding. The P&A sent a letter regarding its investigation stating that it had established probable cause of abuse and neglect of all of the residents from reports received from the residents and staff and that included sexual assault, physical injury, being forced to work “at the farm”, financial exploitation and theft by the providers who were also acting as SSA representative payees. From the P&A investigation, Adult Protection Services (APS) collaboration, and through negotiation and pressure placed upon L&C, none of the residents have been returned and presently these two CFHs are not in operation.

During its investigation, the P&A also identified eight additional residents, placed at the facility over a period of several years, who had died a short time after placement. The CFHs operated as an uncertified facility from 2009 to 2010, and three deaths were recorded during a one year span. The CFH’s certification was reinstated later in July, 2010 until January, 2014. During these three years, five more deaths were recorded, two of whom passed away within one month of being placed at the CFH. The P&A has been working with the county sheriff’s office, prosecutor, coroner’s office, and the State Licensure and Certification Agency (L&C) on this systemic case. The county detective informed the P&A that they are not going to conduct an investigation on these deaths without a formal complaint, since many were placed there under hospice care. Since the P&A almost ran out of PAIR funding, it was unable to investigate these deaths further.

Even though the one owner of the CFH’s was acquitted of previously filed abuse charges, charges of financial exploitation of a vulnerable adult over $1000.00 and grand theft has been filed and a hearing set due to the P&A involvement. The P&A will focus during FY 2015 on the abuse and neglect of clients still living in CFHs prior to removal in its efforts to bring about systemic change with the L&C so that the CFH residents are more adequately protected from abuse and neglect.

1.People with disabilities will live free from neglect.

2. Neglect in facilities.

3. Address issues of neglect in facilities.

4. None.

5. 1 case was handled under this objective during 2014.

6. 6. Client is 50 yo Caucasian woman who is non-verbal, paralyzed on right side of body due to a stroke resulting in neurological impairments. Client was placed in nursing home by co-guardians, daughters, and was not being considered for placement in CFH or other less restrictive environment. P&A SERVICES: P & A staff monitored situation, negotiating with the client’s guardian and providing information on community supports and services and other placement options to consider a lesser restrictive community placement. However, the guardian later reported that the client’s health deteriorated to a level requiring SNF continued placement confirmed by the SNF. OUTCOME: The P&A closed this case but P&A staff will continue to monitor and if client’s health improves and she becomes eligible for a Certified Family Home Lesser Restrictive placement, the P&A will reopen this case and challenge the guardian for community placement. 1. People with disabilities in facilities will have their rights protected.

2. Rights violation in facilities.

3. Address issues of rights violations in facilities.

4. None.

5. 0 cases were handled under this priority.

6. No reports of rights violations in facilities on behalf of PAIR clients were reported to P&A during this FY 2014.

A summary of systemic work is provided: The P&A and the Idaho Commission on Aging Long Term Care Senior Ombudsman is in the process of updating a previous Memorandum of Understanding collaboration agreement. The P&A reviewed and revised this memo and submitted to the Ombudsman for her review and negotiation, if needed. However, she was unable to complete this review due to an emerging priority issue that arose this last FY. The Commission terminated its contract with the largest Regional Area Agency on Aging provider and the Ombudsman dedicated much of her time in transitioning this office to another provider. Completion of this project was carried over to FY 2015.

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.

Fiscal Year 2015 PAIR Priorities and Objectives

This report will provide the following information for each of the PAIR priorities and objectives for the current fiscal year (2014):

1. A statement of each priority. 2. The need addressed by each priority. 3. A description of the activities to be carried out under each priority.

COMMUNITY INTEGRATION

1. People with disabilities will have access to the financial benefits they need to live in the community. 2. Access to SS disability benefits. 3. Provide advice, resources and strategies to assist people with disabilities who are applying for Social Security disability benefits or appealing a denial of SS disability benefits.

DISABILITY DISCRIMINATION

1. Public or private entities will not discriminate on the basis of disability in violation of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Help America Vote Act, or applicable state laws. 2. Accessibility 3. Accept 1-3 cases of violations of Title II of the ADA concerning service animals in public K-12 schools pursuant to case acceptance criteria.

1. Public or private entities will not discriminate on the basis of disability in violation of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Help America Vote Act, or applicable state laws. 2. Accessibility 3. Provide advice, resources and strategies necessary for self-advocacy to people alleging disability discrimination by state and local governments or places of public accommodation.

1. Public or private entities will not discriminate on the basis of disability in violation of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Help America Vote Act, or applicable state laws. 2. Accessibility 3. Continue ongoing effort to ensure that telecommunications services offered in IDOC facilities provide equally effective communication to inmates who are deaf pursuant to Title II of the ADA and Section 504 of the Rehabilitation Act.

EDUCATION

1. Students with disabilities in Idaho public schools will not be subjected to disciplinary actions that violate their rights under IDEA or Section 504 of the Rehabilitation Act. 2. Abuse 3. Provide advice, resources and strategies to parents to prevent or cease the use of unnecessary restraint and seclusion in public schools.

1. Students with disabilities in Idaho public schools will not be subjected to disciplinary actions that violate their rights under IDEA or Section 504 of the Rehabilitation Act. 2. Abuse 3. Provide advice, resources and strategies to parents and students with disabilities to address suspensions/expulsions that violate due process.

1. Students with disabilities will have access to appropriate transition services to help the student prepare for post-secondary activities, (e.g. college, training, employment, adult independent living, etc.). 2. Access to appropriate transition services. 3. Provide advice, resources, strategies, or other short term assistance to parents and students with disabilities to ensure access to appropriate transition services.

GUARDIANSHIP

1. People with disabilities will be free from abusive guardianships. 2. Free from abusive guardianships. 3. DRI will accept (1) to five (5) cases of alleged abusive guardianships for legal representation per case selection criteria.

1. People under guardianship who want to change or terminate the guardianship will receive advice, resource and strategies needed to advocate on their own behalf. 2. No guardianship or appropriate least restrictive guardianship appointments. 3. People under a guardianship who want to change or terminate the guardianship will receive advice, resources and strategies needed to advocate on their own behalf.

1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Protect rights 3. Participate on the Idaho Supreme Court committee on Guardianships and Conservatorships to represent the rights and perspectives of peoples with disabilities regarding guardianships/conservatorships when changes are proposed to Idaho Code/Idaho Court Rules.

1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Protect rights 3. Advocate for the implementation and use of the supported decision making model as an alternative to guardianships.

MEDICAID

1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services. 3. Provide advice, resources and strategies or other short term assistance regarding the fair hearing process to Medicaid beneficiaries who have been denied services.

1. Reduce barriers for people with disabilities accessing the Medicaid for Workers program. 2. Access to appropriate medical services. 3. Provide advice, resources and strategies or other short term assistance to people seeking benefits under the Medicaid for Workers with Disabilities program.

1. Reduce barriers for people with disabilities accessing the Medicaid for Workers program. 2. Access to appropriate medical services. 3. Address systemic barriers to Medicaid for Workers with Disabilities by promoting changes to Idaho Health and Welfare and disability determination services procedures.

OUTREACH/TRAINING

1. People with disabilities will have increased awareness about the services offered by DisAbility Rights Idaho. 2. Access to P&A advocacy. 3. Conduct outreach to transitions age youth with disabilities.

1. People with disabilities will have increased awareness of the services offered by DisAbility Rights Idaho. 2. Access to P&A advocacy. 3. Conduct outreach in the community to increase awareness of DRI services.

1. People with disabilities will have increased awareness of the services offered by DisAbility Rights Idaho. 2. Access to P&A advocacy. 3. Conduct outreach to unserved and underserved populations with disabilities, including military veterans.

PUBLIC POLICY

1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will monitor legislative bills and appropriations affecting people with disabilities, and provide information as needed.

1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Participate with stakeholders and disability groups on task forces, workgroups and councils that provide the opportunity to advocate on behalf of people with disabilities.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will inform policy makers of the benefits of Medicaid expansion for Idahoans with disabilities.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will work with policy makers to improve the personal needs allowance calculations for people who receive aged and disabled waiver services.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will seek changes to Idaho administrative rules for Medicaid state plan personal care services to insure that Medicaid beneficiaries receive their full allowance of PCS hours.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will provide comments on Idaho’s transition plan for new federal Medicaid home and community based services regulations.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will address systemic public policy issues in the Idaho Medicaid or managed care programs which arise during FY2015.

1. Idaho’s Medicaid program will provide access to adequate community based treatment and services for people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will continue to provide leadership to the Consortium for Idahoans with Disabilities in educating policymakers on issues of importance to Idahoans with disabilities.

RIGHTS IN FACILITIES

1. People with disabilities will live free from abuse. 2. Abuse in facilities. 3. Investigate instances of death of people with disabilities in facilities according to case selection criteria.

1. People with disabilities will live free from abuse. 2. Abuse in facilities. 3. Investigate allegations of abuse of people with disabilities in facilities according to case selection criteria.

1. People with disabilities in facilities will live free from neglect. 2. Neglect in facilities. 3. Investigate allegations of neglect of people with disabilities in facilities according to case selection criteria.

1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. Investigate alleged rights violations of people with disabilities in facilities according to case selection criteria.

1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. Conduct monitoring of selected facilities as authorized under federal statutes.

1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. Identify and address unlawful denials of P&A access to residents in facilities and records subject to P&A access authority.

VOTING

1. People with disabilities will have full access to the voting process. 2. Access to the voting process. 3. Conduct voter education trainings for schools and community groups that ensure people with disabilities have full access to the voting process.

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

FY2014 PAIR PPR - NARRATIVE

A. Sources of funds received and expended

Federal $161,772 State 0 All other funds 0

Total from all sources $161,772

B. Budget for the fiscal year covered by the report

Category FY2014 Actual FY2015 Budget

Wages/salaries 83,027 82,486 Fringe Benefits 43,760 39,396 Materials/Supplies 8,565 5,097 Postage 941 634 Telephone 1,443 1,078 Rent 11,816 8,242 Travel 1,448 4,015 Copying 187 740 Bonding/insurance 775 925 Equipment 0 0 Legal services 0 0 Indirect costs 0 0 Misc. 9,810 9,330

Total (from all sources)161,772 148,943 Note: 2014 Actual Expenses includes carryover from FY13 (10/1/12-9/30/13) 2015 Budget includes carryover from FY14 (10/1/14-9/30/15)

C. Description of PAIR staff

Type of Position FTE % Yr Filled Person-Years

Professional 1.25 89.39% 1.10 Full-time N/A N/A N/A Part-time 1.25 89.39% 1.10 Vacant 1.17 9.72% 0.11

Clerical 0.57 80.00% 2.27 Full-time N/A N/A N/A Part-time 0.57 80.00% 2.27 Vacant 1.00 8.33% 0.08

D. Involvement with advisory boards

The PAIR Coordinator is a member of the Community Care Advisory Council (CCAC) advocating for quality care and rights protections for persons with disabilities residing in certified family homes (CFHs) and residential assisted living facilities (RALFs). This allows her the opportunity to advocate for PAIR clients since many reside in these placements, especially the elderly population. She facilitated a work group of advocates on this council to counterbalance the influence of providers and the Idaho Health Care Association’s membership. This advocate work group identified issues that affect the quality of life for RALF and CFH residents and included the participation of Idaho Long-term Care Senior Ombudsman and the ICDD Director. Issues of identified concerns were presented to the Advisory Council and included the need for provider’s to have access to resident’s rights and people first language training for its staff, as well as the need to engage in public comment regarding the state’s federal requirement to change rules to ensure that facilities admitting HCBS waiver recipients are residing in the least restrictive and least institutional-like settings. The PAIR Coordinator also participated in a work group that successfully advocated with IDHW to complete a more accurate CFH listing so that participants can more easily be placed in an appropriate CFH when experiencing crisis.

The PAIR/PATBI Coordinator is a member of the TBI Advisory Board in efforts to improve access to information and resources for persons with TBI and their families, and to advocate for improved delivery systems for persons with TBI in Idaho, including military veterans. These individuals are often funded under PAIR when PATBI funding is limited. She is also on a sub-committee that is developing an informational brochure to assist college students with receiving appropriate reasonable accommodations.

The P&A is on the State Department of Education Advisory Panel (SEAP) and on the Idaho Interagency Council on Secondary Transition addressing special education and transition services for Idaho students with disabilities. The P&A Advocacy Director (A.D.) continued her membership on the State Rehabilitation Advisory Council as the CAP representative reviewing IDVR service reports, client outcomes, and budget data to provide input for improvement. Focus for 2014 has been on upcoming regulatory changes for Vocational Rehabilitation (VR) due to the Workforce Innovation Opportunity Act (WIOA) with an increased focus on improving outcomes for transition-aged students.

PAIMI Advisory Council for the P&A provided training to its members regarding the needs and purpose of the council. The Council shared information regarding emerging issues with the P&A on behalf of persons with mental illness in facilities and the community. Information was also provided to the Council members so they can better understand the P&A role, services and obligations so it can better advice and guide the P&A on how to meet the needs of persons with mental illness.

The P&A E.D. continued his membership on the Idaho Medicaid Care Advisory Council reviewing state Medicaid policy and providing comments on proposed rules and implementation.

E. Grievances filed. One grievance was filed by a PAIR client in August of FY2014. Client was an aged and disabled Medicaid waiver recipient with MS and MI receiving attendant care services who had contacted the P&A requesting help with getting on the self-directed waiver after recently firing his provider. P&A determined that he was not eligible for the DD waiver and explained that he could still receive personal care service (PCS) which are self-directed. He was told that he would need to contact his center for independent living (CIL) because it is the fiscal intermediary (FI) which processes Medicaid billing for PCS self-directed services. The client stated this was not an option since they stopped serving him because he didn’t pay his cost share for his PCSs as determined by Medicaid and processed by the CIL/FI. He then requested that the P&A contact the IDHW Director and order that they approve him for the self directed waiver. The P&A informed that client that this would not result in him getting approved since eligibility is governed by federal Medicaid and state rules. P&A provided individual with an explanation of the different options he had to access needed services to assist with self-advocacy. He then filed a grievance with the P&A and demanded that the P&A provide legal representation to change the Federal and state rules so he could become eligible for self-directed waiver option. He became very upset and informed the Advocacy Director that he was sitting in his own feces and must have help. He was asked if he wanted the P&A to contact APS on his behalf and he said yes. The call was made and APS informed P&A that they had gone to his home the week before and he refused to allow them to enter his home and they were unable to determine if he needed assistance but they agreed to staff his case again. He was asked if he wanted the P&A to contact EMTs and he said no. His options for accessing Self-Directed PCSs were again provided in writing.

F. Coordination with the CAP and the State long-term care program

Idaho’s CAP, along with PAIR, are all housed in the same agency, Disability Right Idaho, the state P&A system as well as PADD, PAIMI, PAAT, PATBI, PABSS and PAVA programs,. Many of the staff work in two or more of the programs. Outreach, public awareness and system advocacy activities are examples of how the P&A coordinates with the CAP and the state long-term care programs. Clients eligible for services under CAP, PADD, and PAIMI (for residents in facilities) are served under those programs and are not considered eligible for PAIR. However, many clients served under PAIR may also be served under CAP when needing assistance with getting appropriate vocational rehabilitation (VR) services. The P&A continued its membership on the State Rehabilitation Advisory Council as the CAP representative reviewing IDVR service reports, client outcomes, and budget data to provide input for improvement.

Disability Rights Idaho has a memorandum of agreement with the LTC Senior Ombudsman program operated through the Idaho Commission on Aging. The agreement covers mutual referrals, exchange of information and confidentiality. During FY2013, the LTC Senior Ombudsman and P&A agreed to revisit and update this memorandum of agreement (MOA). During FY 2014, the P&A reviewed and revised the MOA and submitted to the State Ombudsman Director for review. However, she was unable to complete this review due to an emerging priority issue that arose for the Commission this FY. The Commission terminated its contract with the largest regional Area Agency on Aging provider and the Ombudsman dedicated much of her time in transitioning this office to another provider. Completion of this project is carried over to FY2015. As noted above, both the PAIR Coordinator and the State Ombudsman are members of the CCAC and collaborate on issues to help improve the quality of care for PAIR clients residing in CFH and RALFS.

Certification

Signed?Yes
Signed ByJames R Baugh
TitleAuthorized Certifying Official
Signed Date12/23/2014