|Name||Disability Rights Idaho, Inc.|
|Address||4477 Emerald Street|
|Address Line 2||Suite B-100|
|Name of P&A Executive Director||James R Baugh|
|Name of PAIR Director/Coordinator||Angela Eandi|
|Person to contact regarding report||Angela Eandi|
|Contact Person phone||208-336-5353|
Multiple responses are not permitted.
|1. Individuals receiving I&R within PAIR priority areas||45|
|2. Individuals receiving I&R outside PAIR priority areas||319|
|3. Total individuals receiving I&R (lines A1 + A2)||364|
|1. Number of trainings presented by PAIR staff||44|
|2. Number of individuals who attended training (approximate)||1,340|
DRI Advocate provided rights training in facilities with focus on developmental disabilities agencies' (DDA’s) participants and staff, including its administrative staff. This training was requested as a result of concerns identified with this DDA during FY2016 at the Disability Rights Advocacy Day at the Idaho State Capitol. DRI staff had observed some of the DDA’s staff interactions with participants as rights violations regarding not being treated with dignity and respect. DRI filed a subsequent complaint/report with the DDA clinical director of adult services at Gem State by interviewing both staff and participants. After her investigation she realized that not only staff but residents didn't necessarily understand how some interactions are not considered dignified and respectful. She requested rights training for both participants and staff. DRI revised its Rights in Facilities Power Point (PP) and developed a version that included a review of the rules for DDAs. A Q&A session was included, providing the opportunity for specific examples to be presented. DRI’s "Rights in Facilities" brochure was also revised as a result of this presentation. DRI Legal Director (L.D.) participated as a panel member on a discussion regarding the challenges to supported decision making at the Idaho Guardian and Fiduciary Association’s 2016 Annual Event. Each panel member spoke individually about their experiences with supported decision making, offering tips, suggestions, and success stories. L.D. also participated as a panel member on the Supported Decision Making Model during the Idaho Supreme Court’s (ISC) annual court training to magistrate judges discussing Idaho specific issues related to SDM transition in lieu of full/plenary guardianship appointments. At the Tools for Life (TFL) annual conference, L.D. presented a session on Alternatives to Guardianships & Supported Decision Making (SDM) to transition-aged students and parents. Training presented via lecture and Power Point. Guardianship packets, including PP copies, DRI’s Self-Advocacy & Guardianship Manual and sample petitions for change or termination, were distributed. DRI also developed and presented on "Self-Advocacy-Making Your Dream a Reality"-(self-advocacy skills training) providing information on self-advocacy characteristics and basic elements to develop with focus on acquiring knowledge of rights; "Go Vote" providing voting rights training and accessible voting options information for people with PWDs; and "Transition Planning-It’s a Team Sport" providing rights protections information for transition planning requirements which include: IDEA, Section 504, ADA and Work Force Innovation and Opportunity Act (WIOA), information on transitioning to employment, post graduate education, integrated community living and participation, employment and employment services access, self-advocacy for independence and importance of self-advocating for appropriate individual education plan (IEP) transition planning to students, parents, providers and teachers. Presentations provided via PP and allowed for Q&A sessions. Additional transition training was given at the Idaho DD Council’s (IDDC) Partners in Policy Making workgroup providing transition planning training, input and guidance to adults with DD and their family members on policy making advocacy; a two (2) hour workshop at the Regional Northern Rockies Association for Education and Rehabilitation of Blind and Visually Impaired Individuals (AER) conference; a workshop focused on transition planning including student input and an overview of Social Security Work Incentives to 36 individuals with blindness, parents and teachers; a one (1) hour overview about SS work incentives discussing how they can be used to help beneficiaries transition to work and not immediately lose benefits and health care provided to transition aged youth at the Idaho Department of Labor (DOL); a one (1) hour overview about SS work incentives discussing how they can be used to help beneficiaries transition to work was provided to 26 students with disabilities (SWDs), parents and educators at East Jr. High School; and three (3) presentations given at Eastland High school to students, parents and teachers discussing appropriate IEP transition planning, "Transition Planning-It’s a Team Sport", and information on community services and benefits including SSA applications and the assistance the P&A can provide when applying. A two (2) hour training on abuse, neglect and exploitation by PP, lecture and Q&A session was given to Spanish speakers provided in Spanish at the request of a former DRI Board Member, and the DD Council. Information on the P&A and its services also provided. In attendance were adults with disabilities, providers, service coordinators, a child with DD and family members. During FY2016, DRI provided information reaching PWDs, agency representatives, employees with disabilities and family members about the P&A, its services and Social Security (SS) work incentives (WIs) training at four (4) different venues including the Autism Society; Goodwill Working Solutions; the Ada County Housing Authority; and to Vocational Rehabilitation counselors (VRCs) at the University of Idaho’s (UoI) extension campus. Presentation given via PP including a Q&A session. DRI staff attorney presented at the National Disability Rights Network’s annual conference regarding her litigated prison/videophone access case along with the executive director for HEARD to P&A nationwide attorneys and advocates. A PP presentation was developed entitled “Accommodations in Prisons & Jail Settings.” DRI attorney gave case-specific examples from her case in Idaho, helping to get a deaf inmate access to a videophone, along with suggestions for similar types of litigation. DRI presenting training on voting rights and accessible voting options reaching PWDs, poll workers, Democratic Party caucus facilitators, county elections staff, and to the Idaho Commission for the Blind and Visually Impaired (ICBVI) staff statewide. Information on the P&A and its services also provided at every training given. Training provided via PP and Q&A sessions. At most of these events, training on the use of a ballot marking device was also included, when available. Internal PP training(s) developed by and presented to DRI staff included: Ballot Marking Device(BMDs) -How to use BMD Training & the accessibility requirements for the upcoming primary elections; R&S Investigations; Trauma Informed Care Basic Elements; Investigative and Legal Writing for Non-Attorney Advocates; Disability Rights in the Workplace; An overview of MY ADA Disability Rights & My Rights to a Service Animal; Fair Housing Laws; and Slap Assessment Training was developed and conducted throughout FY 2016.
|1. Radio and TV appearances by PAIR staff||1|
|2. Newspaper/magazine/journal articles||8|
|3. PSAs/videos aired||0|
|4. Hits on the PAIR/P&A website||25,450|
|5. Publications/booklets/brochures disseminated||13,345|
|6. Other (specify separately)||0|
Social Media: Blog hits-2331 Facebook: Home page views-884 Page likes-125 Position papers developed by DRI Executive Director (E.D.) disseminated to people with disabilities (PWDs) legislators, disability agencies, newspapers and posted on DRI's blog included: OPE Evaluated the Optum Medicaid Behavioral Health Contract, but Not the Outcomes for People with Mental Illness;and Healthy Idaho Plan Position Paper. Additional position papers authored by DRI E.D. disseminated to Legislators, PWDs, disability agencies included: two (2) position papers on Medicaid Expansion waiver proposal; opposition to proposed S1375 bill allowing for delegation of powers of a guardian; the basis for Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services (HCBS) revised rules and consequences if not implemented; and the basis and need for the Sign Language Interpreter bill.
Count individual once per FY. Multiple counts not permitted for lines A1 through A3.
|1. Individuals still served as of October 1 (carryover from prior FY)||4|
|2. Additional individuals served during the year||112|
|3. Total individuals served (lines A1 + A2)||116|
|4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)||6|
Carryover to next FY may not exceed total on line II. A.3 above 4
|1. Architectural accessibility||1|
|3. Program access||6|
|5. Government benefits/services||65|
|8. Assistive technology||0|
|10. Health care||9|
|12. Non-government services||11|
|13. Privacy rights||0|
|14. Access to records||0|
|1. Issues resolved partially or completely in individual favor||116|
|2. Other representation found||0|
|3. Individual withdrew complaint||1|
|4. Appeals unsuccessful||2|
|5. PAIR Services not needed due to individual's death, relocation etc.||0|
|6. PAIR withdrew from case||1|
|7. PAIR unable to take case because of lack of resources||0|
|8. Individual case lacks legal merit||1|
List the highest level of intervention used by PAIR prior to closing each case file.
|1. Technical assistance in self-advocacy||97|
|2. Short-term assistance||20|
|5. Mediation/alternative dispute resolution||1|
|6. Administrative hearings||0|
|7. Litigation (including class actions)||0|
|8. Systemic/policy activities||0|
|1. 0 - 4||1|
|2. 5 - 22||11|
|3. 23 - 59||79|
|4. 60 - 64||14|
|5. 65 and over||11|
Multiple responses not permitted.
|1. Hispanic/Latino of any race||9|
|2. American Indian or Alaskan Native||2|
|4. Black or African American||1|
|5. Native Hawaiian or Other Pacific Islander||0|
|7. Two or more races||2|
|8. Race/ethnicity unknown||1|
Multiple responses not permitted.
|2. Parental or other family home||26|
|3. Community residential home||2|
|4. Foster care||0|
|5. Nursing home||7|
|6. Public institutional living arrangement||0|
|7. Private institutional living arrangement||2|
|8. Jail/prison/detention center||0|
|10. Other living arrangements||1|
|11. Living arrangements not known||0|
Identify the individual's primary disability, namely the one directly related to the issues/complaints
|1. Blind/visual impairment||5|
|2. Deaf/hard of hearing||8|
|4. Orthopedic impairment||49|
|5. Mental illness||13|
|6. Substance abuse||0|
|7. Mental retardation||6|
|8. Learning disability||0|
|9. Neurological impairment||7|
|10. Respiratory impairment||3|
|11. Heart/other circulatory impairment||5|
|12. Muscular/skeletal impairment||1|
|13. Speech impairment||0|
|15. Traumatic brain injury||2|
|16. Other disability||16|
|1. Number of policies/practices changed as a result of non-litigation systemic activities||7|
|2. Number of individuals potentially impacted by policy changes||14,992|
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.
2016 Systemic Activities-& changes-7 total systemic activities changed policies, practices or legislation Through monitoring activities and case work, DRI identified concerns with State Hospital North’s (SHN) restraint and seclusion, and treatment override policies and practices. During FY2016, DRI worked with SHN to implement policy and practice changes which included: limited law enforcement involvement in behavioral emergencies and eliminate the use of tasing; decreased its treatment override practice of utilizing local police to chemically restrain; amended definition in policy of “seclusion” to include close observation; amended restraint definition in policy to include chemical; improved restrictive treatment practices as a whole to better document, access, debrief and to better adhere to its policies; and advocated for training staff in, and incorporating the use of, trauma informed care. During FY2017, DRI will continue monitoring activities relating to these issues to confirm that facility is implementing as agreed. DRI's next step will be to look at possible IDHW rule changes and/or litigation if changes are not implemented. This systemic work could potentially effect an average of 246 Idahoans yearly admitted to SHN according to Idaho Department of Health and Welfare’s (IDWH) 2015-2016 Facts/Figures/Trends publication (between 2013-2015), page 51 located at: http://healthandwelfare.idaho.gov/AboutUs/Facts,FiguresTrends/tabid/1127/Default.aspx Systemic case summary: DRI currently has ten (10) systemic investigation cases opened in which records have been requested and received on behalf of seven (7) clients and records requested for remaining three (3) clients are being collected. Systemic issues were identified after DRI opened a case during FY2015 on behalf of a 30-year-old male with mental illness alleging he had been injured when tased by the Orofino City Police in November, 2014 after he was placed at SHN. A preliminary investigation was conducted substantiating that he was tased twice, the second time knocking him unconscious and resulting in him being transported to local emergency room. Concerns of inappropriate use of restraint and seclusion were identified including the treatment override practice of utilizing local police to chemically restrain, and to restraint for behavioral incidents, as well as concerns with its restraint and seclusion policies and practices. As a result of this investigation, DRI requested public records from the city police showing how many times they were called to assist during 2015 then later during 2016. DRI requested names of residents involved and nine (9) additional systemic cases have been opened allowing DRI to substantiate systemic concerns. During FY2016, a letter of concern was sent to the SHN administrator summarizing the concerns identified on behalf of this client as well as others and resulting in a meeting with SHN, its Deputy Attorney General and DRI’s staff attorney and Legal Director (L.D.). SHN agreed to modify some of its R&S policies and practices as noted above as well as incorporate trauma informed care into its treatment. Restraint and seclusion and the use of police has decreased. All ten systemic cases are carried over to FY2017 and DRI will continue monitoring SHN to ensure that these systemic changes are being implemented ensuring that SHN is a safer facility. Even though this systemic activity has been funded under PAIMI, PAIR clients living in the community with mental health at risk of mental health commitments and psychiatric hospital placements in the future could also benefit from this systemic activity. In collaboration with the Consortium of Idahoan’s with Disabilities (CID) and the Idaho National Alliance of Mentally Ill (NAMI), DRI successfully prevented the passing of House Bill-H413 which would have created a vanity license plate benefitting the Orofino High School “Friends of the Maniacs” booster group. “Maniac” is the school mascot and State Hospital North (SHN) is located in Orofino. DRI E.D. testified against the bill as promoting negative stereotypes of people with mental illness. According to NAMI Idaho there are 41,000 Idahoans with a serious and persistent mental illness and are often subjected to stigmatization that would have potentially been affected by this bill’s passing, (specifically those 246 yearly admitted to SHN). Systemic activity not case driven. DRI participated on an informal workgroup initiated by two (2) state representatives and DRI to address systemic problems with the Idaho Medicaid for Workers with Disabilities program. The workgroup met with IDHW Medicaid and the Department of Labor Disability Determination (DDS) staff and representatives to identify and address participant barriers to MWD. Issues identified included difficulty navigating the website, the application, self-reliance workers’ unfamiliarity with the program, absence of an appeals process, improper notices (containing generic reasons for denials and not citing specific rules), and ensuring people who approach the program through the Developmental Disability Services unit are redirected back to Health & Welfare. The workgroup met three (3) times this past year, and Medicaid staff addressed the website and application issues, are working with the Idaho Department of Labor to address the links between the two websites, have acknowledged the required appeals process, and are working on how to ensure proper notice is given. The workgroup was provided with detailed information on how MWD applications are processed, and anecdotal information seems to indicate that problems with the program are now individual in nature, not system wide. Health & Welfare now has a new dedicated website to facilitate access and reported that they granted their hearing officers the authority to review/hear DDS denial determination resulting in applicants now having access to due process rights. The first Medicaid fair hearing regarding a DDS denial for a MWDs applicant is to be heard during December, 2016. Data on statistics for those MWDs non-SS beneficiary’s applicants denied during FY2016 were not located. A case summary is provided under correlating Medicaid Priority and Objective in Part V-Priorities and Objective section. During individual case work, DRI identified concerns for transition-aged students eligible for IDVR’s summer pre-employment transition services (PETS) summer work experience program and correlating brochure. IDVR had implemented impermissible requirements for PETS such as an independent hygiene eligibility requirement resulting in some transition-aged students not receiving summer work experience services since the number of PETS slots were limited. DRI advocate and A.D./ CAP Coordinator met with IDVR’s administrator negotiating the following agreed up on remedies: IDVR rescinded the independent hygiene eligibility requirement effective immediately and all VRCs were notified by email; any transition-aged student excluded from PETS was eligible for individual summer work experience services by contacting VRC for facilitation; IDVR will ensure students with significant disabilities are not excluded from current/future PETS programs based on impermissible criteria; and DRI will review all future PETS brochures before dissemination. This systemic activity potentially affects nearly 1500 recipients under 25 years old who are receiving IDVR transition services. Statistics located from IDVR 2015 annual report located at: https://vr.idaho.gov/inc/doc/plans_publication/Annual_Report.pdf Even though this case was funded under CAP, it benefits PAIR clients. Case Summary: Guardian/mother of a 16-year-old African American male diagnosed with cerebral palsy, neurological disorders, PDD, physical/orthopedic impairments, speech impairments, and TBI called DRI requesting assistance with securing summer work experience with their local Voc Rehab. P&A SERVICES: Case assistance/self-advocacy:-DRI advocate, A.D./CAP Coordinator participated in a meeting with the guardian, and IDVR regional manager (RM). DRI/CAP secured summer work experience for the client, and addressed systemic concerns of discrimination as well. DRI/CAP addressed Title II ADA section 504 rule violations and Federal assurance violations regarding the summer work brochures that listed discriminatory eligibility requirements. OUTCOME: Because of the P&A's intervention, all IDVR brochures that listed discriminatory eligibility requirements were rescinded effective immediately, all excluded from the summer work experience will be given the opportunity to participate, now and in future PETS programs, CAP and IDVR administrators will now meet quarterly to discuss systemic issues. As a result of the P&A's intervention, the client's guardian was able to advocate for the client, and systemic discriminatory practices were rescinded. DRI’s efforts to promote the rights of people with disabilities who are, or may be, subjected to guardianship and conservatorship appointments is beginning to show a systemic impact. DRI Legal Director (L.D.) continued as a leading member on the Supported Decision Making (SDM) subcommittee directing its activities during FY2016. SDM Sub-committee began drafting a standard guardianship order template for limited guardianships; facilitated SDM training at the Idaho Supreme Court (ISC) annual conference( in which many Magistrates indicated that they would consider in place of some full/plenary appointments) and convinced the Idaho State Bar Association to publish an article in the Advocate authored by SDM Subcommittee and dedicated to guardianship issues with emphasis on alternatives such as limited guardianships and the supported decision making model of support. DRI continued setting an example by representing two (2) clients with disabilities resulting in their full/plenary guardianships being terminated and replaced by a SDM team. This systemic activity could potentially affect over 7700 Idahoans with a full guardianship, conservatorship or both according to figures provided by the 2016, Idaho Supreme Court Guardianship Monitoring Coordinator, Nanci Thaemart. Two (2) case samples provided below under Section B. Litigation/Class Actions. DRI educated IDHW for several years on the need for the personal needs allowance (PNA) to be increased for recipients required to pay a share of cost for Aged & Disabled (A&D) Medicaid waiver services. DRI E.D.& L.D. facilitated meetings and participated on applicable work groups and committees stressing the need to increase this allowance which wasn’t reasonable in light of current cost of living expenses. During FY2016, a Medicaid appropriation bill (S1391) was introduced providing funding for the PNA allowance increase. DRI testified on the need for the increase and the effect it would have on people with disabilities. The bill passed both houses and signed by Governor. This will allow rules to be adopted and implemented by July 1, 2017. Most A&D Medicaid waiver recipients with a share of cost for A&D Medicaid waiver services will get to keep $214 more of their monthly income. According to statistics located at: http://elderlywaiver.com/state/idaho.html, there are over 2100 A&D waiver recipients in Idaho (potentially affected by this systemic activity). This systemic activity not case driven. During FY2014 while investigating concerns of abuse on behalf of a certified family home resident, DRI identified concerns that IDHW’s licensing and certification (L&C) of certified family homes (CFH) program was not adequately protecting residents. Additionally, DRI identified many suspicious deaths occurring at this same CFH within a relatively short period of time. During FY2015, the CFH provider’s certification was terminated but later reinstated after the provider appealed and the hearing officer rescinded the termination. During FY2016, DRI staff attorney drafted and submitted a letter of its concerns identified from its investigation which included concerns with IDHW L&C’s CFH program’s certification processes; the lack of needed home inspections; processes in place to determine when a reported death needs investigating, and concerns with its investigating procedures. A meeting was requested and facilitated with the L&C Director, CFH supervisors, DRI L.D., staff attorney and investigating advocate. After this meeting, DRI confirmed that the Department had taken steps to seek out additional training on incident investigations for CFH staff; made several changes to their investigation policies/procedures/protocol, including strengthening requirements for documenting evidence to support allegations of abuse or neglect including data collection to determine if a death is suspicious triggering further investigation. IDHW L&C also shared information regarding how they have been completing required home inspections and certification studies and offered to provide DRI, Adult Protection Services (APS) and L&C contact information and DRI’s resident’s rights poster to CFH providers to distribute to residents upon admission to CFHs. Monitoring of these improvements will occur during FY2017 and subsequent meetings and collaboration can continue under DRI’s FY2017 Public Policy priorities. Improvements to IDHW’s L&C CFH program could provide safer placements for over 3200 CFH residents statewide. Statistics taken from IDHW’s 2015-2016 Facts Figures and Trends publication on page 24 located at: http://healthandwelfare.idaho.gov/AboutUs/Facts,FiguresTrends/tabid/1127/Default.aspx Systemic case work summary and summary of objective work completed reported in Part V. Priorities and Objectives Rights in Facilities correlating Priority and Objective. DRI continued its systemic efforts supporting proposed Medicaid expansion legislation during FY2016. DRI E.D. authored a position paper endorsed by CID and the Close the Gap initiative in Idaho and led these groups in efforts to get Medicaid expansion (called Idaho Healthy Plan) legislation passed. E.D. also authored two (2) position papers on Medicaid expansion waiver proposals and provided both written and oral testimony to both the Senate and House Health and Welfare Committees and to the interim work groups in both 2015 and 2016. The House Health and Welfare Committee adjourned without printing a bill to expand Medicaid and close the health insurance gap. However, it is believed that the Close the GAP initiative is gaining momentum and DRI has carried this priority over to FY 2017. This systemic activity is not case driven.
|1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts||225,973|
|2. Number of individuals named in class actions||0|
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.
DRI didn't litigate using PAIR Funds. However, its litigation activities still impact PAIR clients at risk of a guardianship and/or conservatorship appointment and those residing in, or at risk of a placement in, facilities which could be subjected to A&N. DRI’s efforts to promote the rights of people with disabilities who are or may be subjected to guardianship and conservatorships appointments 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 utilize alternatives such as supported decision making. 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. During FY2016, DRI continued its representation on behalf of three (3) individuals in guardianship proceedings protecting against abusive guardians and incorporating the ideals of least restrictive appointments and alternatives to guardianships. DRI also acted as a guardian ad litem (GAL) to assist with getting a guardianship transferred to Oregon after client moved to be near her guardian. Case examples: 1-DRI represented a 21-year-old Caucasian female with Asperger’s Syndrome, depression, and anxiety disorder, who originally came to DRI at age 19 asking for assistance in having her guardianship and conservatorship (G/C) terminated. Her mother had originally been appointed as her G/C while client was hospitalized at age 18 for mental health issues. After hospitalization, client successfully obtained her high school degree, obtained a driver’s license, started working, and attended classes at BSU for a semester. She had wanted to have her G/S terminated, but mother refused. Mother was also demanding that client forgo working to focus on attending school, which client did not want to do. P&A SERVICES: DRI first attempted to negotiate a termination of the guardianship with mother and mother’s attorney, without success. Mother’s attorney filed a motion to have DRI disqualified as client’s legal representative, which DRI successfully defended. Client’s mother then opposed DRI’s motion to have the guardianship modified and/or terminated, so the parties went through discovery then a series of hearings. OUTCOME: Client’s mother was removed as her guardian and conservator and the conservatorship was terminated. Client’s mother was also removed as her rep payee and replaced with a third-party rep payee. A third party, advocate guardianship, LLC, was appointed as client’s limited guardianship for the period of one year. Client was also given permission to move from her mother’s home to her father’s home until she could obtain her own, independent housing. Client worked with limited guardian and support broker to create her own support and spending (self-directed) plan, created a budget, continued working and maintained health appointments, and moved from her father’s home to a home of her own. At the end of the one year period, judge terminated the limited guardianship. Client now has all legal rights and decision making abilities restored and is no longer under a guardianship or conservatorship. 2- During FY2015, DRI represented a 27-year-old Caucasian female under a full/plenary guardianship and conservatorship in which a county Board of Community Guardians (BCG) was appointed. P&A SERVICES: DRI filed a petition to terminate the guardianship and conservatorship in lieu of setting up a supported decision making plan. DRI L.D. educated the client and BCG regarding supported decision making and helped client develop a SDM team. The case was carried over to FY2016. OUTCOME: The Court terminated her guardianship and conservatorship. She 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. Presently this litigation impacted three (3) persons with disabilities. (Additional DRI systemic work to advocate for least restrictive guardian and conservator appointments and alternative to guardianship is discussed in the Systemic Activities noted above). 3-DRI received a favorable decision in federal court clarifying its access authority to records when investigating abuse and neglect in facilities further strengthening P&A’s access authority mandates. Pursuant to a suspicions death investigation case opened during FY2014 on behalf of a 55 year old deceased white female who committed suicide while placed on a hold at a private psychiatric hospital, DRI was sued after requesting the county coroner’s records. DRI provided legal representation on its own behalf in state and federal court after being denied access to coroner’s records and being sued by Ada County and its coroner’s office, the largest county in Idaho, in state court. These records were requested under P&A access authority granted under the Protection and Advocacy for Individuals with Mental Illness (PAIMI) grant. DRI moved the case to federal court and filed counterclaims in which discovery and dispositive motions were filed during FY2015. After both sides filed dispositive motions, during FY2016, Federal Court dismissed Ada County as a party and then granted DRI declaratory relief, declaring the P&A entitled to coroner’s records under PAIMI and that the coroner violated PAIMI by withholding such records. Court also granted DRI permanent injunction against the coroner, requiring them to provide records related to its client, and all future records that DRI is entitled to under PAIMI setting precedent in federal court. Court denied DRI’s request for relief under Section 1983 (attorney fees and costs). The PAIMI grant allows DRI to advocate on behalf of persons placed in psychiatric hospitals to protect against abuse and neglect. In order to do this, P&As need access to records when investigating abuse and neglect on behalf of its clients. This litigation not only affects PAIMI clients, but also PADD, PATBI and PAIR clients since the P&A investigates A&N in facilities for persons with disabilities under all of these grants. Since any PWD could potentially reside in a facility presently or in the future, this litigation affects all PWDs in Idaho. According to the Disability Compendium located at www.DisabilityCompendium.org , there were 204,780 civilians living in the community with a disability in Idaho in 2014 (located on page 16) and another 21,190 Civilian Veterans with a Service-Connected Disability rating of 10-70 % or higher aged 18 years and older living in community in Idaho (located on page 102) = a total of 225,970 PWDs in Idaho potentially affected by this litigation.
For each of your PAIR program priorities for the fiscal year covered by this report, please:
Fiscal Year 2016 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. DRI will provide advice, resources and strategies to assist people with disabilities who are applying for Social Security (SS) disability benefits or appealing a denial of SS disability benefits. 4. No collaborative efforts were involved. 5. 68 cases were handled under this objective for PAIR clients. There were no class actions. 6. One (1) case summary. A 48-year-old Caucasian male with a physical impairment residing in an urban location contacted the P&A requesting help with filing for SS benefits. P&A SERVICES: P&A advocate conducted screening and determined he had a significant shoulder injury from being hit by a car while riding his bicycle. The accident was hit and run. Doctors’ orders restricted the use of his arm and another surgery was needed. He currently had no health insurance, lost his job as a vehicle painter and became homeless, doubling up with friend. The advocate determined that in addition to the shoulder injury, he had previously been treated for depression from a counselor from the Idaho Hope program which helped people with no insurance to access MH services and provided SOAR assistance to help with SS applications. He had begun applying for SS benefits but the application was not submitted prior to his accident. He said he had been seen by a counselor who believed he had PTSD and depression. In high school, he had been diagnosed with dyslexia so it was difficult for him to complete the application and to understand steps to follow. DRI advocate contacted SOAR provider to submit a referral on client's behalf but was informed that they lost their funding and were no longer providing SOAR assistance. They could give him his medical records if requested and the consent form completed. This referral and instructions were provided to the client. A referral to a mental health provider providing pro-bono case management services also was provided with specific instructions on how to access. Written information on SS disability programs and the application process, suggestions and strategies to help with the SS application, including physician questionnaires for doctor’s completion and a memorandum for writing a letter of support were provided. Information on how to preserve appeal rights, and attorney referrals including referral to the Idaho Trial Lawyers Association were provided in case the application was denied. Suggestions and strategies to secure center for independent living (CIL) advocacy and independent living services were provided. Written information and a referral to Idaho Vocational Rehabilitation (IDVR) were provided, as well as a referral to DRI CAP services if problems with CIL or IDVR arise. OUTCOME: Resources, information and strategies provided to assist client with applying for SS benefits and to access pro-bono case management and CIL advocacy assistance. A referral to DRI provided in case he encountered difficulties accessing VR and CIL services. DISABILITY DISCRIMINATION 1. Public or private entities will not discriminate against individuals with disabilities 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. 4. No collaborative efforts were involved. 5. Not a case driven priority. No class actions. 6. One (1) case summary. A summary explaining why this priority was not met is provided: DRI legal department contacted the 4th and 5th district Trial Court Administrators who had previously indicated that they desired to receive this training. DRI staff attorney prepared training on ADA protections under Title II regarding PWDs right to access with service animals and began preparing additional trainings. However, when 4th and 5th Trial Court Administrators were contacted by DRI during FY 2016, they were not willing to schedule/receive this training because the Idaho Supreme Court was in the process of changing from its paper based records system to Odyssey, an electronic judicial records management system. The transition to Odyssey is state-wide. 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 to promote self-advocacy to individuals alleging disability discrimination by state and local governments or places of public accommodation. 4. No collaborative efforts were involved. 5. 27 cases were handled under this priority for PAIR clients, with one (1) carried over to F 2017. There were class actions. 6. One (1) case summary. A 50-year-old blind Caucasian male with joint and lung disease contacted DRI requesting assistance addressing issues he had with the local paratransit company. According to the client, he was being suspended from using paratransit due to too many cancellations. At first his use was restricted and then, starting in March of 2016, it was suspended. The client depends on paratransit services to get to and from his medical appointments, stores, and other transportation needs. Paratransit use is governed by the Americans with Disabilities Act, falling under DRI FY2016 priorities. P&A SERVICES: case assistance/self-advocacy; P&A staff attorney communicated with paratransit office on client’s behalf, determined client needed to reapply for services as eligibility had expired and then assisted client in making sure application process was completed. The attorney also provided the paratransit office with an ADA Title II reasonable accommodation request on the client’s behalf regarding written communications sent to the client. The paratransit office had been simply mailing documentation, such as notices, to the client which the client could neither read nor complete. OUTCOME: After completing the re-application process, the client was determined unconditionally eligible for paratransit services. Case closed since all issues resolved. DRI provided short-term case assistance to nine (9) PAIR clients having difficulties with this paratransit provider, many being denied services. Due to the number of calls with concerns about this paratransit provider, DRI added to its 2017 FY priorities to accept up to three (3) cases addressing discrimination against people with disabilities by public or private transportation providers in violation of Title II or Title III of the ADA not limited to short-term assistance. Assistance during FY2017 may include legal representation and/or other legal remedies, if needed. 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. No collaborative efforts were involved. 5. There were no cases or class actions. 6. One (1) case summary. There were no calls received on behalf of, or from, PAIR students regarding concerns of restraint and seclusion during FY2016 but cases were opened under other funding sources. A summary of systemic work completed is provided: DRI updated its technical assistance packet that is provided to parents and/or students with disabilities alleging inappropriate restraint and seclusion by school districts. This materials packet provides rights information, advice, resources and strategies to advocate in preventing or ceasing 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. 4. No collaborative efforts were involved. 5. There were no cases or class actions. 6. One (1) case summary. There were no calls received on behalf of, or from, PAIR students regarding concerns of suspension/expulsion violating due process during FY2016, but cases were opened under other funding sources. DRI has reevaluated its outreach efforts to transition aged students needing assistance with accessing effective transition planning. Previously when outreaching, students and their parents were instructed to call DRI if a service request needed to be opened. Since DRI has not received many calls requesting assistance with transition planning, during FY2017 it will be directly facilitating intakes at the outreaches so transition-aged students have more immediate access to P&A case assistance. A summary of systemic work completed is provided: DRI updated its technical assistance packet that is provided to parents and/or students with concerns of suspension and expulsion that violate rights under IDEA or Section 504 of the Rehabilitation Act. The packet includes rights information, advice, resources and strategies to advocate for due process protections. The P&A completed a final draft of its SECTION 504 SELF-ADVOCACY GUIDE TO EDUCATION RIGHTS FOR ELEMENTARY AND SECONDARY SCHOOL STUDENTS, PARENTS, GUARDIANS, AND ADVOCATES to be disseminated during FY2017. This manual provides guidance regarding concerns of suspension and expulsion for students receiving Section 504 plan services. 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. DRI is a member of the Idaho Interagency Council on Secondary Transition (IICST) collaborating with the State Education 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. There were no cases or class actions. 6. One (1) case summary. No calls on behalf of PAIR students regarding concerns of inadequate transition services were received during FY2016. A summary of systemic work completed is provided: DRI participated on the Idaho Interagency Council on Secondary Transition. The IICST meets quarterly in Boise. The Council is made up of agencies with interest in transition age students — the Dept. of Education, Idaho AT Project, Idaho Division of Vocational Rehabilitation, Idaho Commission for the Blind and Visually Impaired, Dept. of Labor, Juvenile Corrections, Idaho Council on Developmental Disabilities, schools/districts, Idaho Parents Unlimited, DRI, and others. Discussions involved pre-employment transition services for transition age youth, changes required by the Workforce Innovation and Opportunity Act (WIOA), transition technical assistance reports, legislative updates, and planning for the Tools for Life transition conference sponsored by the Idaho AT Project. Additional topics during the year included providing input for the Dept. of Labor’s Disability Enforcement Initiative grant/application, improving transition outcomes for youth, and different programs offered by Idaho colleges and universities to prepare students with disabilities for life after high school. EMPLOYMENT 1. Social Security (SS) disability beneficiaries with a disability will secure, maintain, retain or advance employment. 2. Employment discrimination 3. Provide written advice, resources, and strategies necessary for self-advocacy to individuals with disabilities who have alleged employment discrimination. 4. No collaborative efforts were involved. 5. One (1) case was handled under this priority for a PAIR client. There were no class Actions. 6. One (1) case summary. A 58-year-old Caucasian female living in a rural location and who had become deaf in her in left ear after brain tumor surgery, contacted DRI requesting rights protection information for people with disabilities at work and help with better understanding reasonable accommodations. P&A SERVICES: Case assistance/self-advocacy-DRI advocate provided information by phone and in writing regarding employment rights protections under the Americans with Disabilities (ADA) and the Idaho Human Rights Act. The definition of reasonable accommodations, examples, and strategies for requesting were provided. Information on filing administrative complaints with the Equal Employment Opportunities Commission (EEOC) and Idaho Human Rights Commission (IHRC) were provided including the statute of limitations for each entity. Suggestions and strategies for filing complaints were provided. Referrals were made to the Idaho Council for Deaf and Hard of Hearing for information on appropriate reasonable accommodations in the workplace for persons that are deaf. Information about Idaho Vocational Rehabilitation services and how they can help address barriers to employment was provided. Information on centers for independent living and independent living services was provided. Information and referral provided to the DRI Client Assistance Program (CAP) if difficulties arise accessing VR and CIL services. OUTCOME: Information and resources needed to understand rights protections in the work place provided to help client better understand her rights and advocate for appropriate reasonable accommodations in the workplace. GUARDIANSHIP 1. People with disabilities will be free from unnecessary guardianships or conservatorships. 2. Protect rights. 3. Individuals with disabilities under a guardianship, who want to change or terminate the guardianship or conservatorship, will receive advice, resources, and strategies necessary to advocate on their own behalf. 4. No collaborative efforts were involved. 5. One (1) case was handled under this priority for PAIR clients. There were no class actions. 6. One (1) case summary. During FY2015, the court appointed DRI as guardian ad litem for a 61-year-old white female with mental illness who had a special needs trust and a paid guardian and conservator. The client wanted to change her guardianship and conservatorship to family members. P&A SERVICES: Short-term assistance/litigation: After reviewing the client’s yearly accounting, the DRI attorney determined that the private paid guardian and conservator’s charges were unreasonable, her trust had been depleted and that G/C had taken a $20,000 lien out on her home to continue receiving payment for services. A motion was filed for G/C to pay back the unreasonable charges and the amount of the lien put on the home. OUTCOME: During FY2016, the judge ruled in the client’s favor, determined that charges were unreasonable and ordered for paid G/C to pay back some charges determined unreasonable and all of the lien monies. The conservatorship and guardianship were changed. This case has been carried over to FY2016 since disputes with the final accounting are still being addressed. DRI will remain as this client’s GAL. 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 people with disabilities regarding guardianships/conservatorships. 4. No collaborative efforts were involved. 5. This was not a case driven objective. 6. One (1) case summary. A summary of systemic work completed is provided: The DRI Legal Director (L.D.) continued her membership on the Idaho Supreme Court (ISC) Committee on Guardianships and Conservatorships (G/C). This committee is tasked with revising Idaho’s guardianship and conservatorship statutes to better protect Idahoans. Through this membership, she has vigilantly promoted the rights of people with disabilities by influencing this committee to evaluate the Idaho Magistrate court’s practice of primarily appointing full guardianships and conservatorships, and advocating for courts to consider alternatives to full guardianships, such as limited guardianships and the supported decision making model. The L.D. is a member of the Committee’s Rules and Legislation Guardianship Subcommittee. During FY2016, this subcommittee amended statutory changes to the temporary guardianship sections for both adults and minors. The amendments were passed by the full committee and have been submitted to the Idaho Supreme Court for approval. If approved, the amendments will be submitted to the Legislature during FY2017 for statutory change. The sub-committee amendments narrowed the circumstances for appointing a temporary guardianship without a hearing for minors. The amendment also expanded protections for parents at threat of losing their parental rights in guardianship proceedings by requiring that parents be appointed attorneys, further expanding parental protections, especially parents with disabilities who may need services and supports to assist with parenting. Even though parents with disabilities are appointed legal representation for Adult Protection Services parental rights termination court proceedings, they were not previously guaranteed legal representation in guardianship proceedings for minors. See DRI L.D.’s participation in Supported Decision Making Sub-committee discussed in objective below. 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 guardianship. 4. Collaborating on the Idaho Supreme Court Subcommittee on Supported Decision Making advocating for least restrictive guardianships and alternatives to guardianship such as the supported decision making model. 5. One (1) case. No class Actions. 6. One (1) case summary. The mother of a 17-year-old Caucasian daughter with high functioning autism spectrum disorder (ASD) contacted DRI with questions on how to challenge a guardianship since the daughter’s father was in process of petitioning for a full guardianship. P&A SERVICES: DRI attorney provided the mother with information on alternatives to guardianship including the supported decision making model. Information on services and treatment available under the adult DD waiver was provided, as well as information on the application procedures. The P&A guardianship self-advocacy packet was provided to the client and her mother, including a manual on how to advocate for the least restrictive or no guardianship; a sample copy of how to terminate or change a guardianship petition, and information on rights protections during guardianship proceedings. OUTCOME: Client received materials and her mother will help her advocate for no or least restrictive guardianship so she can live as independently as she can in the community. A summary of systemic work completed is provided: During FY2015, DRI L.D. successfully persuaded the committee to convene a Supported Decision Making Sub-committee and has continued as a leading member directing its activities. During FY2016, the Supported Decision Making Subcommittee began drafting a standard guardianship order template for limited guardianship. Templates were drafted for both the Uniform Probate Code (UPC) and the Developmental Disabilities Act. In the UPC template, the court visitor report is moved from the statute to court rules. The court rules require much more detail on the report including functional abilities or limitations information, must identify which alternatives were tried and failed, and requires the visitor recommend a limited guardianship before recommending a full guardianship. The limited guardianship must identify the issues where guardian decisions are needed and if a full guardianship is recommended it must be justified. The court rules would also require that the visitor qualifications must include knowledge of accessing functional limitation vs the current medical model. In the DD Act template, the Guardianship Evaluation Committee report must also provide detailed information about the respondent’s functional abilities and/or limitations, identify alternatives tried but not successful, consider limited guardianship and specify what areas that a guardian is needed to make decisions. If full guardianship is recommended, it must provide justification. The SDM subcommittee has discussed the objective of the ISC funding court visitors for each region but the G/C committee could only influence the finance committee. Strategies will be discussed during FY2017. The SDM subcommittee successfully influenced the Idaho Supreme Court to devote an entire morning at its annual Magistrate Conference to guardianship issues with the focus on the supported decision making model. The ISC C/G Monitoring Director and facilitator of the G/C Committee, with DRI L.D. support, invited Jenny Hatch and her attorney, Jonathon Martinis to speak at the Idaho Magistrate conference. Ms. Hatch was successful in terminating her full guardianship by showing that a supported decision making model could meet her needs and assist her with making life-decisions. Her success has galvanized into a movement known as the Jenny Hatch Project, a movement advocating to reduce the use of full guardianships in lieu of the supported decision making model. Ms. Hatch was unable to make it to the conference but her Attorney Jonathon Martinis spoke to Idaho magistrates state-wide about his and Jenny’s case and subsequent movement. Mr. Martinis and DRI L.D. also participated on a panel with two (2) magistrate judges and an ISC representative discussing Idaho specifics in relation to the use of the alternatives to guardianships, such as supported decision making model, and limited guardianships appointments. The presentation and panel discussion were well received according to surveys which revealed that Idaho Magistrate Judges are actively considering these lesser restrictive alternatives. The Idaho State Bar Association agreed to publish an article authored by the SDM subcommittee in its publication, “The Advocate”, in a 2017 issue. This publication will be dedicated to guardianship issues with emphasis on alternatives, limited guardianship and the supported decision making model. “The Advocate” is the Bar’s official publication featuring articles written by attorneys on topics of interest to members of the legal community, providing the opportunity to advocate for the implementation of supported decision making and least restrictive G/Cs statewide. The Idaho Fiduciary G/C Association requested that DRI provide a presentation on least restrictive guardianship and supported decision making at its annual conference during FY2017. DRI L.D. developed training during FY2016 and given in October, 2016. The DRI L.D. presentation on Alternatives to Guardianship and the Supported Decision Making Model was given at the Tools for Life annual conference to 35 transition-aged students and parents. 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. No collaborative efforts were involved 5. Five (5) cases were handled under this priority for PAIR clients. No class Actions. 6. One (1) case summary. A 48-year-old Caucasian male diagnosed with cancer, angina, diabetes and kidney failure called DRI reporting a rights violation. The hours of his personal care aide were reduced after the client fired the center for independent living (CIL) fiscal intermediary facilitator for self-directed personal/attendant care (PCA) services. He requested that DRI assist with getting his PCS hours increased and to file a complaint against the CIL. P&A SERVICES: Case assistance/self-advocacy and investigation-DRI advocate requested the client's file and reviewed the relevant documents. After review of the client's records, DRI determined that his PCA hours were reduced prior to firing his PCA provider and confirmed that it was the regional Medicaid unit (RMU) that requested a significant change submission after learning of the PCA's living status and hours billed for the client. DRI advocate provided rights information, suggestions and strategies to assist client with appealing his PCA hour reduction with Medicaid. The client had also refused to initial and sign his PCA hours time-sheets for financial reimbursement, but after DRI advocate reviewed his contractual agreement to do so, he signed the timesheets as required. OUTCOME: As a result of the P&A's investigation, the client was able to advocate for himself. The Medicaid administrative fair hearing overturned the PCA services reduction, his PCA hours were increased and after signing the time-sheets fulfilling his contractual agreement, he was able to choose a different CIL PCA fiscal intermediary to facilitate access to self-directed PCA services. DRI could not substantiate a rights violation by the CIL, a complaint wasn’t filed and the case was closed. 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. Idaho Health and Welfare, Idaho Department of Labor 5. Five (5) cases were handled under this priority for PAIR clients. No class actions. 6. One (1) case summary. A 56-year-old Caucasian woman residing in an urban location and diagnosed with multiple disabilities, including mobility issues and mental illness, contacted DRI seeking assistance with appealing a denial of eligibility for Medicaid for Workers with Disabilities. P&A SERVICES: Case assistance/self-advocacy - Suggestions, strategies, rights information and timelines were provided about the appeal process in order to secure appeal rights. Rights information regarding the Social Security (SS) disability determinations process was provided. Appropriate medical and vocational documentation that can help show that her disability meets a SS impairment listing was explained and strategies to ensure that records were received was provided. The web-page to access SS bluebook impairment listings was provided as well as physician questionnaires, and a memo on writing a letter of support to complete and submit was suggested. The client was referred to a CIL to get assistance with completing the appeal forms within time-lines. OUTCOME: Client was provided with rights information, suggestions, strategies and access to resources to advocate for herself to obtain MWD benefits. Summary of systemic work completed provided: During the 2015 legislative session, testimony was provided regarding barriers to accessing the Medicaid for Workers with Disabilities (MWD) program resulting in limited access to MWDs for non-Social Security beneficiary applicants. Legislators convened a legislative inquiry to identify barriers regarding limited access to the MWD program. The two (2) legislators tasked with this inquiry contacted DRI requesting help with identifying barriers and resolutions and a MWDs workgroup was formed. Initially, the DRI Advocacy Director (A.D.) and a former DRI WIPA advocate facilitated and attended a meeting with the Idaho Department of Health and Welfare (IDHW) staff and the Department of Labor (DOL) Disability Determination Services Professional Relations Officer (PRO) and Adjudicators, the contractor for IDHW, to determine if applicants meet the SS criteria of disability, a MWDS eligibility requirement. Barriers were identified and DRI A.D. provided update on barriers identified to the two (2) legislative representatives tasked with the legislative inquiry. DRI A.D. assisted representative in drafting a letter of identified barriers which was sent to the IDHW Administrator requesting follow up to their concerns to identify possible resolutions. MWDs workgroup meeting was facilitated by IDHW staff that included the representative and DRI staff. Issues and resolutions identified included: Issue 1: Can a loop be created between the Department of Labor (DOL) website and IDHW to improve access to programs? Action Item: Since IDHW contracts with DDS to make disability determinations, IDHW agreed to reach out to the DOL and request that a statement is listed on the website directing people to the IDHW site in regards to MWD. Issue 2: How can we continue to improve upon staff knowledge of MWD so they are providing accurate and consistent information to clients? Action Item: It was suggested that IDHW staff and Disability Rights Idaho increase communication and meet periodically to share information in order to better collaborate and build on existing systems. The suggestion was made for IDHW to provide training/information on MWD on a more frequent basis to ensure consistent/accurate information is being provided. Collaboration between offices and information sharing could improve effectiveness of services. Issue 3: What are the practical things that other states may be doing through statute or rules to ensure clients are able to access MWD? Action Item: IDHW agreed to reach out to some other states to gather information about how things are done; what are the practical approaches to support access to this program? Issue 4: How would someone know that they qualify for MWD and access this resource if already working and not accessing IDHW or DOL services? Action Item: The possibility was discussed of working with HR departments in the state to provide information to workers when they are hired to improve education about the program and services. Issue 5: How could the generic application for IDHW services be adjusted to better alert staff about a MWD case and to alert a client that they may qualify? Action Item: IDHW staff review the form to determine if they can add language to help a client. IDHW staff said they could also reach out to DDS to see if DDS could change their packet to be more specific for MWD. Issue 6: Currently the IDHW denial letter doesn’t delineate the reasons for denial even though recent court rulings and Federal Medicaid regulations have determined that a client has the right to know the reasons for denial so they may know how to appeal. The current denial letter is generic and sent to all applicants, not specifically to MWD applicants, so it is not personalized in explaining the basis for MWDs denial. IDHW indicated they currently have a workgroup updating their notices for all Medicaid programs. Issue 7: Currently, if a person disagrees with a DDS disability determination, they can request reconsideration through IDHW, but cannot appeal the decision to a fair hearing, as IDHW believes hearing officers lack authority to override DDS decisions. This leaves applicants without meaningful due process, since they cannot appeal using the Social Security appeals process if they are not applying for Social Security, and Social Security appeals process does not reach the disability determination level if the applicant is working/making SGA. Action Item: IDHW staff agreed to research the appeals process used in other states. After this meeting, DRI further researched and determined that if the Social Security regulations defining disability are incorporated by reference into the Idaho Administrative Rules (IDAPAs), they essentially become state rules and should be subject to a hearing officer’s authority. DRI provided this information to the representatives and IDHW and suggested that they consult with its Deputy Attorney General. Shortly after this meeting, IDHW reported to DRI that they granted their hearing officers the authority to review/hear DDS denial determination resulting in applicants now having access to due process rights. The first Medicaid fair hearing regarding a DDS denial is to be heard during December, 2016. DRI has agreed to continue its collaboration with IDHW and the legislative representatives. If additional assistance needed, DRI will address under its Pubic Policy objectives during FY2017. 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. Idaho Interagency Council on Secondary Transition (IICST) collaborating with the State Department (SED), Vocational Rehabilitation, Idaho Assistive Technology Project (IATP), the Idaho Council on Developmental Disabilities (ICDD), providers and businesses when planning annual Tools 4 Life conference to transition-aged students. 5. No cases since not case driven. No class Actions. 6. One (1) case summary. A summary of work completed under this priority is provided: DRI remains on the Idaho Interagency Council on Secondary Transition (IICST) and participated on the planning committee for the annual Tools 4 Life Conference. At the Tools 4 Life conference, DRI provided a display booth outreaching to approximately 350 students, teachers, providers and family members providing information on DRI services and how P&A can assist transition students. DRI provided four (4) transition training sessions educating on alternatives to guardianship and supported decision making; “Self-Advocacy, Making your Dream a Reality”-self-advocacy skills training providing information on self-advocacy characteristics and basic elements to develop with focus on acquiring knowledge of rights; “Go Vote” providing voting rights training and accessible voting options information for people with disabilities; and “Transition Planning-It’s a Team Sport” providing rights protections information for transition planning requirements which include: IDEA, Section 504, the ADA and the Work Force Innovation and Opportunity Act (WIOA), information on transitioning to employment, post graduate education, integrated community living and participation, employment and employment services access, self-advocacy for independence and importance of self-advocating for appropriate individual education plans (IEP) transition planning to 162 students, parents, providers and teachers. Approximately 350 students, parents, teachers and providers attended this event, most stopping at the DRI booth receiving information about the P&A, its services and how it can help transition students and PWDs. A DRI staff attorney is a member of the Idaho State Bar Diversity Section and participates on its Love the Law! sub-committee acting as co-chair and secretary during FY2016. Love the Law’s purpose is to create a pipeline program for Idaho high school and college age students (including minority students and those with disabilities) to become more familiar with professionals in the legal community and to encourage them to pursue a career in the legal field. She helped organize events in both northern and southern Idaho. The event in northern Idaho welcomed 50 students from area high schools to the University of Idaho (UofI) Law School to participate in a mock law school class and witness a debate on marijuana legalization laws between two law school professors. The event finished with a panel discussion about law school by law students from the Concordia University School of Law and the UofI School of Law. The southern Idaho event invited 50 students from area high schools to attend the 225th anniversary of the Bill of Rights ratification CLE held in downtown Boise. Students observed judges, attorneys from the ACLU, and other state and federal agencies, speak about the impact of the Bill of Rights, including cases involving civil rights in Idaho, and campaign finance laws. In addition to the transition workshop training and outreach noted above, DRI conducted transition workshops and training to: 1) The Idaho DD Council’s Partners in Policy Making workgroup providing transition planning training, input and guidance to 20 adults with DD and their family members on policy making advocacy; 2) A two (2) hour workshop at the Regional Northern Rockies Association for Education and Rehabilitation of Blind and Visually Impaired Individuals (AER) conference. Workshop focused on transition planning including student input and an overview of Social Security work incentives to 36 individuals with blindness, parents and teachers; 3) A one (1) hour overview about SS work incentives discussing how they can be used to help beneficiaries transition to work and not immediately lose benefits and health care was provided to 16 transition-aged youth at the Idaho Department of Labor. Since most were nearing adult age, information on how to access the voting process was also provided; 4) A one (1) hour overview about SS work incentives discussing how they can be used to help beneficiaries transition to work was provided to 26 students with disabilities, parents and educators at East Jr. High School. Information on P&A and its services was also provided. 5) Three (3) presentations were given at Eastland High School to 25 students, parents and teachers discussing appropriate IEP transition planning, “Transition Planning-It’s a Team Sport”, and information on community services and benefits including SSA applications and the assistance the P&A can provide when applying. Two (2) students contacted DRI requesting help with applying for SSI. DRI has reevaluated its outreach efforts to transition-aged students needing assistance with accessing effective transition planning. Previously when outreaching DRI referred students and their parents to call the P&A if they have concerns and open a service request. Since the P&A has not received many calls requesting assistance, during FY2017 the P&A will be facilitating intakes at outreaches so transition-aged students have more immediate access to P&A case assistance. 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. No collaborative efforts were involved. 5. No cases handled under this priority since not case driven. No class actions. 6. One (1) case summary. A summary of work completed is provided: In addition to outreach efforts for transition-aged students and to the Fort Hall Indian Reservation (noted in above and below objectives), DRI conducted the following outreach increasing awareness of services offered by P&A: DRI participated at Disability Advocacy Day at the Idaho State Capitol. DRI disseminated brochures and talked to 75 PWDS, legislators, agency personnel, providers and family members providing information about the P&A and its services. Local media filmed DRI staff providing training on an accessible ballot marking device (BMD). The DRI E.D. provided testimony on Idaho Health Plan/Medicaid Expansions HB 1204 &HB 1205 to the legislature and on his blog discussing concerns that Idaho’s Office of Performance Evaluation’s (OPE) report on evaluating the Optum Medicaid behavioral health contract was not including outcomes for people with mental illness. During FY2016, DRI provided information reaching 76 PWDs, agency representatives, employees with disabilities and family members about the P&A, its services and SS work incentives training at four (4) different venues including the Autism Society; Goodwill Working Solutions; the Ada County Housing Authority; and to Vocational Rehabilitation counselors at the University of Idaho’s extension campus. DRI Advocacy Director attended the State Independent Living Council of Idaho’s Board of Directors strategic planning meeting (on behalf of E.D.) providing input to 15 board members on what issues should be included in SILC’s 5-year plan Topics included ADA violations, community integration issues, and violations of rights of parents with disabilities. While completing a monitoring trip to northern Idaho, DRI advocates visited three (3) centers for independent living offices, meeting with nine (9) independent living advocates and transition coordinators. Information was provided about DRI services, and its current FY priorities. Collaborative efforts between agencies, including systemic concerns with a para-transit provider, coordinating accessible voting training and registration efforts, and the Medicaid expansion legislative public policy initiative were identified DRI participated at an outreach event at the Northwest Nazarene University (NNU) for its social worker student program. Information was provided to 15 students about the P&A and its services. Several students expressed interest in interning at DRI and a discussion of setting up an intern program in the future was considered. Two (2) DRI staff attorneys participated at a legal clinic for military veterans, providing disability related legal advice to five vets and information about the P&A and its services to an additional 25 VA staff, veterans, and family members. In addition to the outreach actives listed above DRI provided information about the P&A and its services while presenting voting rights and accessible voting options training reaching 430 PWDs, poll workers, Democratic Party caucus facilitators, county elections staff, and to the Idaho Commission for the Blind and Visually Impaired (ICBVI) staff statewide. Additional activities summarizing the DRI’s participation with other stakeholders, disability groups on task forces, workgroups and councils providing outreaching opportunities is provided in Public Policy priority, objective 3 noted below. 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. 4. During case work, DRI collaborated with a Fort Hall Indian Reservation Adult Protection Services (APS) worker to help client access Indian Health Services 477 programs for remaining balance of a prosthetic limb. 5. One (1) case. No class actions. 6. One (1) case summary. Client is a 71-year-old American Indian female with an amputated limb, diabetes, and vision impairment who called the P&A for assistance with an Indian Health Services (HIS) denial of financial payment of a remaining balance (20%) for a prosthetic limb that her health insurance policy didn’t cover. It was denied on the basis that she no longer resided on the reservation. DRI advocate reviewed the client's information and confirmed that Indian Health Services (IHS) had verbally denied the client assistance due to the fact that she no longer resided on the reservation. DRI advocate located information on IHS programs available and rules of eligibility clarifying that tribal IHS can serve all members of federally recognized tribes and that the recipient isn’t required to reside on the reservation. DRI advocate contacted the IHS administrator who confirmed that the client's residence does not impact IHS's ability to assist her with paying for her prosthetic limb, as IHS is a payer of last resort not only for tribal members, but for members of other federally recognized tribes. The tribal APS advocate was also contacted and who agreed to hand deliver the bill to IHS and assist the client with communicating with IHS regarding its obligation to pay under its 477 programs. OUTCOME: As a result of the P&A's assistance, the client was able to advocate for herself and had access to additional advocacy assistance from the tribal APS worker, if needed. She was asked to contact the P&A if further assistance was needed but she never called back on this issue. A summary of systemic work completed is provided: DRI advocate met with the Fort Hall Indian Reservation’s Tribal Adult Protection Services (APS) program/advocate. Advocate provided P&A brochures, information about P&A systems and DRI. Information on DRI services and how it determines case assistance was explained. APS presented concerns with tribal VR which DRI advocate later presented to her supervisor. DRI advocate provided P&A’s Psychiatric Hospitals Patient Rights Handbooks since APS advocate stated that some tribal members have been committed to the state hospital system and called asking for help and she didn’t know how to help them. DRI advocate encouraged her to refer to DRI if tribal members are receiving treatment in state run psychiatric hospital or private hospitals alleging abuse, neglect and/or rights violations since we investigate these types of rights violations. The APS advocate invited DRI to present at its upcoming Elder Abuse Conference and to participate as a vendor. DRI participated at the Shoshone Bannock Elderly Abuse Conference. DRI advocate presented at this conference discussing the P&A, its services and how it helps people with disabilities (PWDs) to approximately 75 tribal members. DRI also had a display booth and advocate answered specific questions regarding CAP services; rights violations and appeals; SSA application process and eligibility criteria; employment rights, providing examples of employment discrimination; discharge from facility issues; educational and individual education plan (IEP) questions; and she explained the difference between DRI and APS. PUBLIC POLICY 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will inform policy makers of the effects of adopting the Healthy Idaho Plan, eliminating the health insurance coverage gap for Idahoans with disabilities. 4. P&A collaborated with the Close the Gap statewide initiative and the Consortium for Idahoans with Disabilities (CID) comprised of disability organizations and providers collaborating on identified public policy legislative initiatives to promote or prevent legislation and rules that effect Idahoan with disabilities. 5. No cases since not case driven. No class actions. 6. One (1) case summary. The Idaho Healthy Plan was a name change for Medicaid expansion legislation. DRI E.D. authored a position paper endorsed by CID and the Close the Gap initiative in Idaho and led these groups in efforts to get Idaho Healthy Plan legislation passed. E.D. also authored two (2) position papers on Medicaid expansion waiver proposals and provided written and oral testimony to both the Senate and the House Health and Welfare Committees and to the interim work groups in both 2015 and 2016. The committee heard two (2) drafted bills, HB2014 and HB2015 and voted to send both bills directly to the House floor without a hearing. The bills would have established a legislative interim committee to examine alternatives to address the health insurance gap issues, and give community clinics $5 million to develop “health homes” and study the “Gap” who come into the clinics for treatment. Neither bill would have made any significant difference for people with disabilities who lack health coverage, only providing access to minimal medical treatment such as examinations and to prescribed medications. Committee members who supported the bills said that it was a step toward real Close the Gap legislation for next year’s legislative session (when they will not be facing an election). OUTCOME: The House Health & Welfare Committee adjourned without printing a bill to expand Medicaid and close the health insurance gap. On the last day, the Senate created some drama by amending the House bill to include a Medicaid expansion waiver and passing the amended bill. The House defeated the bill on a party line vote. However, it is believed that the Close the GAP initiative is gaining momentum and the P&A has carried this priority over to FY2017. 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. 4. As a member of the Consortium of Idahoans with Disabilities (CID), DRI E.D. monitors disability rights related legislation & rules, analyzes its impact directing public policy initiatives of CID and other disability agencies in their advocacy for legislation and rules that are favorable in promoting the rights of PWDs in Idaho. 5. No cases since not case driven. No class actions. 6. One (1) case summary. A summary of systemic work completed is provided: DRI E.D. monitored and provided information and analysis either in writing or orally to all member organizations of the Consortium for Idahoans with Disabilities (CID). This analysis helped in determining the best action for promoting the rights of PWDs in Idaho. The following lists legislation and rules monitored and addressed in addition to those issues specifically included in the other PP objectives: Home and Community Based Services (HCBS) rules: New Medicaid rules designed to protect participants’ rights and opportunities for community integration were presented in House and Senate Health and Welfare (H&W) committees. CID supported and DRI testified about the need for the rules to safeguard participants’ rights. OUTCOME: Both committees approved the proposed rules. H&W Behavioral Health Plan (HCR 54) A concurrent resolution requesting that the Idaho Department of Health and Welfare (IDHW) develop a strategic plan for behavioral health services and report to the Legislature on how it will be accomplished, how they will measure outcomes and what progress is being made toward a coherent and comprehensive mental health system. CID and DRI supported this resolution. OUTCOME: The resolution passed the House unanimously but was defeated in the Senate H&W committee. A senator promised to work with advocates on a strategy to educate legislators and develop a plan to move forward, but admitted he doesn’t know how that will happen. S1268 — This bill revised Idaho Code on DD Council membership to conform more closely with federal statutes. Membership would not be restricted based on working for a state agency or local organization that receives funds for or provides services to individuals with developmental disabilities. This proposed change resolves a current member recruitment issue which the Council finds a barrier to recruiting prospective applicants, especially parents, who do not work in the disability field in some way. DRI and CID promoted this legislation. OUTCOME: Passed both Houses and signed by the Governor. S1326 — This bill clarified that IDHW is responsible for suicide prevention and that there is no fiscal impact because the department already provides these services. OUTCOME: The bill passed both Houses and signed by the Governor. S1328 — Foster Care Reform. This bill addresses many issues for foster children including requirements to report to the court on the use of psychotropic medications, dosages and outcomes. CID supported and DRI E.D. testified in both Houses. OUTCOME: The bill passed both Houses and signed by the Governor. H518 — This bill added dementia to the list of conditions covered by the involuntary commitment statute for mental illnesses. DRI monitored and testified against this bill. OUTCOME: This bill died in committee. H413 - “Maniac” License Plate. This bill created a vanity license plate benefiting the Orofino High School “Friends of the Maniacs” booster group. DRI testified against the bill as promoting negative stereotypes of people with mental illness. OUTCOME: This bill passed the House and died in the Senate Transportation Committee. S1375 — Delegation of powers of a guardian. This bill would have allowed a guardian to “delegate” guardianship authority to another person for up to three years at a time with unlimited renewals without having the person subjected to evaluation by the committee or having a criminal history or background check. There were also many drafting problems. DRI’s E.D. contacted the sponsor, and after their conversation he agreed to send the bill to be amended and remove people with developmental disabilities from the bill, leaving only children covered by the provision. When the bill came before the committee, they didn’t even consider a motion to amend the bill. A senator suggested that the chair just hold on to it for the rest of the session. OUTCOME: The bill failed for lack of a motion. S1327 This bill clarifies the definition of “neglect” in the Adult Protection Act. The current statute defines neglect as a failure of a caretaker to provide certain basic needs "in such a manner as to jeopardize the life, health and safety of the vulnerable adult." By using the word “and” the statute requires an act or omission to endanger the life of the person. The bill changed the definition to read “life, health or safety”. This statute does not govern DRI’s neglect investigations, but it does govern Idaho adult protection services and it controls when prosecutors can charge someone with a crime. DRI and CID supported this bill. OUTCOME: The bill passed. H579 — This IDHW bill appropriates $97,605,000 to the divisions of Mental Health, Psychiatric Hospitalization, and Substance Abuse Treatment and Prevention for two new mental health crisis centers in the Treasure Valley and in the northern part of the state. CID and DRI supported. OUTCOME: The bill passed and was signed by the Governor. S1207- This IDHW appropriation bill includes additional funding of $511,600 for increased staff at state hospitals. CID and DRI didn’t oppose. OUTCOME: The bill passed and signed by the Governor. 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. 4. See below 5. Not case driven. No class actions. 6. One (1) case summary. A summary of systemic work completed provided: DRI Executive Director (E.D.) is a leading member of the Consortium of Idahoans with Disabilities (CID) and served on its Board of Directors during FY2016 guiding its public policy agenda; he continued his membership on Partners in Crisis which is a CID sponsored 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 the 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 his membership IDHW’s Medical Care Advisory Council (MCAC) expired, but he was replaced by a DRI staff attorney, to review state Medicaid policy and provide comments on proposed rules and implementation. E.D. is a leading member of the of the Idaho Health Care for All/Close the Gap Committee significantly impacting and guiding this initiative; and is a board member for both the Idaho Council on Developmental Disabilities (ICDD) and the State Independent Living Council (SILC) helping in developing strategic planning and supporting their public policy initiatives. DRI 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 Legislative Rules Subcommittee which revised rules for temporary guardianship appointments during FY2016; and she continued leading action on its newly formed Supported Decision Making (SDM) Subcommittee which drafted a template for least restrictive guardianship for both the DD and Uniform Probate Code statutes. The Supported Decision Making Sub-committee also facilitated at the annual ISC Magistrate conference a full morning of training on SDM, which included a leading SDM proponent/attorney presenting to the Magistrates. L.D. also participated on a panel to discuss specifics of incorporating this model in Idaho. DRI 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 and receives ongoing cultural training. A.D. is a member of the U.S. Commission on Civil Rights-Idaho Advisory Panel meeting biannually to discuss issues impacting civil rights in Idaho and continued her participation on the panel’s Disability Subcommittee continuing work on its project to assess Idaho’s compliance with the Olmstead integration mandate with regards to Idaho’s adult mental health system. All DRI licensed attorneys (including DRI A.D.) are members of the Idaho State Bar Diversity Section emphasizing improving diversity related issues such as cases involving racism, and the Bill of Rights. During FY2016, DRI staff attorney served on the Diversity Section’s Subcommittee called “Love the Law” acting as its Secretary and Co-Chair. “Love the Law’s” purpose is to create a pipeline program for Idaho high school and college age students including minority students and those with disabilities to become more familiar with professionals in the legal community and encouraging these students in pursuing careers in the legal field. The A.D., as the CAP Coordinator, continued membership on the State Rehabilitation Advisory Council as the CAP representative reviewing Idaho Vocational Rehabilitation (IDVR) service reports, client outcomes, and budget data providing input for improvement. Focus for 2016 was on providing input to ensure IDVR’s compliance with the new WIOA (Workforce Innovation and Opportunity Act) regulations, especially with regard to transition-age youth. A.D. is a member of the State Department of Education 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 Tools 4 Life planning committee for its annual conference. A.D. and senior advocate continued on the Idaho Employment First Consortium organized by the IDCC including representatives from IDVR, Idaho Department of Labor (IDOL), IDCC, SILC, and IDHW. This collaboration is for the purpose of ensuring that employment is the first outcome considered for people with disabilities. During FY2016, a strategic plan was developed to approach IDHW with the recommendation that funds be allotted in its annual budget for development of an employment plan for individuals with disabilities who access state Medicaid funds and other services. The plan with recommendations was developed and presented to IDHW during 2016. During 2017, this Consortium will be requesting that IDHW submit the plan to the legislature for changes to Idaho Medicaid rules to support funding employment education and access. DRI senior advocate participated in a four (4) hour workshop as an invited commentator to IDOL’s disability employment initiative grant review conducted by federal DOL staff. This audit included review of efforts being addressed at a statewide level to incorporate federal guidelines when helping individuals with disabilities access work in Idaho. A.D. participated (later replaced by DRI staff attorney mid-year) on a regional Keeping Children Safe (KCS) Child Protection Services’ (CPS) Citizens Panel. During FY2016, A.D. provided input on recommendations made by the panel to the governor, which will be presented at the annual KCS panel conference in October. Issues included ensuring schools use of trauma informed care when developing IEPs and discipline programs to prevent re-traumatizing of children in foster care. DRI provided training to child protection staff regarding parents with disabilities rights to access services and accommodations to help with parenting. DRI senior advocate and PAIR/PATBI Coordinator remains as 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). During FY2016, its primary focus was developing a universal assessment and guidance to RALFs to utilize when determining appropriate admissions. She also assisted with drafting its yearly report submitted to the legislature on council work completed and its recommendations. PAIR/PATBI Coordinator is on the Board of Directors for the Brain Injury Alliance of Idaho (BIAID) advocating for the rights of persons with brain injury and prevention. During FY2015, she was asked to chair its subcommittee project developing materials to help post graduate students with brain injury access reasonable modifications and auxiliary aids and services. During FY2016, she completed authoring BIAID’s brochure entitled-“Preparing for College/Post Graduate Education-Accessing Accommodations & Disability Services-WHAT YOU NEED TO KNOW” which has been disseminated to colleges state-wide.
DRI senior advocate and PAAT/PAVA Coordinator is a member of JAVA (Justice and Advocacy for Vulnerable Adults). JAVA is a state-wide professionals group associated with protecting the vulnerable adult population in Idaho from fraudulent activities, promoting state wide support for elderly with Alzheimer's and other issues effecting senior citizens and/or vulnerable adults. DRI supports and advocates for self-determination initiatives and DRI senior advocate serves on the Self Advocacy Leadership Network’s (SALN) Executive Committee planning outreach activities and public policy agenda issues pursued during FY2016 and 2017. The monitoring advocate for State Hospital South, one of the state operated institutions, is a member of its Patient’s Rights Committee providing rights information education and self-advocacy training. This membership also allows her to identify systemic or individual issues helping to guide her monitoring activities and individual case work. This participation allows DRI 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 DRI 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; educate the community regarding the dangerous practice of restraint and seclusion in schools and the community; address whether persons with disabilities are receiving appropriate IDVR, DOL, and Social Security employment services or are encountering employment barriers, all factors that greatly improve the quality of life for persons with disabilities in Idaho. Through this involvement, DRI is able to address the ever-changing issues of Medicaid and its budget and service cuts that greatly affect the access to, and quality of, health care. It allows DRI 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 this P&A to constantly remind agencies and others of protections under the Americans with Disabilities and Rehabilitation Acts, the Fair Housing Act, and the prevention of disability discrimination. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will advocate for changes to Idaho Medicaid rules to improve the personal needs allowance for people on the Aged and Disabled waiver. 4. No collaborative efforts involved. 5. Not case driven. No class actions. 6. One (1) case summary. A summary of systemic work completed provided: DRI E.D. and L.D. have been facilitating meetings, participating on applicable work groups and committees, and educating IDHW for many years on the need for the personal needs allowance (PNA) to be increased for those recipients required to pay a share of cost for A&D Medicaid waiver services. The current allowance rate is unrealistic in light of the current cost of living rates. During FY2016, a Medicaid appropriation bill (S1391) was introduced providing funding for the PNA allowance increase. DRI has worked for three (3) years to implement this bill’s passing. DRI testified on the need for the increase and the effect it would have on people with disabilities. OUTCOME: Passed both houses and signed by Governor. This will allow rules to be adopted and implementation by July 1, 2017. Most A&D Medicaid Waiver recipients with a share of cost for A&D Medicaid waiver services will get to keep $214 more of their income each month. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will address system public policy issues in the Idaho Medicaid or managed care programs which arise during FY2016. 4. There were no collaborative efforts involved. 5. Not case driven. No class actions. 6. One (1) case summary. A summary of systemic work completed provided: IDHW has two (2) managed care contracts: a contract with OPTUM facilitating distribution of Medicaid paid behavioral health (mental health) services; and a contract for facilitation of Medicaid paid non-emergency medical transportation (NMET). IDHW managed care contract with OPTUM: After IDHW contracted with OPTUM, access to psycho-social rehabilitation services, now called community-based rehabilitation services (CBRS), were significantly reduced practically to the point of elimination. For children’s access to CBRS, DRI has maintained that access through Medicaid early periodic screening, diagnostic and testing (EPSDT) federal requirements is applicable. DRI’s E.D. and L.D. met several times with IDHW’s Medicaid Director and its Deputy Attorney General (DAG) stressing the need for EPSDT access to CBRS or some other type of PSR service, informing of consequences occurring such as DRI legal action if needed. This approach is also in conjunction with the L.D. representing a child with a Medicaid appeal at an administrative hearing on this basis. DRI developed and disseminated a TA letter with suggestions for appealing denials on the EPSDT access basis. OUTCOME: During FY2016, IDHW Medicaid Director acknowledged that they need to incorporate a psych rehab service for children, and that it will be addressed through the Jeff D. settlement process. This settlement addresses children’s access to mental health services. DRI E.D. is also a member of the CID sub-committee addressing concerns with the Optum managed care contract. This subcommittee requested an Office of Performance Evaluation (OPE) review of the contract through the Joint Legislative Oversight Committee (JLOC) of the 2015 Legislature, and the OPE reported their findings to the 2016 session. DRI E.D. analyzed the report and submitted his written analysis/position paper to legislators and policy makers with concerns that the OPE didn’t include measures showing effectiveness for behavioral health beneficiaries. Rather, the report focused on monies saved from this change, primarily due to the reduction of PSR services. The only PSR/CBRS like service now available is peer supports. Furthermore, there was no mention as to how other funding sources are affected such as county indigent programs paying for psychiatric hospitalizations for persons put on holds with no insurance and if these numbers have increased due to the CBRS reduction. E.D.’s analysis was also published in the DRI web site blog. CID’s sub-committee met with the Medicaid Director, Director of Behavioral Health, and other Medicaid officials on four (4) occasions. IDHW now wants to make it a sub-group of its Medical Care Advisory Committee for further negotiations. (MCAC advises Idaho Medicaid in the development and refining of the Medicaid program by providing a sounding board and, as an advisory group, giving Idaho Medicaid feedback on current and evolving issues). OUTCOME: Negotiations during FY2016 resulted in two (2) policy changes: A policy modifying its CBRS eligibility in which Optum will cease using an IQ score cutoff as criteria for CBRS; and IDHW will be revising its eligible services policy. IDHW is developing new services under the contract to replace CBRS for certain participants; and two (2) more services are about to be implemented: partial hospitalization, and intensive outpatient services. Even though little progress on CBRS issues was made during FY2016 progress was made to be implemented during FY2017. DRI and CID will continue monitoring these issues and negotiating for needed PSR/CBRS increases. The other managed care program being addressed by DRI and CID is IDHW’s non-emergency medical transportation (NEMT) contract. During FY2016, IDHW changed to Veyo, a new contractor to facilitate all Medicaid paid NMET transports. Difficulties for Medicaid participants and NMET drivers arose immediately. Initially, there was no complaint process in place for recipients. CID facilitated a sub-committee addressing this and with DRI’s involvement from two legislators. DRI developed and disseminated a technical assistance (TA) NEMT letter with suggestions on appealing directly to IDHW including IDHW contact information for filing complaints. OUTCOME: A complaint process was put in place. Veyo/NMET contracted services have improved slightly after DRI and CIDs intervention, but serious problems remain and DRI will continue monitoring this issue during FY2017 and address, as applicable. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Access to appropriate medical and mental health services. 3. DRI will continue to provide leadership to the Consortium for Idahoans with Disabilities in educating policymakers on issues of importance to Idahoans with disabilities. 4. Collaborate with the Consortium for Idahoans with Disabilities 5. Not case driven. No class actions. 6. One (1) case summary. A summary of systemic work completed provided: In addition to monitoring and analyzing disability rights related legislation and proposed rules as noted above in Public Policy Objective 2, the E.D. continued as a member of CID’s Board of Directors. He authored all of the CID adopted position papers during FY2016 on the topics of: the pros and cons of Idaho Healthy Plan and waiver proposals; opposition to proposed S1375 bill allowing for delegation of powers of a guardian; the basis for centers for Medicare and Medicaid services (CMS) home and community based services (HCBS) revised rules and consequences if not implemented; and the basis and need for the sign language interpreter bill. 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. 4. CID and the Idaho Council for the Deaf and Hard of Hearing. 5. Not case driven, no class actions. 6. One (1) case summary. A summary of systemic work completed provided: DRI and CID supported this Idaho Council for the Deaf and Hard of Hearing (ICDHH) bill requiring licensing of sign language interpreters. During the 2015 legislative session, the bill was passed but the Governor vetoed the bill due to Idaho Supreme Court (ISC) objections. Prior to pushing any action forward within the legislature during the 2016 session, ICDHH withdrew their bill due to ISC’s actions. To clarify these objections, DRI E.D. attended a meeting with the ISC administrator and one of its justices to clarify ISC’s objections. The justice explained that ISC objected to being required to use only licensed interpreters on the grounds that this could compromise legal and constitutional time limits on many proceedings. They argued that they needed to be able to use “qualified” but unlicensed interpreters to meet these deadlines. OUTCOME: DRI and ICDHH decided to exclude the courts from the current bill because ISC was successful in previously getting the Governor to veto the last bill and believed that they could get another veto, not necessarily because they believed it to be a legitimate reason. A redraft of the bill was completed in light of ISC’s objections and will be introduced again in the 2017 session with an exception for the courts from the requirement. 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). 4. No collaborative efforts were involved. 5. Not case driven, no class actions. 6. One (1) case summary. A summary of systemic work completed provided: DRI E.D. attended four (4) meetings with state officials and an interested Senator. It was determined that the more reasonable and likely avenue to pursue is exploring how Idaho can promote access to ABLE accounts in lieu of Idaho passing legislation to operate ABLE accounts since it doesn’t appear likely that this type of bill would pass. OUTCOME: No bill was introduced in 2016 session because development of an Idaho ABLE account system is not feasible. However, since Idahoans can open ABLE accounts through programs sponsored by other states, the Senator agreed to introduce a bill in 2017. This bill would fund a position to provide assistance to people wanting to open ABLE accounts through other sponsoring states by protecting the assets in ABLE accounts from being counted for state and local means tested programs. This is needed since, if counted, these assets would disqualify Able account holders from state operated programs and services such as Medicaid and/or home and community based services (HCBS). DRI will be monitoring this bill to determine appropriate strategies for its passing. 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 (A&D) Medicaid waiver. 4. SILC 5. Not case driven, no class actions. 6. One (1) case summary. A summary of systemic work completed provided: DRI E.D. and the State Independent Living Council (SILC) approached the IDHW Medicaid Alternative Care Coordinator requesting new A&D Personal Centered Plan (PCP) development rules since current rules are not in compliance with federal CMS PCP rules. The IDHW Medicaid Alternative Care Coordinator acknowledged the need to do so and that currently Idaho was not in compliance with CMS regulations. OUTCOME: No further progress was seen during FY2016, but plans on how to proceed were discussed and follow up during FY2017 is planned. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights 3. DRI will seek changes to Idaho administrative rules for Medicaid state plan personal care services (PCS) to ensure that Medicaid beneficiaries receive their full allowance of PCS hours. 4. SILC 5. Not case driven, no class actions. 6. One (1) case summary. Below summary of work completed provided: At the beginning of FY2016, DRI and SILC E.D.s addressed with IDHW officials the issue that occasionally some cost of share for A&D waiver services were higher than legally required. This inconstancy was occurring because not all regional Medicaid services were consistently counting the first 16 hours of personal care services (PCS) as a state plan service which doesn’t require a share cost. Any additional PCS hours are considered an A&D waiver service which can require a cost of share for those beneficiaries with monthly income three (3) times the monthly SSI benefit rate. By not counting the first 16 hours as a PCS state plan service, the calculated cost of share is higher than legally required since cost shares do not apply to state plan services. OUTCOME: IDHW officials agreed to correct this inconsistency. No confirmation that the problem had been corrected was received and no follow up from DRI or CID to clarify if remedied or not was completed. Needed confirmation that issue was corrected should occur during FY2017. 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 in which death was caused by physical assault; failure to treat, care or monitor the individual; seclusion; or physical, mechanical or chemical restraint. 4. No collaborative efforts were involved. 5. One (1) systemic case opened on behalf of multiple residents residing in Certified Family Home. No class actions. 6. One (1) case summary. On January 24, 2014, Adult Protection Services (APS) received a complaint describing the alleged abuse of a 60-year-old male with physical and intellectual disabilities residing at a property housing two (2) certified family homes (CFH) located in rural Idaho. Upon receiving this complaint, APS reported this information to the Department of Health and Welfare (DHW). APS, the Department, and local law enforcement then arrived on the scene to conduct investigations. Residents were removed from both CFHs the same day. The Department later revoked the CFH licenses of both certified providers at both homes. The initial complaint received by APS, was reported by the stepdaughter of one of the providers a staff member at the CFH. On March 4th, 2014, Disability Rights Idaho (DRI) learned of the alleged abuse from the local newspaper. After a DRI abuse and neglect team meeting review, an advocate was assigned to conduct a secondary investigation into the Department’s primary investigation of the alleged abuse. Records were reviewed and witness interviews completed. During this secondary investigation, DRI uncovered information regarding several suspicious deaths on behalf of these PAIR deceased clients, prompting DRI to open an additional systemic case regarding the circumstances behind those deaths. The investigation and report was completed in July of 2015 and after a legal review the final report was revised and drafted during FY2016. After the CFH provider’s certification was terminated by the Department she appealed this decision at an administrative fair hearing. This systemic case was then assigned to a DRI staff attorney who reviewed a copy of the Department’s hearing officer’s preliminary order, reversing the CFH license revocations in April, 2016. The hearing officer noted several issues in regards to the Department’s investigation into this matter including the following: admitted bias and lack of objectivity by the Department investigator; lack of investigator training; lack of evidence including photographic evidence to support allegations regarding uncleanliness, locks on resident doors, and inadequate temperature. In addition to the issues identified above, the DRI attorney identified the following concerns to address with the Department: Whether or not the Department conducts initial certification studies at the time CFHs are certified, including if such studies were conducted at the time these two (2) CFHS were certified as required by Idaho Rules (called Administrative Code (IDAPAs)); whether or not the Department conducts home inspections (annual or bi-annual) of homes certified through its CFH Program, including whether or not such inspections were done with these two (2) CFHS, as required by CFH IDAPAS; why the Department did not use its discretion to conduct more frequent home inspections of the CFHs, pursuant to IDAPAS, in light of the fact that three (3) residents died prior to the issuance of a CFH license for this provider, and then five (5) more residents died after the issuance of such a license; whether or not the Department followed the complaint procedure outlined in IDAPAs upon receipt of a complaint of a suspicious death from the county coroner; and issues concerning a lack of evidence, including but not limited to photographic evidence, to document and support allegations concerning uncleanliness, locks on resident doors, and lack of adequate temperature. To address such issues, DRI drafted a letter outlining its concerns with the abuse investigation, the identified suspicious deaths and the Department’s hearing officer’s preliminary order reversing the CFH license revocations (noted in the above priority/objective). The letter also included DRI’s concern that the Department needs to develop a protocol for determining when reported deaths in CFHS rise to the level of suspicious, needing more thorough investigations. The letter requested that the Department meet with DRI staff to discuss concerns identified and that their investigators receive adequate investigation training including a referral to the trainer who conducted Suspicious Incident Investigation and Effective Final Report Writing trainings to DRI staff. Negotiations and results of this meeting is discussed in further detail in the following A&N objective reported on below. 1. People with disabilities 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 IDWH investigate the reported deaths. 4. Negotiations occurred between DRI and IDHW’s Licensing and Certification program for the goal of implementing better protections for residents. 5. Not case driven, no class actions. 6. One (1) case summary. A summary of systemic work completed provided: The letter submitted to L&C Chief listing DRI’s concerns identified during the course of its systemic death investigation case (reported above) resulted in a meeting between DRI and L&A department staff. Those in attendance included the DRI investigating advocate, L.D., and assigned staff attorney. IDHW staff including the Department’s Licensing and Certification (L&C) Chief; both the outgoing and incoming CFH L&C supervisors and their Deputy Attorney General (DAG). L&C administrator reviewed the steps taken by the Department to improve investigations. Significant incident investigations training had begun during FY2016 to be completed for all staff during FY2017. A CFH staff had been sent to a training down in Austin getting estimates for having that training brought to Idaho for all CFH and residential assisted living facility (RALF) investigating staff. All staff are broken into two (2) separate trainings so not all staff are not to be pulled out of the field at the same time. They are currently looking at doing a three (3) day training. Current training occurred at the Idaho 2016 CFH annual summit in discussing this case, procedures, and brainstorming ideas for ways to improve investigations in the future, including death investigations. In the CFH program, a workgroup on investigations has been developing protocol on complaint procedures, critical incident investigations and reviewing revision updates. CFH investigators are also increasing their partnering with APS when investigating. DRI staff attorney asked if CFH program had conducted visits at the CFHs in question. CFH Supervisor stated that they had received complaints about the homes and CFH program and APS investigated and determined that they were operating as an unlicensed RALF confirming that all six (6) residents were private pay. The homes were certified in 2010, after providers attended training and completed certification requirements in April of 2010. An initial certification study then annual inspections were conducted after certification. The supervisor clarified that a desk review was conducted in 2013 and an in-person visit completed in 2013. However, L&C admitted that these visits/surveys alone were not sufficient in preventing the deficiencies later cited after the battery charges were filed resulting in the residents being removed which included locked doors, windows nailed shut, and unsanitary conditions necessitating improved investigations to be addressed from improved investigation training. The issue regarding death reports and investigations was discussed. Per Idaho Administrative Code (IDAPAs), both CFH and residential assisted living facilities (RALFs) are required to report deaths but not all reports are investigated fully. Preliminary investigations are conducted to determine if suspicious. L&C has identified additional evidence types to collect for their preliminary investigations. DRI staff attorney asked if the suspicious death reported in 2009 by the county coroner was investigated. CFH program confirmed that they investigated this report by reviewing the coroner’s and sheriff’s office reports and charges were filed. The facility was acting as an unlicensed RALF when the report and subsequent investigation resulted. However, CFH and the providers reached an agreement where charges would not go forward if the providers did what was needed to become certified. DRI staff attorney presented the large number of deaths that occurred from 2009-2014 and asked if that prompted any additional visits into the home. CFH supervisor stated that after 2010, all of the deaths were age-related and since the deceased were on hospice at the time of their deaths, the deaths were determined not to be suspicious and no additional inquiry was completed. L&C Chief explained that for state certification purposes, CFH doesn’t have as much guidance or protocols as federally-licensed/certified facilities have per Centers for Medicaid and Medicare (CMS) regulations. She said it would be a resource issue for them to have protocols as detailed as CMS has for certain facilities. Even though there is a staff shortage CFH program currently has no plans to ask for additional appropriations to increase staff to do surveys or investigations due to legislative restraints. Although, temporary staff have been hired to catch up its survey and complaint investigations. CFH staff admitted that they don’t necessarily meet individually with residents. They instead focus on the providers, reviewing documentation, conditions of the home in general. They physically look at the residents to see if there are any signs of physical abuse (bruising, etc.). DRI suggested that they make efforts to independently meet with CFH residents when they are out there doing their annual or 24-month certification studies/inspections. DRI also emphasized that the L&C/CFH program should make an effort to create a more user-friendly way to file a complaint against a provider — perhaps an online form, etc. The parties also discussed sharing DRI’s, APS and L&C contact information with providers to share with residents upon admission. DRI offered to share its resident’s rights poster with CFH program to incorporate into CFH admission packets as well. L&C asked if DRI would be interested in partnering with them to conduct primary investigations of CFH in the future which DRI stated they would be interested if resources permit. Additionally, L&C administrator clarified that she had shared with the Department director the need for a meeting between all of the players in charge of ensuring that providers are following the rules and participants are safe — including DRI, APS, the police, Licensing and Certification, and Medicaid — to discuss each one’s different roles in cases such as this one, the overlap between jurisdictions, the holes that exist between our authorities, and then perhaps we can attempt to remedy those holes through rule or statutory change. DRI LD asked if there were going to be any rule changes as a result of this case. L&C administrator and DAG stated that there would be rule changes but not as a result of this case since the hearing officer reinstated the provider’s certification. The Department had proposed some changes for this year, but because of the HCBS mandated changes in facilities, they have backed off on pushing those through during FY2016 but plan to submit during FY2017. In summary, as a result of the P&A concern letter submitted and consequent meeting, DRI confirmed that the Department has taken the steps to seek out additional training on incident investigations for CFH staff as DRI requested. L&C also made several changes to their investigation policies/procedures/protocol, including strengthening requirements for documenting evidence to support allegations of abuse or neglect including data collection to determine if a death is suspicious triggering further investigation. The Department also shared information regarding how they have been completing required home inspections and certification studies and offered to provide DRI, APS and L&C contact information and resident’s rights poster to CFH providers to distribute to residents upon admission to CFHs. Consequent meetings and collaboration can continue under a FY2017 Public Policy priority to participate with stakeholders and monitor statutory and rule changes. 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. No collaborative efforts were involved. 5. No cases or class actions. 6. One (1) case summary. There were no calls received on behalf of, or from PAIR clients regarding concerns of abuse in facilities that met the A&N Team protocol (other than systemic case noted above) during FY2016, but cases were opened under other funding sources. PAIR allegations of abuse not meeting the A&N team protocol received non-case technical assistance and I&R with referrals to APS, SO and to Departments L&C Unit. 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. No collaborative efforts were involved. 5. Eight (8) cases were handled under this priority with one carried over to FY2017. No class actions. 6. One (1) case summary. A 64-year-old Caucasian male with a County Board of Community Guardian (BCG) and diagnosed with respiratory disorders, emphysema, COPD, and asthma called DRI requesting assistance with being discharged from skilled nursing facility (SNF). The social worker (SW) at SNF had given client P&A contact info. P&A SERVICES- Case assistance/negotiation - P&A advocate contacted SW and confirmed that the client was eligible for discharge and that SNF placement was no longer needed. SW clarified that client would need some community services support. Advocate contacted IDHW to determine if the client was eligible for the Idaho Home Choice program (money follows the person). IDHW provided IHC client specific eligibility requirements and also agreed to assess client for A&D waiver eligibility since the discharge was appropriate. SW reported to DRI that BCG complained to her administrator because she gave the client a referral to the P&A and that lack of consent by the BCG presented a barrier to discharge. Attempts to discuss discharge with the guardian were unsuccessful. BCG refused to discuss a discharge, refused to communicate with the advocate and complained to the attorney/county prosecutor regarding P&A assistance. The prosecutor contacted DRI and presented the position of the BCG which was primarily unsuccessful failure in LRE in past. Complaint filed with BCGs and CCd to the prosecutor and IDHW Bureau of LTC administrator quoting statutory protections regarding guardian’s duty to act least restrictive as possible; client’s right to reside in least restrictive environment as appropriate; and referenced to Olmstead mandate for states to reduce institutional placements when individuals can safely reside in the community LRE. OUTCOME: Client discharged to residential assisted living facility (RALF) in community with supports needed. 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. Collaboration with Department’s Licensing and Certification (L&C) Residential Assisted Living Facility (RALF) Supervisor occurred during individual case work in which she provided clarification of rules and suggestions for client & P&A to address issues. 5. Seven (7) cases were handled under this priority. No class actions. 6. One (1) case summary. While working on another case for a 65-year-old Caucasian female diagnosed with multiple sclerosis, muscular/skeletal impairment, physical/orthopedic impairments, and visual impairment (not blind), the client reported to DRI advocate that a previous RALF facility terminated her admission without written notice and that some of her possessions were not returned. While residing at this RALF, she acquired pneumonia and was transferred to a hospital. When she was ready for discharge she contacted the RALF and staff told her they had already terminated her admission and donated remaining possessions, including her computer, printer and some clothes, to a local church. P&A SERVICES: case assistance/self-advocacy - DRI advocate opened another case on this issue. Advocate contacted facility administrator who stated that she was storing the computer to keep safe but her other items were transported to her new placement. Client’s computer was transported to current facility. Advocate requested discharge records and a listing of possessions but discharge records weren’t provided. Advocate consulted with DRI staff attorney who directed to send a demand letter to facility outlining P&A access authority and state rules clarifying record retention requirements for RALFs. Some records were received but some were still missing indicating that they were not completed and filed as required. Contact to IDHW RALF Licensing and Certification supervisor for confirmation on rules for required discharge documentation retention and for facilities obligation to protect possessions completed. RALF director confirmed that a written notice is required even under emergency circumstances, but RALF L&C unit probably did not investigate since her admission termination would meet requirements as an emergency termination. It was suggested that a letter to the facility be sent listing missing items and requesting their return or reimbursement, and to cc her the letter. Demand letter sent listing the missing items (including citation of rules regarding RALF requirements to protect resident’s possession) and requesting their return or reimbursement. Also included were the rules on prior written notice requirements when discharging. OUTCOME: The computer was returned and the client received a check for reimbursement of missing items not returned. Facility educated on discharge notice requirement rules. Case closed since all issues addressed. 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. 4. No collaborative efforts were involved. 5. Not case driven, no class actions. 6. One (1) case summary. A summary of systemic work completed provided: Besides monitoring three (3) PADD facilities, the P&A monitored two (2) state-run psychiatric hospitals and one (1) children’s residential care facility. Monitoring activities at State Hospital North (SHN) during FY2014-2015 resulted in DRI identifying systemic concerns with its use of restraints, seclusion, treatment override, police tasering and related practices. DRI attorney monitored SHN once with ongoing negotiations and meetings with administrative staff. Through this visit, letters and, negotiations, DRI worked with SHN to modify policies and practices. To date, DRI has been successful in working with SHN to implement the following policy and practice changes: Limit law enforcement involvement in behavioral emergencies; - Improved treatment override practice; - amend "seclusion" definition regarding close observation issues; - amend "restraint" definition to include chemical restraint definitions and guidelines; - Improve restrictive treatment practices as a whole e.g. documentation, assessment, debriefing, policy adherence in general; - facilitate de-escalation intervention model and trauma informed care and TA to all facility staff. During its monitoring visit, DRI staff attorney assessed facility conditions, met with residents and opened (10) systemic cases as well as completed intakes for residents meeting other priority objectives and confirmed that DRI contact was posted. DRI will continue monitoring activities relating to these issues. SHN continues to provide DRI with R&S data as well as patient complaint/grievances. DRI's next step will be to look at possible IDHW rule changes to better safeguard residents against abuse and neglect. DRI monitored State Hospital South (SHS) two (2) times during FY2016. A monitor of all units was completed, conditions inside and outside were clean and maintained. The R&S rooms were observed but no concerns identified. Advocate met with residents and provided I&R services but no priority abuse, neglect or rights violations issues presented nor was any priority case assistance requested. DRI rights posters and contact information was posted and accessible on all units. In addition to the monitor visits, the advocate is also an ongoing member of the facility’s Patient’s Rights Committee. She met with this committee two (2) times during FY2016 providing the opportunity to educate about the P&A and its services as well as provide facility rights training. The P&A monitored a children’s residential care facility located in rural Idaho during FY2016. Written notice was sent prior to the visit informing of upcoming monitor providing P&A access authority to facilities, residents and records citations and need to inform guardians providing a sample letter for dissemination. Prior to the monitor, DRI advocate contacted L&C unit clarifying facility licensure since she couldn’t locate the facility’s most recent survey or RALFs on-line. L&C clarified that even though it is a residential assisted living facility, it is licensed under children’s residential care not as a RALF and to access these surveys requires a public records request. Request submitted, survey received and reviewed identifying deficiencies cited including: misuse of restraints; using restraints improperly inflicting pain; not trying less restrictive methods to address behaviors prior to restraint; not documenting need; lack of staff training; not having required finger printing completed; and environmental violations such as fire exits being clearly marked and not meeting requirements to have the waterfront access. Upon arrival, administrator questioned P&A access so additional P&A access authority information provided. Administrator presented concerns that resident contact may be harmful since many had been traumatized. Since the campus was large, DRI advocates agreed to administrator tour of facility but explanation of right to unaccompanied private access to facility and residents clarified. Since residents were attending its own school housed on campus, direct contact to residents was limited but DRI did observe most in classroom setting. P&A determined that the deficiencies previously cited had been corrected and no signs of inappropriate restraints identified. Rights information and grievance procedures posted. Facility administrator was sent a follow-up letter informing that no concerns were identified during monitor. Letter informed administrator that DRI would be conducting another monitor during the next summer so it could meet with residents when not attending school to educate about P&A services since no private contact to residents occurred during this monitor. 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. No collaborative efforts involved. 5. No cases opened under this priority. No class actions. 6. One (1) case summary. Even though no individual PAIR cases were opened under this priority during FY2016, as discussed above in Rights Violation priority case summary, an unlawful denial of access to records was addressed for this PAIR client. In lieu of opening another case which would have been tracked, the advocate elected to associate her work under DRI’s DAD Access Denial project note. The advocate has been directed to open individual cases when working on priority issues so priority work is more easily tracked and appropriately counted for reporting purposes instead of consolidating more than one priority issue into same case.
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:
Fiscal Year 2017 PAIR Priorities and Objectives DISABILITY DISCRIMINATION 1. Public or private entities will not discriminate on the basis of disability in violation of the Americans with Disabilities Act. 2. Accessibility 3. Accept up to three (3) cases of discrimination against people with disabilities in violation of Title II or Title III of the ADA. 1. Public or private entities will not discriminate on the basis of disability in violation of the Americans with Disabilities Act. 2. Accessibility 3. Accept up to three (3) cases of discrimination against people with disabilities by public or private transportation providers in violation of Title II or Title III of the ADA. 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 assistance to parents to prevent or stop 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. File a complaint with the State Department of Education and, if appropriate, federal authorities regarding under-identification of children with emotional disturbance in violation of the “Child Find” requirement under the IDEA. 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 under IDEA, Section 504, and the Workforce Innovation and Opportunity Act. 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. Conduct transition workshops that provide information and educate on the benefits of competitive, integrated employment. GUARDIANSHIP 1. Promote the rights of people with disabilities who are, or may be subjected to, unnecessary guardianships and conservatorships. 2. Free from unnecessary guardianships and conservatorships. 3. Participate on the Idaho Supreme Court committee on Guardianships and Conservatorships to represent the rights and perspectives of peoples with disabilities regarding guardianships or conservatorships. 1. Promote the rights of people with disabilities who are, or may be subjected to, unnecessary guardianships and conservatorships. 2. Free from unnecessary guardianships and conservatorships. 3. Advocate for the implementation and use of the supported decision making model as an alternative to guardianships. 1. People with disabilities will be free from abusive or unnecessary guardianships or conservatorships. 2. Free from abusive or unnecessary guardianships and conservatorships. 3. Provide legal representation to up to four (4) people with disabilities to modify or terminate abusive or unnecessary guardianships or conservatorships. MEDICAID 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services. 3. Provide legal representation to Medicaid eligible children who have been denied necessary mental health services by the Medicaid managed care contractor. 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services. 3. Consult and assist plaintiff’s counsel in K.W. v. Armstrong to ensure adults with developmental disabilities have access to appropriate developmental disabilities waiver services. 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services. 3. Ensure implementation of the CMS information bulletin “Clarification of Medicaid Coverage of Services to Children with Autism”, dated July 2, 2014, through public policy or other system change activities. OUTREACH/TRAINING 1. People with disabilities will have increased awareness about the services offered by DRI and the Client Assistance Program (CAP). 2. Access to P&A advocacy. 3. Conduct outreach to transitions-age youth with disabilities, including transition-age youth in facilities. 1. People with disabilities will have increased awareness about the services offered by DRI and the Client Assistance Program (CAP). 2. Access to P&A advocacy. 3. Conduct outreach in the community to increase awareness of services offered by DRI and the CAP. 1. People with disabilities will have increased awareness about the services offered by DRI and the Client Assistance Program (CAP). 2. Access to P&A advocacy. 3. Conduct outreach to up to nine (9) sheltered workshops. 1. Conduct outreach to unserved and underserved populations with disabilities. 2. Access to P&A advocacy. 3. Provide information about services offered by DRI and the CAP and other rights information to people with disabilities residing on the Fort Hall Indian Reservation. 1. People with disabilities will have increased awareness about the services offered by DRI to increase access to voting. 2. Access to voting 3. Conduct outreach/training in the community to increase awareness of DRI services, including voter training and information. PUBLIC POLICY 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Analyze the effect on Idahoans with disabilities of closing the health insurance gap, and provide the information to policy makers and stakeholders. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. 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. 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. Address systemic public policy issues in the Idaho Medicaid or managed care programs which arise during FY2017. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Inform policy makers of the benefits of adopting and implementing the Achieving Better Life Experience (ABLE) Act. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Provide leadership on the Adult Developmental Disability (DD) Services Collaborative Work Group to improve services for adults with DD. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Participate in the development of state rules governing adult residential treatment facilities. 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. Investigate requirements for residential habilitation, supported living, and certified family home providers to report deaths to the Idaho Department of Health and Welfare and propose necessary rule changes. 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 in facilities according to case selection criteria. 1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. Investigate allegations of rights violations of people with disabilities in facilities according to rights violation 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 nine (9) selected facilities, including facilities housing children with disabilities under the Juvenile Corrections Act. 1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. In collaboration with the American Civil Liberties Union, investigate allegations that people with mental illness in county jails do not receive appropriate mental health treatment. 1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities. 3. Identify and address unlawful denials of the Protection and Advocacy system’s access to residents in facilities and records subject to P&A federal access authority.
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.
FY2016 PAIR PPR - NARRATIVE A. Sources of funds received and expended Federal $157,825. State 0 All other funds 0 Total from all sources 157,825. B. Budget for the fiscal year covered by the report Category FY2016 Actual FY2017 Budget Wages/salaries 80,722 99,342 Fringe Benefits 39,167 44,107 Materials/Supplies 12,304 8,711 Postage 1,275 853 Telephone 1,415 1,368 Rent 11,119 11,275 Travel 1,085 7,877 Copying 57 337 Bonding/insurance 732 1,074 Equipment 0 0 Legal services 0 0 Indirect costs 0 0 Misc. 9,948 10,993 Total (from all sources)157,825 185,937 Note: 2016 Actual Expenses includes carryover from FY15 (10/1/14-9/30/15) 2017 Budget includes carryover from FY16 (10/1/15-9/30/16) C. Description of PAIR staff Type of Position FTE % Yr Filled Person-Years Professional 1.72 79.49% 1.13 Full-time NA NA NA Part-time 1.72 79.49% 1.13 Vacant 1.00 10.42% 0.13 Clerical 1.44 80.00% 2.37 Full-time NA NA NA Part-time 1.44 80.00% 2.37 Vacant 1.00 8.33% 0.08 D. Involvement with advisory boards The PAIR Coordinator is a member of the Community Care Advisory Council (CCAC) advocating for quality care and rights protections for persons with disabilities residing in certified family homes (CFHs) and residential assisted living facilities (RALFs). This allows her the opportunity to advocate for PAIR clients since many reside in these placements, especially the elderly population. 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. CCAC continued its work developing an affective assessment tool that all RALFs can utilize in determining appropriate admissions for CFH and RALF residents. The RALF admission assessment was posted on IDHW Licensing and Certification (L&C) RALF website and during FY2017 CCAC plans to complete an assessment tool for CFHs. CCAC will also monitor IDHW’s plans to create a new facility licensure for individuals with problematic behaviors currently being pursued with legislative support. 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. No meetings during FY2016 occurred but the TBI implementation lead investigator confirmed that these meetings should occur during FY2017. DRI 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 2016 addressed 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 DRI requested training from the P&A to its new members regarding the needs and purposes 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’s roles, services and obligations so it can better advice and guide DRI on how to meet the needs of persons with mental illness. Until his membership expired, DRI E.D. was a member of the Idaho Medical Care Advisory Council (MCAC) reviewing state Medicaid policies and commenting on proposed rules and implementation during FY2016. E.D. was replaced by a DRI staff attorney thoroughly trained on Medicaid and emerging issues. E. Grievances filed. Six (6) grievances from PAIR clients were filed during FY2016. The first grievance filed was received from a 57-year-old Caucasian male with physical/orthopedic impairments seeking legal representation because his dental care provider had not yet provided him with his fitted dentures, even though Medicaid had already authorized the services. He felt this violated the ADA. After the A.D. was unable to reach him by phone, a please call me (PCM) letter was sent. Grievance was closed since client didn’t respond to the PCM letter; The second grievance was filed by a 52-year-old Caucasian female with a respiratory impairment who disagreed with the decision that her issue was not disability related. She had received an information and referral (I&R) letter from DRI stating the issue she called about did not meet priorities and was not related to her disability. She disagreed with the determination that her issue was not disability related since she has lung disease and on oxygen and needed help paying her utility bill before they shut her power off which would disenable her oxygen machine. A.D. contacted the client by phone to clarify her grievance issue and explained that her issue was still out of priority so case assistance could not be provided. Client wanted an advocate to call her. Since her issue was out of priority, her intake wasn’t assigned to an advocate, but she was sent additional referrals for possible financial aid access. In the grievance letter it stated that if she was still dissatisfied with her determination she could contact DRI E.D but she never contacted the E.D; The third grievance was filed at the end of FY2015 by a 72-year-old Caucasian male with COPD, coronary heart disease, diabetes, prostate and colon cancer, and acute stress disorder requesting legal representation for a federal housing law suit filed against his housing provider. Client filed a grievance because his request for legal representation was denied. A.D. explained that violations of the Fair Housing Act (FHA) were not included in the issues addressed under the DRI Disability Discrimination priorities for FY2015. The A.D. explained that requests for services regarding alleged FHA violations received rights information and referrals to the Intermountain Fair Housing Council (IFHC). At the beginning of FY2016, this client filed another grievance with DRI E.D. because he was dissatisfied with AD’s determination (at the end of FY 2015). E.D. discussed DRI’s resource limitations and explained that FHA alleged violations during both FY2015 and 2016 were limited to I&R services since IFHC addresses these violations. The fourth grievance filed was from the same client after he later requested legal representation during FY2016 for a breach of contract personal injury law suit. A.D. contacted client explaining that the assistance requested again didn’t meet DRI FY2016 priorities and she clarified that personal injury cases were outside of DRI’s expertise. During this phone call, client presented an ADA Title II issue he was experiencing with the city of Moscow where he lived for allowing smoking on its public sidewalks and thus preventing his access due to respiratory condition. A.D. provided client with short-term assistance on addressing internally through Moscow city government’s ADA compliance officer and if not resolved, provided information needed to file a complaint with the Department of Justice (DOJ) Disability Rights Section. No additional grievances were filed from this client during FY2016. The fifth grievance was filed by a 76-year-old white male with orthopedic impairments due to a car accident who was wanting to appeal a denial of legal representation by DRI. He was seeking a personal injury attorney to take over his case, as his previous attorney had resigned. He also wanted assistance in pursuing a complaint with Idaho State Bar against his former attorney. Priorities and limitations on case acceptance were explained, along with written referrals to personal injury attorneys printed off of the Idaho State Bar Referral Service (ISBRS) website since he reported the ISBRS wouldn’t provide him any more referrals when requested. A.D. also explained the procedure for receiving an ISB guaranteed $35.00 legal consult and informed him how to access ISB attorney complaint procedural information. A copy of DRI's grievance procedure was provided, but no additional grievance was filed. The sixth grievance was filed by 45-year-old Caucasian Oregon resident with blindness requesting legal representation to challenge a child support decision and assistance with filing a complaint against the court for not providing information in audio format. His grievance was compounded since the I&R services he received from DRI were sent in writing and not audio. AD explained that legal representation could not be provided since child support issues are outside DRI’s priorities and expertise and clarified that P&A case assistance must be limited to Idaho residents per federal requirements. She provided technical assistance (TA) on filing a complaint with the DOJ and apologized for DRI information not being in audio format assuring him that a new letter with information would be sent on a CD. He was not satisfied and requested full grievance policy and contact information for PAIR funders. Requested information was provided both in writing and via CD/audio format. Coordination with the CAP and the State long-term care program Idaho’s Client Assistance Program (CAP), along with PAIR, are both housed in the same agency, Disability Right Idaho, Idaho’s P&A system which also includes the PADD, PAIMI, PAAT, PATBI, PABSS and PAVA programs. Most of the staff work in two or more of these programs. Outreach, monitoring, public awareness and system advocacy activities are examples of how the P&A coordinates with 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, some PAIR clients with mental illness may be served under PAIR when the issues are not facility related and many clients served under PAIR may also be served under CAP and PABSS when needing assistance with getting appropriate vocational rehabilitation (VR) services and addressing employment barriers for Social Security beneficiaries. DRI’s A.D. continued membership on the State Rehabilitation Advisory Council as the CAP representative and Coordinator reviewing IDVR service reports, client outcomes, and budget data to provide input for improvement. She also monitored IDVR’s efforts to incorporate and become compliant with the Work Innovative Opportunities Act (WIOA) regulation changed for state Vocational Rehabilitation Services. Disability Rights Idaho had a memorandum of agreement with the Idaho Long-term Care Senior Ombudsman program operated through the Idaho Commission on Aging. The agreement covered 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 FY2014, the P&A drafted the MOA revision including both the SO and Adult Protection Services (APS) interchangeably in the same MOA. During FY2015, the P&A submitted this draft to the State Ombudsman (SO) Director for approval. She reviewed and informed PAIR Coordinator that the MOA was being reviewed by the Administrator of the Idaho Commission on Aging, the Ombudsman’s Supervisor but no response from the Administrator has yet been provided to DRI. During FY2016, the SO informed DRI that their program focused on implementing regulation changes to the SO and Adult Protection Services (APSs) programs more clearly separating the two (2) entities further limiting the information that they can share. Regarding the MOA with DRI, the SO suggested that during FY2017, DRI draft separate MOAs for each program. SO also suggested that DRI meet with her and the APS supervisor separately prior to drafting the MOAs to better identify any barriers to collaboration, especially regarding confidentiality of records requirements. This information was given to DRI A.D. and L.D. and meetings will be scheduled during FY2017. The PAIR Coordinator and the State Ombudsman are members of the Community Care Advisory Council collaborating on issues to help improve the quality of care for PAIR clients residing in CFH and RALFS. As well as other council and committees, each agency refers to each other when appropriate.
|Signed By||James R Baugh|