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

Idaho (DisAbility Rights Idaho, Inc.) - H240A150013 - FY2015

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 areas82
2. Individuals receiving I&R outside PAIR priority areas360
3. Total individuals receiving I&R (lines A1 + A2)442

B. Training Activities

1. Number of trainings presented by PAIR staff35
2. Number of individuals who attended training (approximate)1,268

1) Healthy Idaho Plan (Medicaid expansion) Impact on Idahoans with Disabilities Training: The P&A collaborated with the Close the Gap coalition and the Idaho Consortium of Idahoans with disabilities. The P&A Executive Director (E.D.) developed a Power Point presentation regarding the impact of Medicaid expansion (renamed Healthy Idaho plan) would have in Idaho. The presentation reviews the five components for Medicaid redesign/expansion; provides statistics on the money that Idaho would save over the next ten (10) years and educates about the current Medicaid eligibility standards showing that it is not available to all low-income families. Location and audience: The ED and other CID members provided workshops statewide to a total of 172 people with disabilities and families, legislators, providers, state agencies and advocacy organizations. 6 trainings total. 2)Transition planning titled “You’re Graduating — Now What?” Content: Topics included what should be included in a school transition plan, involvement of VR, self-advocacy, and other supports/services available to transition age youth when moving to adulthood, and self-determination. Location & audience- T4Life and 2 high schools in eastern Idaho given to 75 students, teachers and staff. 3 trainings 3) Guardianship training titled “Alternatives to Guardianships”. Content: provided a description of the guardianship process, emphasized alternatives to guardianship such as powers of attorney, supported decision making model, and bill pay or representative payee services. Limited guardianship was explained as an alternative to full guardianship. Format: PP and lecture. Guardianship packets given including a petition for change and Idaho Supreme Court complaint forms. Location and audience: T4L transition conference to students, parents, staff; in-service to VR counselors; Idaho Department of Health and Welfare Developmental Disabilities evaluation committee, and a residential habilitation provider. 4 trainings. 4) Voter training titled “IDVOTE”. Content: Provided information about federal and state voting rights and resources, registration and accessible voting options. Each training provided hands on ballot marking device (BMD) training depending on the device used in the county which include the AutoMARK, Express and Hart Systems. Format: PP and/or lecture, and hands on training on AutoMARK. Packets of information including PP presentation and registration forms. training provided at Tools for Life conference, Shoban Reservation, high school, 2 college disability centers, a center for independent living located in northern Idaho, a developmental disability agency in Boise, a chapter of the Self Advocacy Leadership Network (SALN) in northern Idaho; 4 employment networks in central western and eastern Idaho, an election office, an organization for adults with DD to a total of 615 participants which included persons with disabilities, providers, election officials, families, college staff, students, and advocacy organizations. total: 15 trainings 5) Work Incentive Training: 2 sessions provided. Content: Information about P&A and its services, Medicaid and Medicare information, SS disability benefits and work incentives, Vocational Rehabilitation (VR) services and community services and supports available for work development. Format: PP and lecture, handouts. Location and audience: T4L conference and a high school career exploration project in central Idaho to 120 students w/disabilities, teachers, staff and parents. 2 trainings. 6) Presentation on ADA Title II and necessary accommodations. Format: PP and lecture. Audience: 45 clerks of the court and administrators at 2 district courts; 7) Overview of ADA disability rights and rights to a service animal under the ADA. Format: PP and lecture. Location and audience: VA hospital given to approximately 30 veterans, staff and providers. 8) ADA training regarding Title I employer obligations to provide reasonable accommodations to employees with disabilities. Format & audience: Intermountain Fair Housing Council to 14 Board members. 9) Least restrictive community placement training providing information on SSI, SSDI, and Medicaid HCBS Medicaid waivers. Location and Audience: VA hospital to 30 veterans, staff and providers in lecture format. 10) Special education rights training in lecture format to 30 Spanish speaking parents discussing IDEA rights at a IDDC conference.

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 website7,280
5. Publications/booklets/brochures disseminated10,665
6. Other (specify separately)240,748

Narrative

Social Media: Blog hits - 3,498; Facebook "post" hits - 237,250. Articles/publications posted on P&A's blog receiving 3,498 hits included: "Idaho’s Mental Health System and the ADA Integration Mandate” The P&A was asked to provide testimony to the Idaho Advisory Committee of the U.S. Commission on Civil Rights concerning Idaho's mental health system and compliance with the U.S. Supreme Court decision in Olmstead v. L.C.. Testimony was drafted and submitted by P&A E.D. The testimony document submitted to this advisory council was posted on its webpage blog; "Psychosocial Rehabilitation and the Idaho Medicaid Managed Care Contract". This article focused on the problems being experienced by Idahoans with serious mental illness and children with serious emotional disturbance, in obtaining community based mental health services and supports. The article highlighted the controversy revolving around the authorization of community based rehabilitation services by the state contractor for Idaho’s behavioral health services managed care program, Optum; "Idaho Medicaid Redesign and People with Disabilities: Option 3.5” This E.D. article explained the Governor’s work group on Medicaid redesign’s recommendation to support a “hybrid” version of Medicaid expansion called “Option 3.5”. This article clarified the P&A’s support of this option, since it would still provide access to affordable health care for people in the “coverage gap”, benefiting Idahoans with disabilities, and the state and county budgets. "Comments of DisAbility Rights Idaho on Idaho Medicaid Transition Plan for Compliance with CMS/HCBS Community Integration Regulations". In this article, the P&A E.D. included an introduction summarizing the P&A’s opposition to Idaho’s current plan & transition process and why. He explained that insuring that Idahoans with disabilities having full access to their communities, and control over their lives and homes, is a high priority for the P&A; and believed that Idaho’s approach to this transition should be much broader than the review of current state facility rules. In addition to this introduction, the P&A’s recommendations submitted to Idaho Medicaid were provided further describing concerns identified.

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)3
2. Additional individuals served during the year79
3. Total individuals served (lines A1 + A2)82
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)3

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 5

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility3
2. Employment1
3. Program access17
4. Housing1
5. Government benefits/services41
6. Transportation1
7. Education1
8. Assistive technology0
9. Voting0
10. Health care9
11. Insurance0
12. Non-government services1
13. Privacy rights0
14. Access to records0
15. Abuse2
16. Neglect2
17. Other6

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor71
2. Other representation found2
3. Individual withdrew complaint0
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case7
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit0
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy71
2. Short-term assistance8
3. Investigation/monitoring0
4. Negotiation0
5. Mediation/alternative dispute resolution0
6. Administrative hearings0
7. Litigation (including class actions)1
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 - 228
3. 23 - 5962
4. 60 - 647
5. 65 and over5

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females45
2. Males37

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race7
2. American Indian or Alaskan Native2
3. Asian1
4. Black or African American0
5. Native Hawaiian or Other Pacific Islander0
6. White69
7. Two or more races3
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent57
2. Parental or other family home13
3. Community residential home3
4. Foster care0
5. Nursing home2
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center2
9. Homeless3
10. Other living arrangements2
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment4
2. Deaf/hard of hearing12
3. Deaf-blind0
4. Orthopedic impairment22
5. Mental illness5
6. Substance abuse0
7. Mental retardation2
8. Learning disability3
9. Neurological impairment9
10. Respiratory impairment2
11. Heart/other circulatory impairment6
12. Muscular/skeletal impairment6
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability11

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities8

2. Number of individuals potentially impacted by policy changes67,112

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) In response to a bill introduced to the Idaho Legislature which would have eliminated eligibility for indigent health care assistance for people in households with income above the federal poverty level, P&A Executive Director (E.D.) collaborated with the Consortium of Idahoans (CID) and the Partners in Crisis Coalition opposing this bill. He prepared and provided an analysis educating Idaho legislators on how people with disabilities would be adversely affected by this bill. In a Boise Statesman article published on February 1, 2015, the Governor’s Medicaid Redesign Work Group estimates that 78,000 uninsured adults in Idaho fall within the insurance coverage gap unable to access health care coverage because they are ineligible for Medicaid but too poor to qualify for tax credits to access private insurance through the Idaho Insurance Exchange. A percentage of this total are individuals that have already qualified for Social Security Disability Insurance (SSDI) but still within the 24 month waiting period for Medicare coverage to begin. According to a recent study of the Idaho County Indigent Program, roughly 42% of the 5000 applicants in 2014 (calculated to roughly 2100) were people that were Social Security recipients with no health care coverage. This study was conducted by Dr. Douglas Dammrose and can be located at (http://www.healthandwelfare.idaho.gov/Portals/0/Medical/MoreInformation/08-14-2014%20Medicaid%20Redesign-Idaho%20Doug%20Dammrose.pdf). Furthermore, Medicaid expansion would cover the 10,0000 Idahoans with mental illness (according to Idaho NAMI statistics) that fall within this gap. County indigent health care assistance is the only funding source that pays for medical and mental health treatment for this population when in crisis. 2) The Idaho Department of Health and Welfare (IDHW) sought budget authority to establish a second mental health crisis center which would provide crisis treatment and care coordination for Idahoans with mental illness in crisis that are uninsured. The P&A continued its collaboration with Partners in Crisis Coalition and CID and the E.D. prepared and presented an analysis in support of this initiative to the Joint Finance Appropriations Committee. This budget measure was approved by JFAC and the second crisis center will be established increasing treatment access to the 10,000 people with mental illness in Idaho without insurance coverage. 3) Two issues affecting people with disabilities arose during this year in the Medicaid managed mental health care contract. MCO, Optum Idaho, systematically reduced authorizations for psychiatric rehabilitation services (PRS) for people with intellectual disabilities, and also for children in general, including children with serious mental illness. The P&A conducted research on APA and AACAP treatment standards and provided this information to providers, Medicaid officials and the public (through the P&A online blog) to assist in discrediting Optum’s reduced PSR authorizations and to justify appropriate PRS authorizations. The P&A participated with IDCC, CID and Partners in Crisis in forming a CID subcommittee to monitor Optum’s contract. The P&A E.D. provided information to legislators about the contract performance which resulted in a resolution to have the contract reviewed by the Legislature's Office of Performance Evaluation (OPE). The OPE report will be available in January of 2016. Optum’s April 2015 Quarterly report shows that it is authorizing behavioral health services for approximately 16,000 children and adults with serious mental illness. 4) The P&A collaborated with child advocate organizations in getting a bill passed requiring schools to train employees on bullying and requiring schools to intervene when school employees are aware of bullying. The P&A E.D. drafted and presented to legislators an analysis providing information and data on bullying and children with disabilities, who are often victims. According to data collected for IDEA 2011 Child Count and the 2010-11 Common Core of Data (CCD), there are 23,485 children in public schools in Idaho between the ages of 6-21 receiving special education services. 5) The P&A E.D. met with Medicaid officials and negotiated changes to the state rules for Medicaid cost sharing which will allow A&D waiver participants an increase in their personal needs allowance (PNA) up to 180% of SSI levels. This is $214/month more than they now receive, and it will rise with SSI COLAs. IDHW planned on proposing its rule change to its legislative committees in the house. However, IDHW was later directed to submit to the JFAC committee first since it is a rule change that has budgetary implications. The P&A will monitor this rule change to determine if further advocacy is needed. The IDHW Public Records Coordinator reported that there were 7,858 A&D waiver recipients in 2014. 6) The P&A has became increasingly concerned during FYs 2014 and 2015 with department designees providing oversight to committed persons placed into the custody of the Department’s Director. From case work, the P&A identified several incidents in which department designees were utilizing authority similar to that granted under the guardianship statutes rather than the authority allowed under the Idaho commitment statues. This misunderstanding/misuse of authority resulted in rights restrictions on behalf of clients (within most regions) such as removing rights guaranteeing private phone use, visitation, privacy with receiving mail, participating in treatment decisions, and providing consent on their own behalf. On one occasion after opening a case to conduct an abuse allegation investigation on behalf of a 64 year old male with a DD, committed and placed into a private ICF/ID, the P&A realized that the client never received his letter with the service agreement and release forms enclosed for his signature and sent by mail. The P&A advocate contacted the facility and inquired if the client received the letter sent. She was informed that the client’s P&A letter was never received. Another letter with the forms was sent and when returned the forms were signed by the commitment designee (referred to as commitment custodian), not by the client. After receiving legal consultation, the advocate contacted the custodian informing that her signature wasn’t sufficient and explained that the client had the right to provide consent since he didn’t have a legally appointed guardian. The advocate was referred to the department’s Regional Deputy Attorney General (DAG). The P&A Legal Director (L.D) promptly contacted this DAG, presented the P&A’s concerns and her analysis of the commitment statutes. Shortly after, the advocate was directed to resend the forms and the client signed and returned the forms. This misunderstanding hasn’t occurred in this region since. Additionally, the L.D. met with the department’s head DAG, discussed this practice and has been assured that all regional offices will receive instruction clarifying their roles and the rights that people retain while committed. The P&A has not received additional reports of these types of rights restrictions after the negotiations occurred but is still monitoring this issue. According to the 2014 Idaho Supreme Court annual report “The Idaho Judiciary”, mental commitments have increased by over 80% over 5 years and more than 5,000 were filed in 2014 speculated to be a result of behavioral health service reductions. 7) The P&A’s efforts to promote the rights of people with disabilities who are or maybe subjected to guardianship and conservatorships is beginning to show a systemic impact. Its guardianship priorities for several years have been designed to protect against abuse, to promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship; and to promote the least restrictive appointments as well as alternatives. In the FY2015 priorities, an objective was added to promote the implementation of the supported decision making model as a mandated consideration in the statutes as well as encouraging the practice of utilizing this model. The P&A Legal Director continued her membership on the Idaho Supreme Court committee on Guardianships and Conservatorships, participated on its Rules subcommittee to influence statutory change that better protects the rights of people with disabilities; and helped to create, and participated on, its Supported Decision Making subcommittee in efforts to implement this alternative into guardianship proceedings. During FY2015, the P&A represented four (4) individuals in guardianship proceedings incorporating these ideals. It represented a young woman under a full/plenary guardianship and conservatorship who wanted to terminate her guardianship. A county Board of Community Guardians was appointed as her guardian and conservator. The P&A filed a Petition to Terminate the guardianship and conservatorship in lieu of setting up a supported decision making team. The court terminated her guardianship and conservatorship. This client now has a functioning supported decision making team, has moved out of a residential assisted living placement and lives in the community with the supports and services needed for independence. Instead of a conservator, she now has a representative payee. The P&A L.D. provided her Supported Decision Making presentation to a county Board of Community Guardians. This Board had heard about the P&A’s efforts and requested this presentation. It wishes to terminate some of its clients’ guardianships in lieu of developing a supported decision making team. The P&A informed this board that additional guidance can be provided, if needed. This systematic change could improve the quality of lives for many Idahoans. The Idaho Supreme Court Guardianship Monitoring Coordinator confirmed in 2014 that there were 2,669 adults, the majority with full/plenary guardianship types. 8) The Idaho Bureau of Homeland Security (IBHS) asked the P&A to participate in a work group to review and provide suggestions for the Idaho Home Land Security's Emergency Operations plan section Emergency Support Function (ESF) 6-Mass Care, Emergency Assistance Housing and Human Services. The PAIR Coordinator attended this meeting and identified concerns with the current plan equating service animals as pets and not requiring that they be allowed to accompany their owner in emergency shelters. PAIR Coordinator requested the Legal Department provide an analysis of federal requirements. The Legal Department provided language located from the US Department of Justice, American’s with Disabilities Act division article entitled: “The ADA and Emergency Shelters: Access for All in Emergencies and Disasters” specifying that service animals must generally be allowed to accompany its owner anywhere other members of the public were allowed to go; and that emergency shelters must modify “no pet” policies to allow people with disabilities to be accompanied by their service animal. This language was incorporated into the ESF 6 revised plan. Additional systemic activities completed during FY2015 are discussed throughout Part V. PAIR’s Priorities and Objectives.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts7,766
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 six (6) current cases (but no class actions) involving litigation. Summaries provided below: 1) The P&A has been litigating since 2012 on behalf of a 56 year old deaf, Caucasian inmate at the Idaho State Correctional Institution (ISCI), to assist with accessing effective communication outside of the prison. All of his deaf contacts had upgraded to videophones and the prison would only offer the use of a TTY. Several requests to access a videophone in order to effectively communicate had been denied by Idaho Department of Corrections (IDOC) officials. Furthermore, the TTY did not allow him to speak in his primary language, American sign language, whereas a videophone would. P&A staff attorney filed a lawsuit in the Federal District Court for the District of Idaho on January 23, 2012, alleging that IDOC officials/defendants violated the Americans with Disabilities Act of 1990 as well as the Rehabilitation Act of 1973. The P&A represented the client at three judicial settlement conferences without any settlement being reached in the matter. During FY2014, the P&A successfully filed a motion to strike defendants’ request for a jury demand, setting the case for a five-day bench trial to begin on January 20, 2015; and the P&A successfully opposed a motion by defendants to continue the trial until spring or summer of 2015. During FY2015, shortly before trial was to begin in this matter, IDOC presented to the P&A and its client an offer for settlement, which was accepted by the client. OUTCOME: Pursuant to the terms of the settlement, IDOC agreed to provide client with access to a videophone, including Video Relay System, no later than January 7, 2015. Due to technical limitations on the IDOC network, client’s access to the videophone was initially limited. In June, 2015, IDOC’s network issues were resolved and the client was allowed access to the videophone during the same times and duration as other offenders are allowed telephone use. As a result of this settlement agreement, the case was dismissed with prejudice and the P&A received attorney fees. On July 8, 2015, the P&A received confirmation from both the client and defendants that all terms and conditions of the settlement agreement had been met so the case was closed. As a result, of this litigation, IDOC now has its network compatible for the use of video phones and has a contract with the video relay system. This should allow all deaf inmates in Idaho prisons access to video phones when requested. IDOC reported to the P&A that there are 2 inmates identified as deaf within the client’s prison and other deaf inmates currently incarcerated within the entire Idaho prison system but never provided a total. 2) During F 2014, the P&A conducted an abuse and neglect death investigation on behalf of a woman who committed suicide at a behavioral health while detained on a mental hold. While conducting this abuse investigation, the P&A encountered records access denials by both the hospital and the county coroner’s office. The coroner denied the P&A request for access to the client’s autopsy records; then suing the P&A in state court requesting that the court do an in camera review to determine if the coroner’s office was required to produce the records. The P&A litigated removing the action to federal court and filed a counterclaim for access to the requested records. The coroner attempted to have the case remanded to the state court, but was denied. Both the death investigation case and the resulting coroner’s denial to access records case were carried over to the next FY. During FY2015, both parties proceeded to file motions and briefs for summary judgment. The Department of Justice filed a Statement of Interest in support of the P&A. The case has been fully briefed and the parties are waiting to see if the court would like oral argument or if it will issue a decision on the briefs during FY2016. This death investigate and the resulting access denial litigation potentially effects over 5,000 Idahoans yearly placed on mental holds for the purpose of keeping them safe. According to a Boise State University PBS radio investigation, data collected from the Idaho Division of Behavioral Health revealed that there were 5,095 persons in Idaho that were put on holds during 2014 and 5,056 Idahoans placed on mental holds during 2013. 3) During FY2014, the P&A began representing a young, 19 year old female with a developmental disability and a mental illness diagnosis who was wanting to have her full guardianship and conservatorship terminated. Her mother had been appointed as her full guardian and conservator (G/C) when she was 17 or 18 years old also serving as her representative payee. Although the young woman was very high functioning, had a driver’s license, was managing her own personal spending money from her earned wages, made her own medical appointments and managed her own medications, graduated high school, attended classes at Boise State University, and had been working part-time for several months, her guardian/conservator refused to step down/terminate and was extremely controlling of the young woman. After the P&A agreed to represent their client and filed a petition to terminate the guardianship and conservatorship on her behalf, her guardian became more controlling. She took away the client’s ability to manage her own finances by taking her earned income and only providing on an as-needed basis. The P&A successfully petitioned to have the client transferred from a probate code guardianship to a developmental disability guardianship resulting in the judge appointing the Guardianship Evaluation Committee to interview both the client and the G/C. This Committee recommended that the client’s full guardianship be terminated, that a limited guardianship be put in its place for the duration of one year and then re-evaluate the need for even a limited guardianship. The Committee also recommended that her mother not be considered for the limited guardian role suggesting a neutral, third party be appointed as both the limited guardian and as the representative payee. As a result of the Committee’s recommendations and the assistance of DRI, the court agreed to terminate the full guardianship and conservatorship and appoint a third-party, professional guardian as the limited guardian for the duration of one year. As a result of DRI’s involvement, client is now living on her own and has had almost all of her decision-making abilities restored. It is anticipated that if all goes well, client will be able to have her limited guardianship terminated in one year, resulting in her regaining all of her decision-making abilities. This case was carried over to FY2016 since the review hearing is scheduled for September 2016, to re-evaluate whether a limited guardianship is still needed or if client can have all of her rights restored at that time. 4) This litigation involved a previous P&A attorney who was originally appointed as guardian ad litem for a woman with developmental disabilities in her guardianship and conservatorship case in 1995 when she was 39 years old. When that attorney retired in 2014, another P&A staff attorney was substituted in her place as guardian ad litem when the client was 59. After taking over the case, the attorney discovered that the woman’s conservator and co-trustees had been charging a large amount of fees, resulting in her conservatorship and supplemental/special needs trust running out of funds. Additionally, the conservator and co-trustee went and secured a $20,000.00 loan/encumbrance on the woman’s property in order to have funds available to continue to pay their fees, without any sort of plan or ability to repay the loan. The P&A attorney became increasingly concerned that the woman’s home may be lost in foreclosure proceedings if the loan was not repaid. She filed three separate guardian ad litem reports to the court to express her concerns about the unreasonable fees and loan. Current P&A attorney appeared on behalf of the client at multiple hearings held in April, June, and September 2015 regarding whether the current conservator and current co-trustees of the client’s trust acted appropriately. Closing arguments from those hearings were due on October 30, 2015. The judge entered an order on November 13, 2015, finding that the conservator and co-trustees acted inappropriately in regards to the $20K loan they placed on client’s home and has ordered that they repay the trust with any monies applied to their own interest, such as the fees associated with getting the loan in the first place (real estate fees, loan support fees) and the monies they spent paying themselves (their fees and attorneys fees paid from the loan). It is possible that the parties may file motions to reconsider this decision, which will require more attorney involvement from the P&A. The P&A continues as her GAL. 5) The P&A became involved in July of 2015 after being referred by the Idaho Department of Health and Welfare (IDHW), which had been investigating allegations of Medicaid fraud committed by an individual’s co-guardians and co-conservators. The individual, a 24 year old man with developmental disabilities, had reported to IDHW that his co- guardians and co-conservators were billing and being paid from his DD Medicaid waiver budget for time that they were not actually spending with him. He had also reported to the Social Security Administration (SSA) that the co-guardian serving as his representative payee, had been withholding his Social Security funds from him for several months, which prompted SSA to investigate then remove as his representative payee. Additionally, the individual discovered that his guardians and conservators had opened utility accounts (power, gas) in his name for their own personal residence and then left the bills unpaid, causing him to go to collections. As a result, he wanted legal representation to assist him in having them removed as his guardians and conservators or, in the alternative, having his guardianship and conservatorship terminated. The P&A opened a case providing legal representation for this client filing a petition to terminate the guardianship and conservatorship or, in the alternative, to have the current guardians and conservators removed with someone else substituted in their place. Shortly afterwards, an emergency situation arose in which the P&A attorney was compelled to file ex parte proceedings which resulted in the removal of his current guardians and conservators and the appointment of a temporary emergency guardian and conservator in their place. This case was carried over to FY2016 since the next hearing is scheduled in December 2015 and still pending. 6) During FY2015, the P&A opened a case providing legal representation on behalf of a 28 year old Caucasian woman with mental illness who had filed a petition to terminate her guardianship. A county Board of Community Guardians had been appointed as both her guardian and conservator. The P&A litigating this case helped the client present to this Board how a supported decision making team could meet her needs negating the need for the guardianship and conservatorship. The P&A attorney developed and helped the woman establish a supported decision making team. The county board agreed to stipulate to the termination of the guardianship. OUTCOME: The court signed the stipulation and the guardianship and conservatorship were terminated. This county board has asked the P&A for further guidance in further utilizing the supported decision making model in efforts to terminate additional guardianship and conservatorships, as appropriate. The Idaho Supreme Court Guardianship Monitoring Coordinator confirmed in 2014 that there were 2,669 adults, the majority with full/plenary guardianship types.

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.

Part V. PAIR’s Priorities and Objectives Fiscal Year 2015 PAIR Priorities and Objectives Report 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. 4. None. 5. 40 cases were handled under this priority during FY2015 with 2 carried over to FY2016, but no class actions. 6. One (1) case summary. A 26 year old white female with a neurological disorder/Asperger’s Syndrome contacted P&A requesting assistance with applying for Social Security (SS) disability benefits. She reported that the Social Security Administration’s (SSA) was telling her that she hadn’t worked enough to qualify for Social Security Disability Insurance (SSDI) and had previously told her that she couldn’t apply for Supplemental Security Income (SSI). She wanted to know when she can apply for SSDI and why she was unable to apply for SSI previously. She was confused since her psychologist/counselor insists she is disabled and should qualify. P&A SERVICES: P&A advocate interviewed client and provided information on SSA’s earning requirements and provided its webpage to access the recent and durable work test table/chart. Advocate explained why she didn’t previously qualify for SSI due to income. Information on substantial gainful activity (SGA) was explained and she was encouraged to apply since she wasn’t working and hadn’t earned SGA for almost one (1) year. Provided information in writing on how to apply, SSA’s impairment listings, the five (5) steps SSA follows to determine disability, a physician questionnaire to give to her psychologists to submit with application, and a memo for friends and family on writing a letter of support. The importance of providing medical evidence and ensuring that it is collected and considered was stressed. In case needed, information on preserving appeal rights as well as when attorneys take SS cases and attorney referrals also provided. OUTCOME: The client was provided with strategies, rights information and resources to advocate for accessing 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. 4. None. 5. 0 6. One (1) case summary. No calls for PAIR students concerning service animal access in public K-12 schools were received during FY2015. However, cases were opened under other funding sources. 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. 4. None 5. 27 cases were handled during FY2015 under this priority with one (1) carried over to FY2016 but no class actions. 6. One (1) case summary. Father contacted the P&A on behalf of his 15 year old daughter with diabetes who relies on an insulin pump to regulate her disability. Father requested assistance on her behalf in dealing with a recent issue she encountered with a referee during one of her 8th grade basketball games (school-sponsored team). Referee was concerned about client wearing a pump during her games — claimed that the safety of other players would be at risk (thinking it was full of needles and could potentially spill blood). He told client that she needed to play without the pump, which is not an option. The school’s superintendent became involved and the parties agreed that she would play with the pump taped securely to her body. Father was concerned about this continuing in the future as taping the pump securely to her body actually causes more harm to client by interfering with pump readings and restricting the hose inside, which could cause it to become disconnected if bumped. Father requested a letter or some guidance to provide to the school and referees concerning his daughter’s ability to play with a pump (without having to tape it). P&A SERVICES: Short term assistance (STA)-P&A staff attorney contacted the Office of Civil Rights (OCR) and the Dept of Justice (DOJ). OCR provided P&A attorney with a guidance letter addressing the issue of the rights of persons with disabilities to participate in extracurricular activities (in general). P&A staff provided this guidance letter to the client’s father as well as provided written instructions on how to request a reasonable modification to any rule or requirement that his daughter must tape the pump to her body in order to play. P&A staff also provided client’s father with information on filing complaints with the Department of Justice (DOJ), Office of Civil Rights (OCR) if the reasonable modification request was denied or if daughter was denied the ability to play. OUTCOME: Father was provided with disability rights information, OCR guidance, resources and tools to effectively advocate for the reasonable modification needed for his daughter to participate in extracurricular activities safely. 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. 4. None. 5. One (1) case but no class actions. 6. One (1) case summary. A 56 year old deaf, Caucasian inmate at the Idaho State Correctional Institution (ISCI), contacted the P&A requesting assistance with accessing effective communication outside of the prison, during FY2012. Several requests to access a videophone in order to effectively communicate had been denied by Idaho Department of Corrections (IDOC) Officials. Even though the client had been provided the use of a TTY, none of his deaf contacts outside the prison utilized TTY as they had upgraded to videophones. Furthermore, the TTY did not allow him to speak in his primary language, American Sign Language, whereas a videophone would. P&A SERVICES-Litigation: P&A staff attorney filed a lawsuit in the Federal District Court on January 23, 2012, alleging that IDOC officials/defendants violated the Americans with Disabilities Act of 1990 as well as the Rehabilitation Act of 1973. The P&A represented the client at three judicial settlement conferences without any settlement being reached in the matter. During FY2014, the P&A successfully filed a motion to strike defendants’ request for a jury demand, setting the case for a five-day bench trial to begin on January 20, 2015; and the P&A successfully opposed a motion by defendants to continue the trial until spring or summer of 2015. During FY2015, shortly before trial was to begin in this matter, IDOC presented to the P&A and its client an offer for settlement, which was accepted by the client. OUTCOME: Pursuant to the terms of the settlement, IDOC agreed to provide client with access to a videophone, including Video Relay System, no later than January 7, 2015. Due to technical limitations on the IDOC network, client’s access to the videophone was initially limited. In June, 2015, IDOC’s network issues were resolved and the client was allowed access to the videophone during the same times and duration as other offenders are allowed telephone use. As a result of this settlement agreement, the case was dismissed with prejudice and the P&A received attorney fees. On July 8, 2015, the P&A received confirmation from both the client and defendants that all terms and conditions of the settlement agreement had been met. As a result, this case was closed as no further assistance was necessary. 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. 4. The P&A collaborated with the Special Education Advisory Panel (SEAP), a Regional Child Protection Panel & ICDD in efforts to reduce the use of R&S in Idaho Schools. 5. 0 6. One (1) case summary. No calls on behalf of or from PAIR students regarding concerns of restraint and seclusion were received during FY2015 but cases were opened under other funding sources. A summary of systemic work completed is provided: The P&A developed a technical assistance packet to provide to parents and/or students with disabilities alleging inappropriate restraint and seclusion by school districts. This materials packet provides advice, resources and strategies to advocate in preventing or ceasing the use of unnecessary restraint and seclusion in public schools. The P&A is a member of a regional child protection panel. The panel meets monthly to explore issues with the child protection system and offer recommendations annually to the Idaho Department of Health and Welfare (IDHW). Recommendations are reviewed by IDHW representatives and responses are provided as to whether or not action can/will be taken and if so, what that action will be and then is forwarded to the Governor for review. The P&A proposed that the panel develop strategies to ensure that children in foster care are not re-traumatized by R&S in schools, as well as recommended that CPS staff are trained on the ADA and IDEA. The panel is considering these proposals for the next FY. The P&A is a member of the Special Education Advisory Panel (SEAP). This membership allowed the P&A to educate the panel regarding the harmful effects of R&S and the need for Idaho to regulate its practice. SEAP agreed to provide recommendations to the SED that R&S data should be tracked. 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. 4. None. 5. 0 6. One (1) case summary. No calls on behalf of or from PAIR students regarding concerns of suspension/expulsion violating due process were received during FY2015 but cases were opened under other funding sources. A summary of systemic work completed is provided: The P&A developed a technical assistance packet to provide to parents and/or students to address concerns of suspension and expulsion that violate rights under IDEA or Section 504 of the Rehabilitation Act. This material packet includes rights information, advice, resources and strategies to advocate for due process protections. 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. 4. The P&A is a member of the Idaho Interagency Council on Secondary Transition (IICST) and collaborated with the State Department (SED), Vocational Rehabilitation, Idaho Assistive Technology Project (IATP), the Idaho Council on Developmental Disabilities (ICDD), and providers to facilitate the annual Tools For Life (T4L) conference and to improve transition services for Idaho students with disabilities and Idaho Parents Unlimited (IPUL). 5. 0 6. One (1) case summary. No calls on behalf of PAIR students regarding concerns of inadequate transition services were received during FY2015. A summary of systemic work completed is provided: As a member of the Idaho Interagency Council on Secondary Transition (IICST), the P&A provided staff to participate on the T4L planning committee (discussed further in the outreach report section) as well as participated in projects geared towards improving transition services in Idaho. The P&A joined a pilot project to improve transition and post-school outcomes for deaf students. Pilot project partners include the P&A, the State Department of Education, Vocational Rehabilitation and the Idaho Education Services for the Deaf and Blind (IESDB) task group. The project is in its infancy, and will complete strategy development and activities during FY2016. The P&A is collaborating with the ICDD and the Parents Training Center, Idaho Parents Unlimited (IPUL), updating the “Moving On” binder disseminated to parents and students state-wide. Additionally, the P&A provided facilitators for a National Secondary Transition Technical Assistance Council (NSTTAC) conference/institute in Idaho that occurred during FY2015 sponsored by the Idaho SED. P&A advocates organized groups of teachers and school staff from school districts around the state to develop or revise their transition plans for each district. The P&A was asked to present advocacy and independence related workshops for next year’s institute. Unfortunately, the future of another NSTTAC conference, as well as IICST as a whole, is in question since the SED staff who facilitated and championed these groups took another position, and this position remains unfilled. The P&A will advocate for this position to be filled during FY2016. 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. 4. The P&A collaborated with a private attorney to promote the rights of the ward. 5. One (1) case was handled under this priority but no class actions. 6. One (1) case summary. Grandmother of a 19 year old Caucasian female, diagnosed with auto immune deficiency (non Aids/HIV) and learning disabilities contacted the P&A reporting a possible abusive guardian. The grandmother was aware that her granddaughter had surgery in which the guardian consented and was concerned that she may have been sterilized as believed by the client. P&A SERVICES: The P&A Legal Director (L.D.) reviewed the information that the client's grandmother provided, and contacted the client’s attorney to discuss the report presented. The L.D. provided technical assistance to the client's attorney regarding the matter of a possible sterilization and limitations on a guardian’s authority. The client's attorney attended a hearing on behalf of the client and later reported to the P&A that there were no rights violations regarding the client or her guardian. The judge reviewed the client’s issues and it was clarified at the hearing that the client was not sterilized. Rather, she had an ovary removed as needed medically. OUTCOME: As a result of the P&A's intervention, the client was able to advocate for herself and inform the court that she didn’t want to be sterilized. 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. 4. None. 5. One (1) case was handled under this priority but no class actions. 6. One (1) case summary. A 22-year-old Caucasian male diagnosed with seizures and PTSD under a full guardianship contacted P&A requesting a Declaration of Mental Health Treatment form to file with his termination petition. The P&A determined that he didn’t meet PAIMI criteria, for this issue. He had previously received a guardianship termination packet from the P&A and was informed that it would be helpful to include a Declaration of Mental Health Treatment form with his petition to show that during intermittent periods of crisis he would receive the treatment needed. P&A Services-Short term assistance (STA): P&A advocate requested a consultation with a staff attorney who located the Idaho Code explaining the statutory requirements for the form and a copy was provided. The advocate also located a sample form and provided the client a copy as well as providing him with the webpage to access additional copies, if needed. The advocate located guidance for form completion in Idaho off the NAMI website and provided client a copy. OUTCOME: The P&A provided the client with the resources and guidance needed to assist in advocating to terminate his guardianship. 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. 4. Judges, private attorneys and the Idaho Guardianship Monitoring Board Director participating on the Idaho Supreme Court Guardianship/Conservatorship Committee formed to better protect people with guardians and conservators in Idaho. 5. Class Actions? None since not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A Legal Director (L.D.) is a member of the Idaho Supreme Court Committee on Guardianships and Conservatorships. Through this membership, she has promoted the rights of people with disabilities by influencing this committee to evaluate the Idaho Magistrate’s court practice of primarily appointing full guardianship and conservatorships even though the Idaho statutes encourage the use of lesser restrictive alternatives. She has encouraged the committee to consider lesser restrictive alternatives such as the supported decision making model. She has successfully educated the committee on how restrictive full/plenary guardianships tend to be since they provide a legal mechanism that potentially removes all rights and decision making opportunities from people with disabilities under full guardianship and places them under the authority of the guardian, which are often abused/misused. In addition to the Idaho Supreme Court Committee, the P&A L.D. participated on its Rules Subcommittee. This subcommittee recommended to the full committee that the court visitor and the IDHW Evaluation Committee statutes be altered to ensure that necessary information needed by the court is included in the reports. Proposed language was drafted, submitted, comments collected and the final draft was completed this FY. Other recommendations by this subcommittee and later approved by the full committee included drafting forms and guidelines to assist judges and participants in the use of alternatives, and providing training and outreach to stakeholders. The guideline for judges was drafted and finalized during FY 2015. During this FY, the L.D. also developed and presented training to the full committee on supported decision making and its possible implementation in Idaho. After this training, the full committee created a Supported Decision Making Subcommittee. The L.D was appointed to this subcommittee and information on work completed is provided below in Objective 2. 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. 4. The Idaho Supreme Court Committee on Guardianships/conservatorships and its Supported Decision Making subcommittee in efforts to implement this lesser restrictive alternative in the Idaho. 5. 0 cases were opened on behalf of PAIR clients this FY but the P&A represented a client (under another funding source). 6. One (1) case summary. A summary of systemic work is provided: A Supported Decision Making subcommittee of the Idaho Supreme Court Committee on Guardianship and Conservatorships was formed after the P&A. L.D. provided a presentation. It was determined it was necessary to identify recommendations for implementation of this lesser restrictive alternative in Idaho. The P&A L.D. was asked to participate and provide guidance. This subcommittee reviewed extensive materials and identified recommendations for implementation in Idaho which included: provide the court, stakeholders and the public with training on supported decision making as an alternative to guardianship and limited guardianships and appropriate entities to train were identified; create resources such as forms, benchmarks and checklists for limited guardianships; continue to evaluate recommendations for modification of current statute and court rule to transition from a substituted decision making standard to a standard that is focused on the preferences of the person and providing support in areas in which the person needs assistance in decision making; locate resources to assist appointed guardians ad litem and court visitors to report on areas of functioning and to better provide the court with information to tailor lesser restrictive guardianship and conservatorship orders. This subcommittee presented to the full committee its recommendations and the P&A L.D. provided an overview of the supported decision making model providing information on why a discussion on decision making is important during guardianship proceedings; legal requirements to consider, the need to better define capacity, and highlights of supported decision making models used in other states and countries. The P&A L.D. provided the supported decision making presentation to the Bannock County Board of Community Guardians. This Board had heard about the P&A’s efforts and requested this presentation. It wishes to terminate some of its clients’ guardianships in lieu of developing a supported decision making team. The P&A informed this board that additional guidance can be provided, if needed. The P&A represented a young woman under a full/plenary guardianship and conservatorship who wanted to terminate her guardianship. A county Board of Community Guardians was her guardian and conservator. The P&A filed a Petition to Terminate the guardianship and conservatorship in lieu of setting up a supported decision making team. The Court terminated her guardianship and conservatorship. This client now has a functioning supported decision making team, moved out of a residential assisted living placement and lives in the community with the supports and services needed for independence. Instead of a conservator, she now has a representative payee. 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. 4. None 5. Five (5) cases were handled under this priority but no class actions. 6. One (1) case summary. A 52 year old female residing in rural location with an auto-immune disorder/Lupus contacted P&A requesting assistance with a Medicaid denial of transportation services to desired provider. P&A SERVICES: Technical assistance was provided explaining the timeliness to secure appeal; how to obtain a written denial if not provided; access to the Administrative Code regarding Medicaid transportation and the rules for filing an appeal; advantages of asking for an informal conference and/or a pre-hearing conference; specific suggestions for additional information to submit, strategies when attending the hearing; and options to pursue if hearing is not successful. OUTCOME: The client received the information, strategies and access to resources needed to advocate on her own behalf. 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. 4. None. 5. Three (3) cases were handled under this priority but no class actions. 6. One (1) case summary. A 51 yr old Caucasian woman with mental illness contacted the P&A after being referred by a center for independent living (CIL) regarding problems with eligibility for Medicaid for Workers with Disabilities (MWDs) program. P&A determined that this client didn’t meet the eligibility criteria to be served under PAIMI for this issue, therefore served the client under PAIR. Client applied for MWD in late 2011, was denied, and went through the appeals process, (with P&A representation at a Medicaid hearing), and was denied at director review. However, an appeal to court wasn’t filed at that time due to a lack of resources/funding. Reason for denial was she did not meet SSA definition of disability because she was working at same job/level for several years. Disability Services Unit did not take into account her primary field of training and past work experience as a teacher, which she could no longer do because of her disability and was currently working as telemarketer. P&A SERVICES: P&A advised the client to reapply and was given forms and resources, including SS impairment listings, physician's questionnaires, and strategies on how to focus issue on how she cannot to do past relevant work (teaching) and that she is now having issues with her current job due to disability. She is currently insured, but seeks MWD to help with premiums and other out of pocket costs. After being provided with technical assistance she was referred back to CIL for help with re-application and with instructions to contact P&A if denied again. OUTCOME: Client’s issues were examined by P&A legal department in which a systemic issue was identified and proposed for consideration in 2016 FY priorities. The client received advice, program information, asset requirements, strategies and needed resources including MWD application, and SS disability report forms and physician questionnaires to advocate on her own behalf to advocate MWDs program access. She was directed to contact P&A again if her new application is denied. 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. 4. None 5. 0 since not case driven. 6. One (1) case summary. A summary of systemic work is provided since not case driven: The P&A has advocated for improvements to the application and eligibility process for the MWDs program for several years. Systemic issues previously identified and primarily resolved included: IDHW workers not allowing applicants to apply for the MWDs program due to misunderstanding of program requirements and inadequate training; and Idaho Disability Determination Services (DDS) not being trained on the MWD program. The P&A met with SILC staff, IDHW and DDS administrators to discuss barriers and negotiate remedies. The P&A also developed a TA packet for clients providing strategies that addressed barriers preventing applicants from applying; and providing program information, advice, strategies and resources to assist with the eligibility process. However, the P&A was still receiving calls primarily from non-SS beneficiaries reporting that their applications were denied. After meeting with a client and the CIL, the Advocacy Director (also a licensed attorney) reviewed SSA policies and the Idaho rules governing MWD. The SSA medical criteria for people with mental illness creates a catch-22 in that the primary way to show their mental illness is severe enough to qualify as a disability is if they do not work; which conflicts with the MWD program requirements that applicant must work. Therefore, individuals with MI who have never stopped working and never qualified for SSA disability benefits have no legal recourse. Due to a lack of resources, the P&A was unable to complete research needed to identify a legal remedy. This issue was approved as a carry-over priority for FY2016 but will be funded though PAIMI funding only. 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. 4. P&A worked with the State Education Department (SED), Idaho Vocational Rehabilitation (IDVR) , the Idaho Council on Developmental Disabilities (ICDD), Idaho Assistive Technology Project (IATP), providers and businesses, school district administrators and teachers in efforts to improve transition services and outreach to Idaho transition aged students. Collaboration discussed below. 5. 0 cases were opened under this priority since not case driven. 6. One (1) case summary. A summary of outreach activities is provided since not case driven: P&A participated on the Tools for Life (T4L) planning committee to facilitate this annual conference which provides training and outreach to transition aged Idaho students. Its partners included representatives from SED, IDVR, ICDD, IATP, providers and businesses. Planning included selecting break-out topics, 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. P&A participated at the T4L conference located in northern Idaho. P&A provided four (4) training sessions on transition planning, self-advocacy/guardianship, SS Work Incentives and accessible voting access. P&A also had a display booth providing information about the P&A and its services. There were over 300 attendees, primarily transition age students, some parents, agency representatives, and service providers. P&A provided transition planning training to two (2) classes at an eastern Idaho high school to students receiving special education services and teachers. A presentation on appropriate transition and life planning was provided as well as information about P&A services. The Idaho Department of Labor, the Blaine County School District, and the Idaho Division of Vocational Rehabilitation facilitated a transition fair/conference for high school students with special needs for a county school district called the High School Career Exploration Project and asked the P&A to participate. Life skills and job development skills training and information were provided. The P&A provided transition planning training focusing on accessing employment supports, services and supports, and work incentives information as well as information about P&A and its services. P&A staff participated as facilitators for school district teams state-wide at a NSTTAC (National Secondary Transition Technical Assistance Center) Institute put on in Idaho. Teams were provided with data from the SDE on transition statistics and were tasked to develop plans on next steps to improve transition for students. Facilitators provided guidance on the NSTTAC process to keep teams moving towards their end goal of a plan. Workshops were provided. 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. 4. Veterans Affairs (VA) staff who helped with facilitating outreach and disability rights training to veterans and the Idaho Volunteer Lawyers program that hosted a veterans legal clinic. The P&A outreached to Spanish parents at an ICDD sponsored event to provide information about the P&A and special education service training. 5. 0 cases opened under this priority since not case driven. 6. One (1) case summary. A summary of systemic work completed is provided: P&A attorney met with staff from the Idaho VA and an Idaho Volunteer Lawyers Program (IVLP) attorney with the ABA Home Front Project serving Idaho veterans. Information about the P&A and its services were provided. The P&A participated at a IVLP sponsored veterans legal clinic. P&A attorney provided legal consultation to veterans regarding disability rights and information about the P&A and its services. The P&A developed and provided two (2) disability rights trainings to veterans at the Boise VA Medical Center, as requested by VA staff. The P&A was also able to provide information on the P&A and its services. P&a PAIR/PATBI Coordinator contacted the local VASH (Veterans Affairs Supported Housing) administrator and provided information about the P&A and its services and clarifying when appropriate to provide referrals to VASH. The P&A outreached to Hispanic parents at an ICDD sponsored event discussing the P&A and its services as well as providing training on IDEA protections and how to advocate for appropriate special education services. The P&A met with an Amigas-a Latino organization serving the Latino community to provide information about the P&A and its services. Collaborative efforts were identified. The P&A Advocacy Director is on the Board of Directors for the Women of Color Alliance (WOCA), a non-profit organization that provides support and education for women of color in Idaho to overcome racial oppression, and build alliances and economic independence. WOCA serves as a recruitment source to bring more people of color into the disability field/community resulting in the WOCA Executive Director serving on the P&A’s PAIMI Advisory Council (PAC). This Alliance has several hundred members throughout Idaho and surrounding states including many Idaho Native American tribal members. P&A Advocate met with elders and the tribal council chairman from the Shoshone Bannock Tribe providing information about the P&A and its services. Outreach to this reservation has been approved and planned for FY 2016. 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. 4. The ICDD, State Independence Living Council (SILC), the Northwest ADA, and state wide CILS on the 25th ADA Anniversary Celebration event planning committee event titled “Hands Around the Capitol”. 5. 0 cases opened under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: In addition to the outreach discussed above, the P&A participated at events targeted for the disability community and conducted several trainings allowing the P&A to outreach increasing community awareness about its services. The P&A participated at the Disability Advocacy Day event at the Idaho Capitol by providing its display booth. Nearly 150 people attended this event. 50 attendees comprised of people with disabilities, providers and legislators requested additional information about the P&A and its services. The P&A participated on the planning committee for ADA 25th anniversary titled “Hands Around the Capitol”. P&A also provided staff to help facilitate the event and set up its display booth. Approximately 400 people with disabilities, family members, agencies, providers, legislators and media attended this and P&A brochures were disseminated. Nearly 150 people stopped at its booth requesting additional information about the P&A and its services. The P&A conducted trainings in the community statewide throughout FY2015 (described in Part 1.B). These trainings were provided to people with disabilities, family members, disability agencies, providers, legislators, IDHW & Idaho Vocational Rehabilitation (IDVR) administrators & staff, civil rights agencies, legal organizations, court clerks, judges, attorneys, CILS, and state facilities residents, administrators and staff. As a part of any training conducted, the P&A uses these opportunities to educate the community about the P&A and its services. 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. 4. The P&A collaborated with CID, Partners in Crisis, the Idaho Council for the Deaf and Hard of Hearing (ICDHH), health care providers and associations, and child advocate groups to address legislation effecting people with disabilities in Idaho. 5. 0 cases were handled under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A monitored all disability rights legislation introduced in the 2015 session of the legislature. The P&A E.D. educated the legislators by preparing analyses of the effect on people with disabilities regarding the following four (4) proposed bills: 1) American Sign Language interpreter licensing: P&A E.D. provided information to legislators on how a bill to require licensure for American sign language interpreters would affect people with disabilities and explained the current problems faced by people who are receiving inadequate interpreter services; 2) Indigent health care changes: a bill was introduced which would have eliminated eligibility for indigent health care assistance for people in households with income above the federal poverty level. The E.D. provided information on how people with disabilities who would be adversely affected by this bill. Even though the bill passed the House it was defeated in the Senate committee; 3) A bill was introduced requiring schools to train employees on bullying and requiring schools to intervene when school employees are aware of bullying. The P&A assisted child advocate organizations by completing and providing an analysis of information and data on bullying and children with disabilities. The bill was passed. 4) IDHW sought budget authority to establish a second mental health crisis center which would provide crisis treatment and care coordination for people experiencing a mental health crisis. The E.D. provided an analysis in support of this initiative and the budget measure was approved by JACO, the legislative budget committee. A summary of systemic work completed is provided: 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 below. 5. 0 cases were handled under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: 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 FY2015 guiding its public policy agenda; he continued his membership on Partners in Crisis which is a mental health policy group addressing and monitoring Idaho’s coordinated care system and its contracted provider, Optum presenting concerns to Idaho legislators. 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 participates on many IDHW sponsored committees including: the IDHW Committee on DD Service Access addressing issues in children’s developmental disabilities service delivery system; the Adult DD Services Collaborative Work Group providing recommendations under consideration by IDHW for revising its budget process; the Personal Assistance Oversight Committee addressing issues with HCBS Medicaid Waivers; and continues his membership on the Idaho Medicaid Care Advisory Council reviewing state Medicaid policy and providing comments on proposed rules and implementation. He is a leading member of the of the Idaho Health Care for All/Close the Gap Committee significantly impacting and guiding this initiative; and on the Board of Directors for the Idaho State Independent Council (SILC) and ICDD. The PAIR/PATBI Coordinator remains as a member of the 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). She was chosen to participate on the Councils’ sub-committee addressing concerns with the lack of uniform assessments for RALF admissions resulting in inappropriate placement and a high number of involuntary discharges. She is on the Board of Directors for the Brain Injury Alliance of Idaho advocating for the rights of persons with brain injury and prevention and chairs a BIAD sub-committee developing materials to help post graduate students access reasonable modifications and auxiliary aids and services. She participated on an Idaho Bureau of Homeland Security work group to review and provide suggestions for the Idaho Home Land Security's Emergency Operations plan section Emergency Support Function (ESF) 6-Mass Care, Emergency Assistance Housing and Human Services; and was a member of the Idaho Functional Needs Preparedness work group developing an annex to the Idaho Emergency Operations Plan (IDEOP) addressing functional needs of persons with disabilities in Idaho’s emergency preparedness planning. The P&A is a member of the Idaho Justice Alliance for Adults, a coalition supported by the Commission on Aging addressing issues effecting the lives of vulnerable adults. The Advocacy Director (A.D.) continues membership on the Women of Color Alliance Board of Directors providing support and education on voting rights, systemic issues and recruitment to the P&A board. She is on a U.S. Commission on Civil Rights-Idaho Advisory Panel meeting biannually to discuss issues impacting civil rights in Idaho; and she participated on this panel’s disability sub-committee that developed a project to assess Idaho’s compliance with the Olmstead integration mandate with regards to Idaho’s adult mental health system; and is on the Board of Directors for the NW Social Justice Fund. The A.D. participates on a regional Keeping Children Safe Child Protection Services (CPS) Citizens Panel providing input on how to improve the child protection system; the dangers of school districts restraining and secluding foster care children. This panel agreed for the P&A to provide training to child protection staff regarding parents with disabilities rights to access services and accommodations to help with parenting to occur during FY2016. She continued as President of the Board of Directors for the Intermountain Fair Housing Council reviewing 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 A.D. as the 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 2015 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: 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. The P&A Legal Director (L.D.) was appointed to and is a leading member of the Idaho Supreme Court authorized Guardianship Committee evaluating the strengths and weaknesses of the Idaho guardianship statutes. She is also on the Rules subcommittee to enact statute change and she help enact and is the lead for the Council’s new Supported Decision Making Subcommittee identifying steps to incorporate this less restrictive alternative into the Idaho statutes as a required consideration. A staff attorney is on the Idaho State Bar Diversity Section that emphasizes improving diversity related issues such as cases involving racism, and the bill of rights; and she is on the sub-committee called “Love the Law” encouraging minority and disadvantaged youth to explore law as a future career. The P&A Advocate Supervisor is on the State Department of Education Advisory Panel (SEAP) assisting the State Education Department (SED) in addressing the needs of students receiving special education services. 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 and was a member of the T4L planning committee . The P&A supports and advocates for self determination initiatives and serves on the Self Advocacy Leadership Network’s Executive Committee; participated on a work group planning committee facilitating the Idaho Utah Self Advocacy Summit occurring during FY2015. The monitoring advocate for State Hospital South, one of the state operated institutions, is a member of its Patients Rights Committee.; and the P&A participates on a regional adult mental health council monitoring changes within the adult mental health delivery system. 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; educate the community regarding the dangerous practice of restraint and seclusion in 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 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. 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 4. CID, Close the GAP initiative which includes a broad coalition of health care providers, health care consumer advocates and child advocate groups, and the Idaho Association of Counties in efforts to get a Medicaid expansion bill passed. 5. 0 cases were opened under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A E.D. produced an article, and two PowerPoint presentations on people with disabilities who are in the health insurance gap and presented to various forums state-wide, as well as to legislators. DRI also produced two articles on Medicaid expansion waiver proposals. These papers have been cited by blue ribbon panels appointed by the Governor in recommending that the legislature adopt a plan to close the gap. The information in these papers/blogs and Power Points has been used by advocates for Close the Gap, state officials and legislators who want to adopt a plan. This initiative is gaining momentum and the P&A has carried this priority over to FY 2016. 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. 4. None. 5. 0 cases since not case driven. 6. One (1) case summary. A summary of systemic work is provided: DRI Executive Director met with Medicaid officials and negotiated changes to the state rules for Medicaid cost sharing which will allow A&D waiver participants a personal needs allowance (PNA) of 180% of SSI levels. This is $214/month more than they now receive, and it will rise with SSI COLAs. 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. 4. None. 5. 0 cases were opened under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A continued ongoing negotiations with IDHW during FY2015. Although Idaho has not adopted new rules on this issue yet, IDHW has modified its practices to allow people on the A&D waiver to use their state plan services before using HCBS services, reducing their share of costs. However, implementation has been uneven and more P&A negotiation is needed and still occurring. This priority is carried over to FY2016. 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. 4. The P&A E.D. provided his analysis of concerns regarding Idaho’s Transition plan for compliance with CMS Medicaid HCBS new regulations to ICDD, the Commission on Aging and NAMI of Idaho to assist with their advocacy on this issue. 5. 0 cases were handled under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: DRI's Executive Director attended monthly meetings at an IDHW sponsored stake holders group; and he provided extensive comments on Idaho's implementation plan for HCBS rules. These comments pointed out that the main factors limiting choice and integration were, rates, budget formulae, and transportation limitations. These main points were disregarded by the IDHW, however, some comments on the need for better verification of compliance in the plan resulted in IDHW agreeing to survey participants and revise person centered planning procedures and rules. The E.D. also informed policy makers and provided analysis for ICDD, the Idaho Commission on Aging and NAMI. 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. 4. CID & ICDD to address concerns. 5. 0 cases were handled under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: Two issues affecting people with disabilities arose during this year in the Medicaid managed mental health care contract. MCO, Optum Idaho, systematically reduced authorizations for psychiatric rehabilitation services (PRS) for people with intellectual disabilities, and also for children in general, including children with serious mental illness. The P&A conducted research on APA and AACAP treatment standards and provided this information to providers, Medicaid officials and the public (through the P&A online blog) to assist in discrediting Optum’s reduced PSR authorizations and to justify appropriate PRS authorizations. The P&A participated with IDCC, CID and Partners in Crisis in forming a CID subcommittee to monitor Optum’s contract. The P&A E.D. provided information to legislators about the contract performance which resulted in a resolution to have the contract reviewed by the legislature's Office of Performance Evaluation (OPE). The OPE report will be available in January of 2016. 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 (CID) in educating policymakers on issues of importance to Idahoans with disabilities. 4. The E.D. works with CID partners which includes disability agencies, providers and associations in efforts to educate policymakers. 5. 0 since priority is not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A E.D. served as President of CID’s Board of Directors during FY2015, guiding its public policy agenda. As the P&A E.D., he is aware of the emerging issues that have the greatest systemic impact affecting the lives of Idahoans with disabilities. Throughout the years, his extensive work educating legislators, including influential committee members, policymakers and administrative heads has garnered him a reputation as a trustworthy leading advocate for promoting and advancing the rights of Idahoans with disabilities. This year, with the P&A E.D.’s leadership, CID developed additional strategies resulting in gaining support in the governor’s office for passing Medicaid expansion legislation; successfully opposed a bill that would have eliminated eligibility for indigent health care assistance for people in households with income above the federal poverty level (which would adversely effected many people with disabilities unable to access insurance coverage); and successfully helped pass a bill requiring training to school staff on bullying and mandating school staff intervention. 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. 4. None. 5. 1 systemic case was opened on behalf of eight (8) deceased PAIR clients under this priority during 2015 but no class actions. 6. One (1) case summary. During FY2014, the P&A investigated two (2) certified family home (CFH) providers on joint property in an isolated rural location accused of physically assaulting one (1) male resident with a pipe. The P&A, as well as IDHW Division of Licensing and Certification (L&C) Certified Family Home (CFH) program, became aware of this allegation from a local newspaper release. This resident and his guardian were contacted, and an investigation case was opened funded under PAIMI since he was diagnosed with mental illness and dementia residing in a facility and alleging abuse. During this investigation, the P&A worked with the regional adult protection service, the county sheriff’s department, prosecutor, and coroner’s office. The P&A monitored the facility, interviewed all eight (8) residents, their guardians and facility staff, establishing probable cause that all residents were in imminent danger of abuse and/or neglect and financial exploitation. After L&C CFH program informed the P&A that they had not yet substantiated the abuse on behalf of its client, that the providers had appealed its certification revocation and that the residents could be returned pending this appeal per Idaho rule, the P&A was successful in preventing the residents return and the CFH providers are still not in operation. However, the P&A identified systemic concerns with the L&C CFH programs providers appeal procedures, its lack of adequate oversight and inadequate reporting requirements per Idaho Code. More troubling was that during the above noted abuse investigation, the P&A also identified eight (8) additional residents that had died at these CFHs within a five (5) year period and shortly after being placed. All of the deceased were elderly, diagnosed with dementia and physical impairments and some placed for hospice care. Due to limited PAIR funding the P&A opened a systemic death investigation case on behalf of these deceased individuals and continued this investigation during FY2015. During a one (1) year time period between 2009-2010, the P&A determined that three (3) deaths occurred while these facilities operated without certification. Early 2010, IDHW L&C CFH program had revoked its certification while they completed an investigation to address a previous abuse complaint filed. Even though the L&C CFH program denied knowing that this home operated without its certification, this investigation revealed that IDHW CFH program staff were aware and never intervened. Instead, L&C CFH program reinstated the provider’s certification in July of 2010 on the basis that they did not substantiate the alleged abuse. Between 2010 and 2014, five (5) more deaths occurred at these CFHS, two (2) residents dying within one (1) month of being placed. Even though the L&C CFH Program Director told the P&A that they were not aware of any of these deaths at the facility during this period of time, the P&A investigator’s evidence proves that she was aware since the coroner provided the P&A with a copy of his coroner’s request forms submitted to the department and requesting an investigation since he believed frequent ongoing deaths were suspicious. The P&A reported its results to the county sheriff’s department. Unfortunately, a county detective later informed the P&A that he was unable to investigate since a formal complaint had not been filed; and since some of the deceased were placed there under hospice care. During FY2015, the P&A completed its investigation on behalf of these deceased PAIR clients and began drafting its report. In the interim, the P&A L.D. met with IDHW’s Deputy Attorney General’s (DAGs) office to discuss its concerns that the current statutes, rules and processes were not adequately protecting CFH residents from abuse, neglect and harm. The P&A L.D. also presented the concern that its adult protection statutes lack mandatory death reporting since the current code allows the provider to determine if it is needed to report. A new objective to advocate for safer licensed and certified facilities by advocating that IDHW mandate death reporting and investigate suspicious deaths was incorporated into its FY2016 priorities. Additional negotiation meetings with the DAG will occur during FY2016 to determine appropriate remedies. If a joint collaboration to meet this objective is not determined, the P&A will publish this investigation’s results seeking community support for legislative change. 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. 4. None. 5. 1 case was opened under this priority, but no class actions. 6. One (1) case summary. Son of an 85 year old female Native American with heart and circulatory conditions, physical and orthopedic impairments, respiratory disorders, and a skin condition contacted the P&A reporting that she had been seriously injured two (2) times requiring hospitalization while residing at a residential assisted living facility (RALF). The son also reported that after the second injury the facility informed that they were going to discharge her without cause. P&A SERVICES: STA- Shortly after the P&A advocate submitted a records request, the administrator spoke with the client and her family, apologizing for the repeated injuries from falls. A fall prevention program was put in place and prescribed physical therapy (PT) and occupational therapy (OT) services were provided. After the P&A completed the records review, violations were identified, discussed with the client, and her family filed a complaint with IDHW’s L&C RALF program outlining the violations. OUTCOME: As a result of the P&A's intervention, the client received appropriate treatment, the injuries stopped, she retained her placement and she and her family were able to advocate on her behalf. Systemic work completed: As discussed above in the priority addressing deaths in facilities, the P&A identified systemic concerns with Idaho’s statues, rules and practices not adequately protecting CFH residents from abuse and neglect and suspicious deaths and will continue its negotiations during FY2016 with the IDHW Deputy Attorney General. If an agreeable remedy is not reached, the P&A may release its public report to gather support for needed systemic change. 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. 4. P&A contacted the Senior Ombudsman program to clarify assistance and offer P&A advocacy, if needed. 5. Two (2) cases were handled under this priority but no class actions. 6. One (1) case summary.

A 62 yr old white female diagnosed with amyotrophic lateral sclerosis (ALS), lupus, fibromyalgia, depression, asthma, and CBO-chronic bowel obstruction, and recently admitted to a SNF/rehab facility in urban location, contacted P&A reporting imminent danger due to a distended bowel and requesting assistance. Concerns of neglect and mental abuse by SNF staff were also reported. She said that several staff accused of her of being too demanding, and denied the severity of her conditions. Caller reported that SNF staff previously retaliated against her for contacting the Senior Ombudsman (SO). P&A SERVICES: STA- P&A advocate contacted the client immediately after being informed of her urgent request for services. The client explained that the opiate medication she received for ALS pain caused ongoing constipation in addition to having chronic bowel obstruction from surgical scar tissue. She said that when she is extremely distended she must get a shot of resistor or her intestines could burst. The SNF would not administer the resistor shot since they claimed she had not completed protocol so she had to go to the ER to get the shot. The P&A determined that the barrier to her going to the ER that day was that she still needed medical records she had requested several times but not yet received. The client said that the SO was aware of her issues and assisting but couldn’t be reached. The advocate offered to come to the facility and assist with getting the needed medical records and treatment. The client asked the advocate to wait until she called back; giving her time to confirm if the last nurse she asked gathered the records as promised. While the advocate waited, research was conducted about ALS, opiate treatment, possible side effects and resistor confirming its use for treating opiod-induced constipation. The client called back, informed the advocate that she received her records and was taking a taxi to the nearest ER. She asked the advocate to contact the SO and discuss the difficulties she encountered. This was completed and the SO stated that the SNF had been neglectful; complaints with the facility and the Bureau of Facility Standards had been filed, the mental abuse and neglect had been confirmed and addressed accordingly as a staff had been fired. A meeting was scheduled and the SO said she would advocate for appropriate bowel management treatment. OUTCOME: The client received the needed emergency treatment, appropriate complaints were filed and SO assistance was being provided addressing all of client’s issues. The P&A directed the client and the SO to call if further help needed but no calls were received. 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. 4. None. 5. 1 case was handled under this priority but no class actions. 6. One (1) case summary. A 61 year old Caucasian male diagnosed with auto-immune (non-aids/HIV, diabetes, and heart/circulatory conditions residing in a residential assisted living facility (RALF) contacted the P&A requesting help with several rights violations: restrictions on visitation rights, records access and restrictions on choice regarding how he spent his personal needs allowance. P&A Services: A case was opened to investigate his allegations and forms sent for client’s signature. The advocate explained that she would investigate to verify his claims, reviewed rights protection information in RALFs per rule and code with the client; and informed about additional complaints he could file. OUTCOME: The P&A had to close the case since the client would not cooperate: signed forms not returned and attempts to contact were unsuccessful; and the client was informed of his rights to assist him advocating on his own behalf. 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. 4. None. 5. 0 cases were opened under this priority but cases were opened under other appropriate priorities and funding sources. 6. One (1) case summary. A summary of systemic work is provided: The P&A monitored all of the state operated facilities in Idaho during FY2015 on nine (9) separate occasions at the two (2) psychiatric facilities, State Hospital North (SHN) and State Hospital South (SHS); and at the Southwest Idaho Treatment Center (SWITC), an intermediate care facility for the intellectually disabled (ICF/ID). At SHN, as a result of monitoring activities, the P&A is addressing concerns with its R&S policy violating federal regulations and resulting in inappropriate restraint and seclusion (R&S) practices. However, this issue has been difficult to address since this facility is not accredited. The P&A is currently working with facility administrators negotiating for policy change and to encourage its accreditation but legal remedies are being explored. The other issue addressed this FY was regarding the high volume of calls made to local police primarily from SHN staff identified from a public report requested and reviewed. This issue was discussed with the administrator who agreed for its quality improvement staff to collect and analyze this data. Cases were opened on behalf of SHN residents addressing allegations of inappropriate restraint and seclusion, neglect and rights violations funded under PAIMI, and PATBI. During FY2015, no systemic issues were identified at SHS; and this facility encourages the P&A presence. The P&A has participated on its Patients Rights Committee for several years. Cases of rights violations and neglect was reported and investigated by the P&A during FY 2015. The P&A has opened cases for SHN clients regarding neglect/discharge planning and rights violations all funded under PAIMI. At SWITC, the P&A identified concerns with chemical restraint and/or over-medication, client to client assault, inaccurate or lack of documentation recording; and no access to vocational rehabilitation services or opportunities for employment for its residents. P&A addressed these issues with new administrator as well as provided information about the P&A and its authority to monitor and investigate abuse. The facility changed its practice of allowing residents to request PRNs without medical justification and returned its Vocational Services Program that had been previously terminated. Cases were opened to address abuse, neglect and rights violations. During FY2015, the P&A also monitored and visited Safe Haven Health Care private facilities. Safe Haven operates thirteen (13) residential assisted living facilities (RALFS), two (2) psychiatric care facilities and two (2) skilled nursing facilities (SNFs) throughout Idaho. The P&A became alarmed with the number of calls received during FY2014 from Safe Haven residents and/or their families reporting neglect and rights violation. The P&A allocated PAIR, PADD, PAIMI and PATBI funding to its monitoring priority to monitor this provider during 2015, if resources allowed. The P&A conducted one (1) formal monitor at a Safe Haven RALF in rural Idaho. Concerns of lack of programming and activities were identified. Four (4) cases were opened on behalf of Safe Haven residents regarding difficulties with getting discharged, an allegation of financial exploitation and an allegation of excessive medication all funded under PAIMI. The P&A opened an additional twelve (12) cases on behalf of Safe Haven residents residing at six (6) of its RALFS, both psychiatric facilities and at one (1) of the SNFs. The P&A visited three (3) of the Safe Haven RALFs, both psychiatric facilities and one (1) SNF either as a result of case work or outreach meeting with clients, the owner and facility administrators. Information about the P&A and its services were provided as well as clarification regarding its authority to monitor and investigate abuse. One (1) case was opened for a PAIR client and the other cases opened were funded under PAIMI. 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. 4. None. 5. 0 6. One (1) case summary. The P&A did not encounter any P&A access denials on behalf of PAIR clients during FY2015. 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. 4. CILS, disability agencies & organizations, and Interagency 5. 0 cases were opened under this priority since not case driven. 6. One (1) case summary. A summary of systemic work is provided: The P&A developed voting training titled “IDVOTE” providing information about federal and state voting rights, resources, registration and accessible voting options statewide during FY2015. Each training provided hands on ballot marking device (BMD) training depending on the device used in the county which for Idaho includes the AutoMARK, Express and Hart Systems. This training was provided at T4L conference, a high school, two (2) college disability centers, centers for independent living located in northern Idaho, developmental disability agencies, a chapter of Self Advocacy Leadership Network (SALN) in northern Idaho; at the Shoshone Bannock Indian reservation, four (4) employment networks in central western and eastern Idaho, an election office, an organization for adults with DD and their families, state wide. This training was given to persons with disabilities including students, disability agencies, providers, election officers, families, college staff, students, and advocacy organizations. Fifteen trainings were provided to a total of 615 participants.

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 2016 PAIR Priorities and Objectives 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, or applicable state laws. 2. Accessibility 3. Train Idaho trial court administrators regarding the courts’ role in providing equal access to its programs, activities, or services to individuals with disabilities. 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, or applicable state laws. 2. Accessibility 3. Provide written advice, resources and strategies necessary to promote self-advocacy to individuals alleging disability discrimination by state and local governments or places of public accommodation. 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. EMPLOYMENT 1. Social Security disability beneficiaries with a disability will secure, maintain, retain, or advance employment. 2. Access to employment 3. Provide written advice, resources, and strategies necessary for self-advocacy to individuals with disabilities who have alleged employment discrimination. GUARDIANSHIP 1. People with disabilities will be free from unnecessary guardianships and conservatorships. 2. Free from unnecessary guardianships and conservatorships. 3. Individuals with disabilities under a guardianship and who want to change or terminate the guardianship or conservatorship, will receive advice, resources, and strategies necessary 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. 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 with Disabilities 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. 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. Conduct outreach to unserved and underserved populations with disabilities. 2. Access to P&A advocacy. 3. Provide information about DRI services and other rights information to people with disabilities residing on the Fort Hall Indian Reservation. 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 inform policy makers of the effects of adopting the Health Idaho Plan, eliminating the health insurance coverage gap for Idahoans with disabilities. 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 proposed rules, analyze their impact on people with disabilities, and provide this information to disability organizations and others. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will participate with other stakeholders and disability groups on task forces, workgroups and councils that present opportunities to advocate on behalf of people with disabilities. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will advocate for changes to Idaho Medicaid rules to improve the personal needs allowance for people who receive aged and disabled waiver services. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will address system public policy issues in the Idaho Medicaid or managed care programs which arise during FY2016. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 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. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will support the Idaho Council on the Deaf and Hard of Hearing in seeking licensing authority for American sign language interpreters. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will inform policy makers of the benefits of adopting and implementing the Achieving Better Life Experience Act. (ABLE) 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. DRI will advocate for full implementation of CMS rules on person centered planning (PCP) in the aged and disabled Medicaid waiver. RIGHTS IN FACILITIES 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities. 3. Investigate instances of death of people with disabilities in facilities in which death was caused by physical assault; failure to treat, care or monitor the individual; seclusion; or physical, mechanical or chemical restraint. 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities. 3. Request that IDHW mandate that facilities licensed or certified to provide services to individuals with disabilities report participant deaths to IDHW and that IDHW investigate the reported deaths. 1. People with disabilities in facilities 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 tin 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 up to four (4) 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.

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

Part IV: Narrative FY2015 PAIR PPR - NARRATIVE A. Sources of funds received and expended Federal $134,805 State 0 All other funds 0 Total from all sources $134,805 B. Budget for the fiscal year covered by the report Category / FY2015 Actual / FY2016 Budget Wages/salaries - 65,753 / $75,609 Fringe Benefits - 33,784 / 36,224 Materials/Supplies - 9,553 / 5,495 Postage - 994 / 668 Telephone - 1,314 / 1,023 Rent - 9,292 / 8,189 Travel - 1,134 / 7,135 Copying - 88 / 709 Bonding/insurance - 720 / 785 Equipment - 0 / 0 Legal services - 0 / 0 Indirect costs - 0 / 0 Misc. - 12,173 / 8,564 Total (fall sources) - $134,805 / $144,401 Note: 2015 Actual Expenses includes carryover from FY14 (10/1/13-9/30/14) 2016 Budget includes carryover from FY15 (10/1/14-9/30/15) C. Description of PAIR staff Type of Position / FTE / % Yr Filled / Person-Years Professional / 1.05 / 87.18% / 1.02 Full-time / N/A N/A N/A Part-time / 1.05 / 87.18% / 1.02 Vacant / 1.67 / 13.89% / 0.23 Clerical / 0.57 / 80.00% / 2.30 Full-time / N/A N/A N/A Part-time / 0.57 / 80.00% / 2.30 Vacant / 1.00 / 08.33% / 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. Unfortunately, these residents lives are greatly impacted when a facility can’t meet their needs, resulting in involuntary discharge which is very disruptive and stressful. This year she participated on an assessment subcommittee of the Council, addressing the need for adequate assessments in determining appropriate admissions for CFHs and RALF residents. Often potential residents needs are not adequately assessed by RALFs and CFHs and inappropriate admissions result in involuntary discharges. This subcommittee clarified with the Department that the assessment most often used is the Uniform Assessment Instrument (UAI), an eligibility and reimbursement tool used by the Department which doesn’t adequately access the needs of the individual in determining care needed. The subcommittee presented its findings and the Council requested that IDHW explore other options for uniform assessment of residents to satisfy licensing requirements, rather than using the UAI, and will continue to work with the Department on this issue during FY2016. 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 which can serve persons with TBI when PATBI funding is no longer available. 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 2015 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 requested training from the P&A to its new members regarding the needs and purpose of the council. The Council also 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. continues his membership on the Idaho Medicaid Care Advisory Council reviewing state Medicaid policy and providing comments on proposed rules and implementation. E. Grievances filed. Two (2) grievances from PAIR clients were filed during FY2015. The first grievance filed was regarding a request to assist with a Medicaid fair hearing regarding a denial based on income not disability resulting in his transportation services being denied. Since his Medicaid denial was not related to his disability, the intake processors determined that he didn’t meet the Medicaid objective to receive technical assistance with Medicaid appeals when denied services. After his grievance was reviewed by the Advocacy Director (A.D), she determined that he should have received appropriate assistance per the P&A priority and as written since it doesn’t limit the denials to those only regarding a denial based on disability since it still effected services he needed for his disability. She reviewed his notice, provided specific strategies for his appeal, explained that he may qualify for Medicaid under a waiver program, as well as providing information about the Pickle Amendment, the federal rule that waives income requirements for Medicaid when they are caused by a COLA increase. TA on the fair hearing process and strategies also provided. Since the language of the priority and objective is unclear, she directed the intake processors to determine callers eligible for this objective in the future, even when the denial is due to income. The second grievance was filed by a caretaker who believed her client met the community integration priority. They were residing in Candle Suites/Motel and received an eviction notice not related to disability discrimination, but rather to an action by the caretaker. The A.D. reviewed the grievance and upheld the determination that the person with the disability didn’t meet the P&As priorities. She provided further explanation to the caretaker why he didn’t meet this priority and provided information and referral services to the person with the disability. 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 drafted the MOA revision. During F 2015, the P&A submitted this draft to the State Ombudsman Director for approval. She reviewed and informed the PAIR Coordinator that it is currently being reviewed by the Administrator of the Idaho Commission on Aging, the Ombudsman’s supervisor. The Ombudsman reviewed the MOU and forwarded to the administrator of the Idaho Commission on Aging for approval. The PAIR Coordinator and the State Ombudsman are members of the CCAC and often collaborate on issues to help improve the quality of care for PAIR clients residing in CFH and RALFS. As well as other council and committees and each agency refers to each other when appropriate.

Certification

Signed?Yes
Signed ByJames R. Baugh
TitleExecutive Director
Signed Date12/22/2015