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

New Mexico (Disability Rights New Mexico) - H240A140032 - FY2014

General Information

Designated Agency Identification

NameDisability Rights New Mexico
Address1720 Louisiana Blvd. NE
Address Line 2Ste. 204
CityAlbuquerque
StateNew Mexico
Zip Code87110
E-mail Addressinfo@drnm.org
Website Addresshttp://www.drnm.org
Phone505-256-3100
TTY 505-256-3100
Toll-free Phone800-432-4682
Toll-free TTY800-432-4682
Fax505-256-3184
Name of P&A Executive DirectorJames Jackson
Name of PAIR Director/CoordinatorJames Jackson
Person to contact regarding reportBernadine Chavez
Contact Person phone505-256-3100
Ext.

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 areas81
2. Individuals receiving I&R outside PAIR priority areas250
3. Total individuals receiving I&R (lines A1 + A2)331

B. Training Activities

1. Number of trainings presented by PAIR staff11
2. Number of individuals who attended training (approximate)345

The following is a list of the trainings and training topics presented by DRNM PAIR staff in FY 2014: Staff provided seven trainings around the state for which the topic was health care; specifically the expansion of Medicaid eligibility, changes to health insurance made by the Affordable Care Act, and the new state health insurance exchange. The locations for training targeted rural areas as well as underserved areas of New Mexico: 1. Las Cruces, Nov 2013, 12- participants 2. Las Vegas, Jan 2014, 6 - participants 3. Roswell, Feb 2014, 18 — participants 4. Carlsbad, Feb 2014, 10 - participants 5. Silver City, March 2014, 8- participants 6. Albuquerque, April 2014 LEND students -35 participants 7. Albuquerque, April 2014 GCD 12 -participants Two additional trainings on “Navigating the Affordable Care Act” were presented at the Parents Reaching Out (PRO) Family Leadership Conferences in Taos and Roswell. Both trainings at these conferences had 20 people present at each session.

Staff provided training on ADA and employment to staff from the Workforce Solutions One-Stop center for employment. We covered Title I of ADA and disability awareness. There were three sessions with 28 participants from around the state in each session.

PAIR staff provided “Disability Awareness” training to federal employees of the USDA and US Park Services for “Disability Awareness Day”. We also covered ADA and reasonable accommodations for employees with disabilities. There were 80 participants at this training.

DRNM PAIR Attorneys gave a CLE presentation at the 7th Annual Civil Legal Services Providers Conference held at the New Mexico State Bar. The subject of the presentation was how to represent clients at Medicaid Administrative Fair Hearings.

The presentation covered how Medicaid administrative hearings work generally: how to request a hearing, how to present evidence and argument during the proceedings, and the process for filing an appeal in the event of a loss. Presentation attendees were also given the regulations and statues that apply to fair hearings in New Mexico, and had the opportunity to ask questions. Approximately forty people attended the presentation.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles2
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website11,624
5. Publications/booklets/brochures disseminated658
6. Other (specify separately)17

Narrative

Part II. Individuals Served

A. Individuals Served

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

1. Individuals still served as of October 1 (carryover from prior FY)4
2. Additional individuals served during the year29
3. Total individuals served (lines A1 + A2)33
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)0

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. Employment0
3. Program access0
4. Housing6
5. Government benefits/services3
6. Transportation1
7. Education11
8. Assistive technology0
9. Voting0
10. Health care9
11. Insurance0
12. Non-government services1
13. Privacy rights0
14. Access to records0
15. Abuse0
16. Neglect0
17. Other2

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor25
2. Other representation found0
3. Individual withdrew complaint3
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources1
8. Individual case lacks legal merit0
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy1
2. Short-term assistance14
3. Investigation/monitoring0
4. Negotiation7
5. Mediation/alternative dispute resolution1
6. Administrative hearings4
7. Litigation (including class actions)3
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 - 229
3. 23 - 5917
4. 60 - 642
5. 65 and over5

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females18
2. Males15

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 Native1
3. Asian0
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White19
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent18
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 arrangement2
8. Jail/prison/detention center0
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment2
2. Deaf/hard of hearing1
3. Deaf-blind0
4. Orthopedic impairment6
5. Mental illness0
6. Substance abuse1
7. Mental retardation0
8. Learning disability6
9. Neurological impairment6
10. Respiratory impairment0
11. Heart/other circulatory impairment1
12. Muscular/skeletal impairment5
13. Speech impairment1
14. AIDS/HIV1
15. Traumatic brain injury2
16. Other disability1

Part IV. Systemic Activities and Litigation

A. Systemic Activities

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

2. Number of individuals potentially impacted by policy changes10,000

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

PAIR program staff were heavily involved in systemic advocacy activities in FY 2014 since there were so many significant changes to services systems affecting persons with disabilities that were planned and/or implemented this year. These included a complete restructuring of the state’s Medicaid system under an 1115 waiver into a consolidated managed care program called Centennial Care; the expansion of Medicaid eligibility pursuant to the Affordable Care Act and the launch of the state health insurance exchange; and the replacement of the most of the state’s largest mental health provider agencies. PAIR staff also continued to be involved in systemic advocacy efforts related to educational services and employment.

Long term services in the new Medicaid program. PAIR efforts focused on providing input to state policy-makers and federal officials related to the changes in the Medicaid program affecting persons with disabilities, with an emphasis on preserving and expanding access to appropriate levels of long-term services with options for self-direction, and preventing or eliminating barriers to accessing needed health care. As a result of current and previous advocacy efforts by DRNM and others, several important policy changes were made to the program.

1. The new Medicaid program now allows prompt access to an extensive menu of community-based long term services and supports to any Medicaid beneficiary who meets the criteria for nursing facility level of care. Previously, most of these services were available only to the relatively few participants who were in a “slot” in the home- and community-based waiver program, which had a waiting list of about 16,000 people. This is a program design change that DRNM has promoted for years, and we estimate that this change will benefit approximately 5,000 individuals, including those who were already in Medicaid and those who have become eligible due to the ACA expansion.

2. Unfortunately, the new program includes a cap on the monetary value of community-based long term services, a cap which we believe violates the Americans with Disabilities Act. However, the Medicaid agency has agreed to “grandfather” all participants who were already receiving a higher level of services prior to the implementation of Centennial Care on Jan. 1, 2014. They will continue to have access to a higher budget for services so long as their need remains high. We estimate that this policy decision will allow about three hundred people to maintain their level of services without arbitrary reductions, and thus avoid nursing home placement. In FY 2015, DRNM plans to address the cap on benefits that applies to all newly enrolled Medicaid recipients.

3. The new Medicaid program also amended the grievance and appeals process. DRNM submitted many pages of public comment about the proposed changes in the Medicaid regulations. However, over DRNM’s objections, HSD implemented new MCO grievance and administrative hearing rules on January 1, 2014. The rules stated that Medicaid participants may only use a court-appointed representative in the grievance or hearing process. Presumably this would mean that a Medicaid participant can only get assistance from her or his guardian, but could not use any other person to help present a Medicaid appeal — even the person’s attorney. Together with other community partners, DRNM wrote a letter to HSD, rejecting this new unreasonable burden on program participants. HSD promptly disavowed the new restriction. HSD again proposed new grievance and hearing rules, this time allowing a Medicaid participant to be represented by “any other individual or individuals designated in writing by the claimant.”

DRNM also submitted comments to HSD on proposed changes to the Self-directed Community Benefit regulations. HSD proposed to incorporate language that limits the eligibility of participants to appeal reductions and denials of services, and limits the rights of participants to be their own Employers of Record. Also of concern to DRNM were proposed changes to the continuation of benefits during the appeals process (shortening the time frame for requesting continuation) and changes to the contents of the Summary of Benefits. Unfortunately, these changes were adopted in state rule despite our concerns.

4. The new Medicaid program also now provides each Medicaid recipient who qualifies for long term services the opportunity to self-direct some of those services. This too was an opportunity that was previously provided only to those in a a specific waiver slot. This policy decision allows gives consumers, who are interested and capable, greater control over the mix of services they receive, which agencies or individuals provide the services and at what times, etc. To date, about 1,000 individuals are benefitting from this policy.

These advocacy efforts have produced a very positive impact on persons with disabilities. However, PAIR staff have also been working on other problematic aspects of long term service delivery that have not yet produced successful systemic outcomes. For instance, the Center for Medicare and Medicaid Services is requiring the state, as a condition of its approval of Centennial Care, to implement a consumer support program for persons in need of long term services, called an “Independent Consumer Support System”. DRNM has led an effort involving many other advocacy groups for seniors and persons with disabilities to voice our collective concern that the program being implemented by the state Medicaid agency falls far short of the requirements imposed by CMS. Neither the state nor CMS has adequately responded to these concerns. DRNM has also noted that while persons with disabilities are exempt under federal law from mandatory enrollment in the “Alternate Benefit Package” that the state typically provides to newly eligible Medicaid recipients, less than 1% of all new enrollees have been determined to be exempt. Persons in need of long term services must be determined exempt before they can access such services under Centennial Care. And as noted above, we believe the cap on the value of community benefits is not consistent with the requirements of the Americans with Disabilities Act.

Systemic advocacy in these areas has involved several strategies. PAIR staff have provided written and oral comments on regulations issued by the state on these and other issues. We have presented testimony and information to legislative committees. We have corresponded with CMS and engaged in a conference call between CMS officials and advocacy group representatives. A DRNM staff member serves on the state’s Medicaid Advisory Committee, and we served on an advisory group to the Medicaid agency related to the ICSS program until it became clear that the program would not meet the need and we no longer wanted to be associated with it even by implication. And we have provided input through informal communication with state staff. DRNM will continue to engage in systemic advocacy efforts in FY 2015 to address these and other concerns related to the provision of community-based supports and services. DRNM/PAIR was also very involved in FY 2014 in promoting public awareness, and implementation in New Mexico, of new opportunities for health care coverage and services under federal health care reform affecting persons with disabilities, including expansion of Medicaid eligibility, health insurance reforms, and the health insurance exchange(s). Based on input from DRNM, the new Health Insurance Exchange agreed to include persons with disabilities as one of the target groups for specific outreach efforts. The result of this policy decision was an outreach contract that provided direct or indirect contact with approximately 500 persons with disabilities, family members, service providers and others interested in expanding access to health care to persons with disabilities. The Exchange also changed its approach to enrollment after the first open enrollment period ended, and decided to utilize community organizations as enrollment agencies and not just as part of outreach efforts. DRNM had promoted this approach in order to take advantage of community involvement and acceptance of these groups. This change in policy is likely to benefit at least 2,000 individuals with disabilities who have an existing connection to community agencies that will now (potentially) have the authority to enroll them in the Exchange.

In addition, DRNM conducted a number of training events around the state that provided information about the impact of the Affordable Care Act on persons with disabilities, including the expansion in Medicaid eligibility, reforms to private insurance practices, and the availability of the Exchange. These trainings are included in the training/outreach section of this annual report. However, we note here that as a result of the collective efforts of DRNM and other groups as well as the work of state agency personnel, there has been significant public awareness of Medicaid expansion. By the end of FY 2014 (9 months into expansion), 175,000 newly eligible individuals have been enrolled in Medicaid. This far exceeds the state’s earlier projections and in fact constitutes over 8.5% of the total state population of 2 million people. In the same time frame, NMHIX enrollment has totaled about 35,000. We have seen no data yet on the percent in either group who are disabled.

PAIR staff were also engaged this year addressing the issue of accommodations for students enrolled in higher education. We met with staff of disability programs at two universities to address concerns that had been brought to our attention, and used these meetings to educate them about their responsibility under federal law to provide reasonable accommodation. The representatives of these university programs that we met with stated that they have a limited budget for support services and further stated their belief that the state VR programs should pay for some of the accommodations needed by students with disabilities. We informed them that it cannot be a requirement for students with disabilities to apply for a program such as DVR just to get them to pay for an accommodation that the university has a legal obligation to provide. As a result of our work, these two major universities changed their operating policies to reflect that the student has the option of applying for VR but it is not a requirement.

Finally, in the area of employment, DRNM’s executive director made a presentation this year to the Disability Subcommittee of the Legislative Health and Human Services Committee on two new federal initiatives intended to enhance and expand employment opportunities for persons with disabilities. The new Section 503 regulations for the first time establish a specific goal for federal contractors that at least 7 percent of their work force be people with disabilities, and require most federal contractors to track and report data on the number of persons with disabilities they employ. A new Executive Order requires most federal contractors to pay a minimum wage of at least $10.10 per hour, and notably this provision specifically extends to workers with disabilities who might typically receive less than the current minimum wage due to their employer holding a “14(c)” certificate that allows the employer to pay less than the minimum wage. The presentation featured handouts on these two initiatives, including fact sheets from the U.S. Department of Labor. Some state legislators were surprised to learn that some employers could pay workers with disabilities less than the minimum wage. There have been no policy changes yet, but there was some interest expressed in addressing this issue in the 2015 legislative session.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts3
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.

A client on the Disabled and Elderly waiver has severe juvenile arthritis with significant pain which has immobilized the client who is also blind. Medicaid denied the prescription for a Lidoderm patch which helps relieve the pain. A DRNM attorney filed an administrative fair hearing request. DRNM was able to secure the prescriptions through negotiation; the fair hearing was therefore unnecessary.

Another client has paraplegia with a very severe open ulcer on his back and requested approval for the purchase of a Tempurpedic bed as part of the individualized services and supports to be provided under the self-directed Medicaid waiver program. Approval was denied, and a DRNM/PAIR staff attorney represented the client in a Medicaid administrative hearing. The denial was upheld in the hearing, but DRNM filed an appeal in state district court. We negotiated with the Office of General Counsel for the Human Services (Medicaid) Department, and obtained a favorable settlement. The bed was added to the client’s budget and we withdrew the district court appeal.

Another client had been prescribed and treated with a custom compounded medication to combat a significant allergy as a result of an earlier court appeal in which the client had been represented by a DRNM staff attorney. In January 1, 2014, when the restructuring of the Medicaid program took effect, this client changed Medicaid Managed Care organizations. His request for the compounded medication was again denied by the new MCO. A DRNM staff attorney represented the client in a Medicaid administrative hearing. After multiple MCO internal appeals and advocacy with the Human Services Department’s Office of General Counsel, HSD directed the MCO to provide the custom compounded medication. DRNM withdrew the fair hearing request.

Another client was a participant in the Medicaid home and community based waiver program. Despite a detailed letter from his physician, the client’s request for additional services was denied and no explanation or reason was given. A DRNM staff attorney attended a pre-hearing conference, where the Medicaid agency staff repeatedly said they were not required to provide any more information to the client. DRNM argued that the state’s position violated the adequate notice provisions of federal Medicaid law. DRNM successfully negotiated a resolution and the Human Services Department quickly ordered the agency to approve the additional funding requests.

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.

Priority A: Community Services 1. Assure that community programs provide services that meet the need of individuals qualifying for or receiving those services. This priority was targeted in FY 2014 to assist eligible individuals or applicants who were denied or terminated from Medicaid funded community-based long-term services, or who faced inappropriate modification/reduction/loss of such services. 2. Many individuals with disabilities do not receive the level of appropriate community-based services they need to maintain their independence, and many recipients have experienced reductions or proposed reductions in services. With a completely restructured Medicaid program implemented in this fiscal year, the need for advocacy was especially important. 3. Indicators of success: Number of cases taken, number of successful case closures 4. DRNM collaborated with many other agencies in conjunction with this priority. We informed other legal service agencies and other disability advocacy organizations about our work and accepted referrals from them. 5. of cases in this priority: 6 6. Case example Client C.1 is a 54 year old Latina with quadriplegia. She receives Personal Care (attendant care) through the Medicaid program and was receiving 65 hours of personal care. She received notice from her Managed Care Organization (MCO), that her hours would be reduced from 65 to 52. The Client believed that her extensive needs for in-home assistance could not be met with that reduction. She contacted DRNM for assistance in appealing the reduction of services.

DRNM interviewed the Client and her family and reviewed her records and determined that the Client’s health and safety would be compromised with the reduction. By promptly filing an appeal for the Client, requesting a Fair Hearing, DRNM ensured that our Client’s benefits would continue until a hearing decision was made. We worked closely with the Client and the Client’s mother to prepare; extensive medical records were gathered. Meanwhile, because the State failed to have its case prepared by the time of the Fair Hearing, it requested an extension and the Administrative Law Judge granted the extension. PAIR staff presented and defended the Client’s case in the Fair Hearing. We prevailed in the hearing, with the result that our Client will continue to receive the full 65 hours of assistance she had been receiving all along. The Client’s health and safety have been ensured by this result.

Priority B: Special Education 1. Assist children with disabilities whose Individualized Educational Plans (IEPs) are not implemented, or who are excluded from appropriate special education services and placements. This priority is targeted in FY 2014 to students with IEPs that are wholly or substantially inadequate or whose substantial lack of implementation by their local school districts keeps the student from benefiting from special education. 2. Many children with disabilities have IEPs that are not properly and reasonably implemented. Many school districts demonstrate a pattern of inadequate compliance with state and federal special education requirements that result in children not receiving the educational services they are entitled to. 3. Indicators of success: number of cases taken, number of cases closed successfully, number of group complaints against school districts where violations are confirmed by state or federal officials. 4. Collaboration with other groups: DRNM worked closely this year with Parents Reaching Out, which is the state’s primary Parent Training and Information center, to plan and provide a number of special education training events and clinics around the state and to provide follow support to parents seeking to enforce the educational rights of their children with disabilities. 5. of cases in this priority: 7 6. Case example Client E.D.2 is a 7 year old who has Attention Deficit/Hyperactivity Disorder (ADHD), and behavioral problems due to his ADHD*. He was attending The International School (TIS), but the school ignored his special education evaluations and was not providing the services he required. DRNM and the client’s parents submitted a formal complaint to the state’s Public Education Department (PED). The PED conducted an investigation, and ordered TIS to provide compensatory services. Instead of providing the services, TIS looked for ways to avoid the ruling. DRNM notified the PED of the failure to comply, with the result that our client was awarded additional compensatory education services for the entire summer of 2014. The family is happy with this result. *Federal officials from the Substance Abuse and Mental Health Services Administration (SAMHSA) have clarified that ADHD is not a severe mental illness and thus such an individual would not qualify for services under the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, and thus such an individual is eligible as a PAIR client.

Priority C: Improving Public Policy 1. This priority is to pursue and promote systemic improvements in policies, statutes and regulations that affect individuals with disabilities. In FY 2014, this included three principal issues: a) providing input to state policy-makers and federal officials regarding the changes to the Medicaid program proposed in the state’s “1115 waiver” application, with an emphasis on preserving and expanding access to appropriate levels of long-term services with options for self-direction, strengthening behavioral health services including community-based alternatives for individual in crisis, and preventing or eliminating barriers to accessing needed health care; b) promoting public awareness, and implementation in New Mexico, of new opportunities for health care coverage and services under federal health care reform affecting persons with disabilities, including expansion of Medicaid eligibility, health insurance reforms, and the health insurance exchange(s); and c) reviewing and commenting on proposed regulatory changes in Medicaid or other publicly funded programs that would have a significant effect on eligibility, benefits or procedural protections for persons with disabilities. 2. Significant changes to the design and delivery of major health care systems were being made in FY 2014. The entire structure of the state’s Medicaid system changed this year with the implementation of "Centennial Care", the state’s 1115 demonstration waiver program. Some elements of the new program have the potential of being highly favorable to persons in need of long term services, while other elements may limit access to an adequate level of services, and the implementation of the program directly affects at least 20,000 individuals with disabilities. At the same time, Medicaid eligibility expansion was going into effect, offering tens of thousands of uninsured New Mexicans with disabilities the opportunity to obtain health coverage, but there was significant concern over the lack of awareness of this change. The state health insurance exchange also began offering an opportunity to obtain health insurance, but there was also a significant lack of understanding of the favorable changes made by the Affordable Care Act that make private insurance much more relevant and affordable for persons with disabilities. 3. Indicators of success *Number of policy chances benefitting persons with disabilities *Identifying and analyzing areas of concern, including access to needed services, opportunities for self-direction of services, an inadequate program for supporting consumers in need of long term services, the process of obtaining an exemption to mandatory enrollment in the Alternative Benefit Package (which offers no long term services), the failure to promptly fill waiver slots for those whose income is above 138% of the federal poverty level, and the cap on the monetary value of community-based services at the cost of nursing home care. : *Identifying positive aspects of the program to promote and encourage, including expanded access to community service benefits without need for a waiver slot and wider access to self-direction *Comments and suggestions submitted *Group or individual presentations to legislators and legislative committees *Participation in advisory groups *Number of trainings conducted and number of participants *Number of people signing up for Medicaid 4. Collaboration with other groups: Through The Disability Coalition, DRNM worked with other disability advocacy groups to identify and monitor design and implementation problems with the new Medicaid program and to educate policy makers about beneficial design elements as well as serious problems in implementation of the new program. DRNM staff made a presentation on these issues in November 2013, and took the lead in arranging for a more comprehensive presentation by a panel of disability advocates to the legislature’s interim Health and Human Services Committee in 2014. The presentation was planned for September but was postponed until October 2014 (just after the end of FY 2014). 5. of cases in this priority: Individual cases related to long term services or health care were handled under Priority A above; Priority C is an area of systemic advocacy. 6. Case example: N/A

Priority D: Self-Determination 1. The goal of this priority is for persons with disabilities to have as much control as possible over the decisions that affect them. The focus of the priority in FY 2014 was to promote the least restrictive level and form of substitute decision-making necessary, promote meaningful input from individuals with disabilities when a substitute decision-maker is proposed or changed, and assure that those substitute decision-makers are legally-appointed, qualified, suitable, effective and active in the lives of the protected person. Substitute decision-makers include guardians and treatment guardians, representative payees, VA fiduciaries, conservators, and medical or financial agents. 2. The decision-making process and the right to self-advocacy for many individuals with disabilities is negatively impacted by restrictive or unnecessary substitute decision-making. Persons with disabilities often become more capable of making their own choices as they get older and gain more experience, but once a substitute decision-maker has been appointed it is often a difficult and arduous process to change the arrangement. 3. Indicators of success: number of individual cases taken, number of cases closed successfully 4. Collaboration with other groups: In addressing this priority area, DRNM collaborates with the DDPC Office of Guardianship, the NM Guardianship association, and with other civil legal service provider agencies which are involved in this area. 5. of cases in this priority: 1. [DRNM served many other clients under this priority but was able to use resources other than PAIR to do so] 6. Case example Client SD.2 is a male who has severe physical disabilities due to a car accident, and he had a learning disability as well. He contacted DRNM because he wanted to terminate his guardianship so that he could make his own decisions and spend his resources as he wished to spend them. We worked with our client to determine whether he would be supported in this effort by his therapist and his medical doctor. Each of them indicated that they were supportive of his wishes to be his own guardian. We assisted our client in obtaining letters to this effect from his physician and his therapist. We also assisted him in writing a letter to the court along with his supporting documentation in preparation for going to court to remove the guardian. The guardian was notified of the client’s wishes and these activities in support of his quest to end the guardianship. The existing guardian notified the court that they would agree to relinquish guardianship. This arrangement was approved by the court and our client now has full decision making authority for himself and is doing well.

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.

Priority A. Abuse/Neglect 1. Improve the practices and procedures of programs and facilities where there are significant allegations of abuse, neglect, or exploitation of individuals with disabilities. 2. Individuals with disabilities are subject to abuse or neglect at a higher rate than non-disabled individuals, and addressing allegations of abuse or neglect is a core function of protection and advocacy agencies. 3. Conduct investigations of alleged or suspected abuse or neglect where there appears to be a pattern or recurrence of significant abuse or neglect, where there has been a death or life-threatening injury, or where the alleged abuse or neglect is particularly egregious.

Priority B. Community-based Services 1. Assure that community programs provide services that meet the need of individuals qualifying for or receiving those services 2. Medicaid-supported community-based services allow persons with significant disabilities to live in and interact with their communities and avoid nursing home placement, and often the level of services offered are inadequate for the needs of the client. 3. Assist individuals in need of long term services, including those who choose to self-direct services, who have been denied access to such services, or for whom the level of services offered or provided is grossly inadequate.

Priority C. Public Policy Changes 1. Pursue and Promote Public Policies and Systemic Changes in Policies, Statutes and Regulations that Affect Individuals with Disabilities 2. State regulations and other policies establish policies and procedures that have a major impact on persons with disabilities, and unfortunately very few other disability organizations monitor and comment on proposed changes so the community depends on DRNM to do so. 3. Review and comment on proposed regulatory changes in Medicaid or other public programs that would have a significant effect on eligibility, benefits, or procedural protections for persons with disabilities.

Priority D. Health Care Coverage 1. Promote public awareness, and implementation in New Mexico, of new opportunities for health care coverage and services under federal health care reform affecting persons with disabilities, including expansion of Medicaid eligibility, health insurance reforms, and the health insurance exchange 2. Access to health care through Medicaid or the Exchange plays a critical role in maintaining the health of people with disabilities and their capacity for independent and integrated community living, but not all programs offering enrollment are accessible to people with disabilities. 3. Promote and monitor accessibility of the health insurance exchange to persons with disabilities, including access to on-line resources, physical accessibility of walk-in offices, and effective assistance (including physical accessibility) by Healthcare Guides

Priority E. Self-Determination 1. Persons with disabilities have control over the decisions that affect them 2. The decision-making process and the right to self-advocacy for many individuals with disabilities is negatively impacted by restrictive or unnecessary substitute decision-making. Persons with disabilities often become more capable of making their own choices as they get older and gain more experience, but once a substitute decision-maker has been appointed it is often a difficult and arduous process to change the arrangement 3. Promote the least restrictive level and form of substitute decision-making necessary, and provide assistance to protected persons with a Representative Payee or under guardianship, including treatment guardianship, where the Representative Payee or guardian appears to be arbitrary or non-responsive to the reasonable preferences of the protected person, or appears to abuse their authority.

Priority F. Special Education 1. Assure appropriate public school services for students with disabilities 2. Access to a free and appropriate education is a fundamental right of school-age children with disabilities, and PAIR is the lead program for students with disabilities other than mental illness or developmental disabilities. 3. Advocate for students with IEPs that are wholly or substantially inadequate or whose substantial lack of implementation by their local school districts keeps the student from benefiting from special education. Pursue systemic change strategies such as supporting family organizing efforts and pursuing group complaint strategies against school districts with a pattern of violations of state and/or federal law.

Part VI. Narrative

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

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

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

A. Source of funds expended: Total expenditure on individuals Federal funds: $145,299 State funds: 0 All other funds: 0 Total from all sources: $145,299

B. Budget for current and following years Category FY2014 Actual / Next FY2015 Budget Wages & Salaries $87,801 / $111,720 Fringe Benefits (FICA, unemployment, etc.) $22,788 / $29,863 Materials/Supplies $906 / $1,336 Postage $280 / $377 Telephone $1,870 / $1,288 Rent $10,031 / $9,246 Travel $2,374 / $3,706 Copying $1,285 / $1,217 Bonding/Insurance $0 / $0 Equipment Rental/Purchase $0 / $0 Legal Services $0 / $0 Other operating costs $5,465 / $5,205 Indirect Costs $12,500 / $14,620 Total Expenses/Budget $145,299 / $178,579

C. Description of PAIR Staff Type of position FTE % of yr. filled Person-years Professional Full-time 1.31 100% 1.31 Part-time 0.12 100% 0.12 Vacant 0 0 Clerical Full-time 0.26 100% 0.26 Part-time 0 0 Vacant 0 0 Total Staff 1.69 100% 1.69 Professional staff in the PAIR program include outreach, training and intake staff, case advocacy staff, attorneys and supervisory staff.

D. DRNM does not maintain an advisory board or committee for the PAIR program, but staff work closely with a number of consumer and family groups and advocacy organizations involved with the constituencies served by PAIR. Our agency Director serves as the Chair of the Steering Committee for the Disability Coalition, a statewide group of organizations and individuals advocating for persons with disabilities. The Steering Committee includes representation from two of the state’s Independent Living Centers as well as the Governor’s Commission on Disability, the state DD Planning Council, The Arc of New Mexico and DRNM.

E. Grievances filed under the grievance procedure There was one grievance filed in the PAIR program in FY 2014. An individual with multiple disabilities contacted DRNM, seeking assistance in a dispute with a provider of subsidized housing. Housing issues were not within PAIR program priorities in FY 2014, and the dispute did not involve discrimination on the basis of disability but appeared to be a dispute over calculation of the amount of the housing subsidy and the individual’s suspicion of discrimination based on race. For these reasons, DRNM declined to provide representation on this issue, and the applicant filed a grievance, appealing the agency’s decision not to take the case. Pursuant to agency policy, the DRNM Executive Director reviewed the grievance, reviewed relevant case notes, correspondence and other information, and upheld the staff decision not to take the case. The basis for the decision was explained in the response to the grievance, and there was no further appeal.

F. Coordination: DRNM is the state’s designated CAP program, so collaboration between PAIR and CAP occurs routinely within the agency. DRNM also collaborates with the Long-Term Care Ombudsman program, which is housed in the state Aging and Long-Term Services Department. During this year we provided a training for Ombudsman staff on the rights of persons with disabilities and services provided by DRNM.

Certification

Signed?Yes
Signed ByJames Jackson
TitleAuthorized Certifying Official
Signed Date12/29/2014