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

New Mexico (Disability Rights New Mexico) - H240A160032 - FY2016

General Information

Designated Agency Identification

NameDisability Rights New Mexico
Address3916 Juan Tabo Blvd. NE
Address Line 2
CityAlbuquerque
StateNew Mexico
Zip Code87111
E-mail Addressinfo@drnm.org
Website Addresshttp://www.drnm.org
Phone505-256-3100
TTY 505-256-3100
Toll-free Phone800-432-4682
Toll-free TTY800-432-4682
Fax505-256-3184
Name of P&A Executive DirectorJames Jackson
Name of PAIR Director/CoordinatorJames Jackson
Person to contact regarding reportBernadine Chavez
Contact Person phone505-256-3100
Ext.116

Part I. Non-Case Services

A. Individual Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas320
2. Individuals receiving I&R outside PAIR priority areas66
3. Total individuals receiving I&R (lines A1 + A2)386

B. Training Activities

1. Number of trainings presented by PAIR staff15
2. Number of individuals who attended training (approximate)265

PAIR staff provided two trainings to 18 new staff persons working for the New Mexico Division of Vocational Rehabilitation (NMDVR) at the Rehabilitation Academy sponsored by NMDVR. The training topics included services provided by PAIR at DRNM and an overview of all titles of ADA . We also provided training on ADA to a support group for individuals with brain injuries. Staff provided training participants and advocates at New Mexico AIDS Services. The 24 participants were residents of a housing program for people living with AIDS and participants of a support group for persons living in the community. DRNM/PAIR staff provided 3 trainings to Albuquerque Transit (city bus) drivers on disability awareness, ADA requirements and how to provide quality services to individuals with disabilities.There were 20 participants at each training. DRNM/PAIR staff provided 6 trainings to parents and students on special education law and their rights under IDEA. Two of these trainings were in rural areas and were provided in Spanish to monolingual Spanish-speaking families. Three of these sessions were to Native American families, as part of our commitment to outreach to minorities and underserved communities. DRNM/PAIR provided two trainings to law enforcement personnel on disability awareness and ADA. We conducted one training for Bernalillo County Law enforcement and another training with the City of Santa Fe law enforcement. The training in Santa Fe was as a result of a young man with TBI being arrested due to his balance issues and not being able to complete a field sobriety test. The required training was part of a settlement agreement with the family. In summary, PAIR staff at DRNM conducted a total of 15 trainings with a total of 265 participants. DRNM/PAIR also participated in 15 informational fairs in which we distributed PAIR brochures and provided information to participants. Of the 15 fairs, 5 were targeted outreach to minorities and underserved populations.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles1
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website1,186
5. Publications/booklets/brochures disseminated680
6. Other (specify separately)100

Narrative

PAIR staff developed a new brochure on service animals. The brochure was developed to address the large number of requests from the disability community. We mail these brochures to callers requesting information about their rights as a person who uses a service animal. We also offer this publication at conferences and fairs where DRNM/PAIR participates in informational booths.

Part II. Individuals Served

A. Individuals Served

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

1. Individuals still served as of October 1 (carryover from prior FY)5
2. Additional individuals served during the year34
3. Total individuals served (lines A1 + A2)39
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)1

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 10

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility1
2. Employment0
3. Program access1
4. Housing2
5. Government benefits/services2
6. Transportation0
7. Education13
8. Assistive technology1
9. Voting0
10. Health care15
11. Insurance0
12. Non-government services1
13. Privacy rights1
14. Access to records0
15. Abuse0
16. Neglect1
17. Other1

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor23
2. Other representation found1
3. Individual withdrew complaint1
4. Appeals unsuccessful3
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case1
7. PAIR unable to take case because of lack of resources1
8. Individual case lacks legal merit0
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy2
2. Short-term assistance10
3. Investigation/monitoring0
4. Negotiation8
5. Mediation/alternative dispute resolution1
6. Administrative hearings8
7. Litigation (including class actions)2
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 2215
3. 23 - 5912
4. 60 - 644
5. 65 and over8

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females23
2. Males16

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race22
2. American Indian or Alaskan Native2
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White13
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent18
2. Parental or other family home15
3. Community residential home1
4. Foster care1
5. Nursing home2
6. Public institutional living arrangement0
7. Private institutional living arrangement2
8. Jail/prison/detention center0
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment1
2. Deaf/hard of hearing2
3. Deaf-blind1
4. Orthopedic impairment4
5. Mental illness1
6. Substance abuse0
7. Mental retardation2
8. Learning disability11
9. Neurological impairment5
10. Respiratory impairment0
11. Heart/other circulatory impairment4
12. Muscular/skeletal impairment2
13. Speech impairment1
14. AIDS/HIV0
15. Traumatic brain injury2
16. Other disability3

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities2

2. Number of individuals potentially impacted by policy changes20,000

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

The New Mexico Medicaid system was transformed in 2014 in ways that dramatically changed the provision of long-term services (LTS) home- and community-based services (HCBS). People with disabilities qualifying for the nursing facility level of care can now receive a variety of LTS or HCBS through "Community Benefit" services, without having to be in a "waiver slot". These services are administered as either Agency Based Community Benefits (ABCB) or Self-Directed Community Benefits (SDCB). The legal structure for both ABCB and SDCB starts with a Comprehensive Needs Assessment (CNA). This CNA is to determine the full array of services the participant needs. The menu of services available includes 14 different ABCB services and 23 SDCB services. In practice, however, the CNA has not been "Comprehensive" at all. In the vast majority of cases, the assessment used for this purpose by the Managed Care Organizations (MCOs) that plan and provide these services under contract to the state has excluded all but one ABCB service (Personal Care Services, or PCS) and all but one SDCB service (named the Homemaker service, which in practice is identical to ABCB's PCS). Very few participants were able to access any of the other services to which they are entitled. During the initial transition year of 2014, the MCOs implementing ABCB and SDCB allowed most participants to utilize a larger budget than they were assessed through the CNA, and as a consequence PAIR/DRNM didn't begin to see the problems arise until 2015. We began to address the problem aggressively, and we were able to see successes on numerous individual cases. Throughout FY2016 we continued to work successfully on individual cases, but also asserted our impact through systemic efforts. In FY2016 we testified at legislative committee hearings, and engaged in negotiations with both the MCOs and New Mexico's Human Services Department (HSD), the state entity that operates Medicaid. As a result, PAIR/DRNM was able to win a commitment from HSD to require the MCOs to supplement the CNA to include questions specific to the all of the available ABCB and SDCB services, and these questions would lead to actual service requests for participants needing them. We contributed to the development of this supplemental questionnaire for the CNA. PAIR/DRNM oversaw the piloted administration of this new and improved, and truly "Comprehensive," CNA through the late part of FY2016. HSD and the MCOs have committed to utilize this full and legally acceptable CNA to all ABCB and SDCB participants early in FY2017. We are aware that problems with the CNA will remain, and PAIR/DRNM certainly expects to continue to work on many individual cases regarding disputes over the correct implementation of the CNA. However, we are pleased that all participants will have the opportunity to qualify for the full array of services to meet their needs. Many thousands of people with disabilities will receive these services that had been functionally unavailable to them previously.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts0
2. Number of individuals named in class actions0

Describe your litigation/class action activities. Explain how individuals with disabilities benefited from your litigation activities. Be sure to include case examples that demonstrate the impact of your litigation.

None this year.

Part V. PAIR'S Priorities and Objectives

A. Priorities and Objectives for the Fiscal Year Covered by this Report

For each of your PAIR program priorities for the fiscal year covered by this report, please:

  1. Identify and describe priority.
  2. Identify the need, issue or barrier addressed by this priority.
  3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.
  4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.
  5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.
  6. Provide at least one case summary that demonstrates the impact of the priority.

Priority A. Investigate allegations of abuse and neglect. 1. Decrease the abuse, neglect and exploitation of people with disabilities by improving the practices of programs and facilities in congregate settings for people with disabilities and/or where there are significant allegations of abuse, neglect or exploitation 2. Individuals with disabilities are subject to abuse or neglect at a higher rate than non-disabled individuals, and addressing allegations of abuse or neglect is a core function of protection and advocacy agencies. 3. Indicator: Conduct investigations of alleged or suspected abuse or neglect where there appears to be a pattern or recurrence of significant abuse or neglect, where there has been a death or life-threatening injury, or where the alleged abuse or neglect is particularly egregious, and produce reports/recommendations as appropriate. 4 . Collaboration: DRNM encourages other agencies and organizations to make referrals to us. We typically conduct investigations on our own, but in some circumstances we attempt to collaborate with Children’s Protective Services or Adult Protective Services. 5. The referrals we received and the investigations we conducted in FY 2016 involved persons with developmental disabilities or mental illness who were not eligible for PAIR services. We did not have any PAIR cases in this priority this year. 6. Case summary: N/A Priority B Facilitate access to community-based services 1. Advocate for persons with disabilities to have appropriate services and facilitate access to community-based services. 2. Medicaid-supported community-based services allow persons with significant disabilities to live in and interact with their communities and avoid nursing home placement, but the level of services offered is often inadequate for the needs of the client. 3. Indicator: The number of cases in which PAIR assisted individuals in need of long term services, including those who choose to self-direct services, who have been denied access to such services, or for whom the level of services offered or provided is grossly inadequate. 4. Collaboration: DRNM collaborated with many other agencies in conjunction with this priority. We informed other legal service agencies and other disability advocacy organizations about our work and accepted referrals from them. This was reinforced by our collaborative efforts with other disability groups to promote systemic changes related to these services. 5. PAIR staff worked on 14 cases under this objective. 6. Case example: A 53-year-old client who has diabetes with complications including heart and respiratory conditions, renal failure and toe amputations contacted DRNM when her Personal Care hours through the state’s Centennial Care agency-based community benefit program were reduced from 28 to 13.5. She had recently been told she needed a kidney transplant. The client had already lost an appeal of the reduction before she contacted us. DRNM agreed to represent her in a Fair Hearing against the NM Department of Human Services. Our attorneys collected medical evidence and interviewed the client’s primary caregiver in preparation for the hearing, carefully reviewing the amount of time the caregiver spends completing each activity on the client’s behalf. The Client explained she suffers from nausea and dizziness after her dialysis appointments, which are 3 times a week. At the Fair Hearing, DRNM’s attorney submitted extensive exhibits detailing the supports the client requires in order to remain in her home with sufficient health and safety supports. When we received the Administrative Law Judge’s decision, we were disappointed to see that only 23.5 hours were awarded. However, the head of the Medicaid Assistance Division overrode the ALJ, and restored all 28 hours. Our client was pleased and relieved when she heard about the decision. DRNM is hopeful that our Client will not face drastic reductions in the future. Priority C. Provide input into proposed public policy changes affecting services to persons with disabilities. 1.Review and comment on proposed regulatory changes in Medicaid or other public programs that would have a significant effect on eligibility, benefits, or procedural protections for persons with disabilities. 2. State regulations and other policies establish policies and procedures that have a major impact on persons with disabilities, and unfortunately very few other disability organizations monitor and comment on proposed changes so the community depends on DRNM to do so. DRNM has created a network for informing the community regarding these policies. 3.Indicator: the number of comments submitted on proposed regulatory changes in Medicaid or other public programs that would have a significant effect on eligibility, benefits, or procedural protections for persons with disabilities. 4. Collaboration: DRNM worked closely with The Disability Coalition to track and disseminate information about proposed changes to Medicaid regulations. We also worked with other legal service organizations such as the Senior Citizens’ Law Office. 5. Number of cases: This priority does not involve individual casework but we submitted comments on three proposed state regulations affecting persons eligible for PAIR services. 6. DRNM submitted comments with respect to policy manual changes affecting care coordination and access to long term services in the Medicaid program (“Centennial Care”); on the state’s transition plan for achieving compliance with the CMS final rule on integrated settings and person-centered planning for community-based services; and on proposed rate reductions for Medicaid providers and their potential impact on network adequacy. Priority D.Promote self-determination. 1. Promote the least restrictive level and form of substitute decision-making necessary, and provide assistance to protected persons with a Representative Payee or under guardianship, including treatment guardianship, where the Representative Payee or guardian appears to be arbitrary or non-responsive to the reasonable preferences of the protected person, or appears to abuse their authority. 2.The decision-making process and the right to self-advocacy for many individuals with disabilities is negatively impacted by restrictive or unnecessary substitute decision-making. Persons with disabilities often become more capable of making their own choices as they get older and gain more experience, or their disability improves, but once a substitute decision-maker has been appointed it is often a difficult and arduous process to change the arrangement. 3. Indicators of success: number of individual cases taken, number of cases closed successful. 4. Collaboration with other groups: In addressing this priority area, DRNM collaborates with the DDPC Office of Guardianship, the NM Guardianship association, and with other civil legal service provider agencies that are involved in this area. We also collaborate with centers for independent living. We have also collaborated with support groups for persons with TBI. 5. We had two cases under this priority for PAIR funding.[DRNM served many other clients under this priority but was able to use resources other than PAIR due to the disability]. Priority E. Special Education 1.Facilitate access to appropriate special education services 2. Educate and empower transition-aged students and families regarding their rights under the Workforce Innovation and Opportunity Act (WIOA) by conducting workshops on transition planning for students 14-22 years of age who have 504 Plans or IEPs. 3. Indicators: Number of children with disabilities who, with DRNM assistance, receive the full array of educational opportunities available to non-disabled peers under an IEP or a 5o4 plan. 4. PAIR staff continue to collaborate with the state's parent training center and several other special education advocates and programs, including the Native American Disability law Center. 5. Pair staff worked on 13 cases under this objective. 6. Case example: Our client is a 15-year-old Special Education student at Mora High School in rural northern NM. She felt isolated from her class members because of extensive medical needs, and wanted the full high school experience. DRNM’s advocate developed a list of items for the client’s IEP in order to facilitate her goals. -Inclusion on school field trips -Social work services once a week -Full time Educational Assistant to help with insulin management -Staff should have Glucagon training for medical emergencies -Work study/transitional services through the Division of Vocational Rehabilitation -Late arrival accommodation for her insomnia and quiet environment -Inclusion in College Prep classes -Accommodation to catch up on missed classes due to medical appointments -Accommodation to reschedule academic tests if insulin levels are out of the norm -Continued transportation reimbursement -Client’s health plan should be attached to her IEP At the IEP meeting, DRNM negotiated with the school for these provisions, advocating for the most inclusive educational experience for our client. We were successful with all of the listed items, with one restriction: if there are field trips to areas in which cell phone coverage is unavailable, our client may not be included, as a medical precaution. Our client and her parents accepted this restriction and are happy with the results DRNM was able to negotiate. Our client is excited about her high school experience and her prospects for the future.

B. Priorities and Objectives for the Current Fiscal Year

Please include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:

  1. a statement of each prioirty;
  2. the need addressed by each priority; and;
  3. a description of the activities to be carried out under each priority.

Priority A 1. Conduct investigations of alleged or suspected abuse or neglect where there appears to be a pattern or recurrence of significant abuse or neglect, where there has been a death or life-threatening injury, or where the alleged abuse or neglect is particularly egregious, and produce reports/recommendations as appropriate. 2. Individuals with disabilities are subject to abuse or neglect at a higher rate than non-disabled individuals, and addressing allegations of abuse or neglect is a core function of protection and advocacy agencies. 3. Conduct investigations of alleged or suspected abuse or neglect where there appears to be a pattern or recurrence of significant abuse or neglect, where there has been a death or life-threatening injury, or where the alleged abuse or neglect is particularly egregious, and produce reports/recommendations as appropriate. Priority B 1. Pursue personal injury, wrongful death or serious civil rights violation litigation where there is a clear opportunity to improve the practices of a provider or public service agency, private co-counsel is available, and fees may be available. 2. Often time individuals are harmed by a lack of poor services, a denial of services, or neglect of the needs of individuals with disabilities. 3. PAIR staff will look at cases where there is clear opportunity to improve the practices of a provider or public service agency. Priority C 1. Assist individuals in need of long term or other community-based services, including those who choose to self-direct services, who have been denied access to such services, or for whom the level of services offered or provided is grossly inadequate. 2. Medicaid-supported community-based services allow persons with significant disabilities to live in and interact with their communities and avoid nursing home placement, but the level of services offered is often inadequate for the needs of the client. 3. PAIR will advocate for individuals in need of long term community-based services, including those who choose to self-direct services, who have been denied access to such services, or for whom the level of services offered or provided is grossly inadequate. Priority D 1.Self-determination - Persons with disabilities have control over the decisions that affect them. 2. Promote the right of individuals with disabilities to make their own decisions as much as possible, including the use of processes such as “Supportive Decision-Making”. Where substitute decision-making is necessary, promote the least restrictive level and form. 3. Provide assistance to protected persons with a Representative Payee or under guardianship, including treatment guardianship, where the Representative Payee or guardian appears to: • be arbitrary or non-responsive to the reasonable preferences of the protected person, • abuse their authority, or • fail to meet their fiduciary responsibilities Priority E 1. Special education under IDEA and equal access under section 504 to facilitate access to appropriate education services. 2. Many children with disabilities have IEPs that are not properly and reasonably implemented. Many school districts demonstrate a pattern of inadequate compliance with state and federal special education requirements that result in children not receiving the educational services they are entitled to. 3.A. Advocate for students with IEPs or 504 plans that are wholly or substantially inadequate or whose substantial lack of implementation by their local school districts keeps the student from benefiting from special education. 3.B. Pursue systemic change strategies such as supporting family organizing efforts and pursuing group complaint strategies against school districts with a pattern of violations of state and/or federal law. 3.C. Advocate for students who may be eligible for special education services but have been denied evaluations due to their placement in a prolonged SAT process, or who have been denied their right to a due process hearing after requesting an evaluation. Priority F 1. Pursue litigation on behalf of individuals or groups where there is an on-going violation of Title III of the ADA and an opportunity for systemic impact benefit to a significant number of persons with disabilities, when DRNM has the staff and other resources needed to pursue such cases. 2. There are very few legal resources in New Mexico to assist with cases that have a systemic impact for a significant number of individuals with disabilities. Cases are often dropped since legal providers don't have the resources to pursue this type of litigation. 3. PAIR will pursue an ADA claim that will have the likelihood of success for many. Priority G 1. Provide technical assistance, self-advocacy assistance, or limited individual advocacy assistance to individuals with disabilities who are denied access to public places, including public accommodations, based on their use of a service animal (but not a companion or comfort animal). 2.These requests are usually resolved with a phone call and a letter, and PAIR has been the only resource in New Mexico for these types of issues. 3. These case will be limited services in and assigned as short-term since they usual involve education an entity regarding their obligations under ADA. Priority H 1. Review and comment on proposed regulatory changes in Medicaid or other public programs that would have a significant effect on eligibility, benefits, or procedural protections for persons with disabilities. 2. State regulations and other proposed program changes establish policies and procedures that have a major impact on persons with disabilities, and unfortunately very few other disability organizations monitor and comment on these proposals, so the community depends on DRNM to do so. DRNM has created a network for informing the community regarding these policies. 3.Indicator: the number of comments submitted on proposed regulatory changes in Medicaid or other public programs that would have a significant effect on eligibility, benefits, or procedural protections for persons with disabilities.

Part VI. Narrative

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

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

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

A. Source of Funding In FY 2016, the PAIR grant award to DRNM was $171,598. In FY 2016, PAIR expenditures totaled $210,176, of which $71,760 was the balance of FY 2015 PAIR funding and $138,416 was from the FY 2016 PAIR award. A total of $33,182 was carried forward to FY 17. An additional $500 in program income was earned and expended in FY 2016. B. Expenditures/Budget Federal PAIR expenditures in FY 2016, and the corresponding amounts budgeted for expenditure in FY 2017, are as follows: Salaries $131,306 / $113,049 Fringe Benefits $28,887 / 29,021 Travel $5,682 / $3,551 Supplies/Materials $1,731 / $938 Office Space $11,658 / 12,134 Telephone $1,653 / $1,038 Printing/copying $904 / $1,302 Other Operating costs $10,870 / $6,769 Administrative $17,485 / $15,072 TOTAL $210,176 / $182,875 Program income expenditure in FY 2016 and budget for FY 17: Other Operating costs $500 / $0 C. PAIR Staff positions in FY 2016: Advocate staff 1.41 FTE Attorney staff 0.47 FTE Support staff 0.34 FTE Supervisory staff 0.17 FTE TOTAL PAIR Staff 2.38 FTE

Certification

Signed?Yes
Signed ByJames Jackson
TitleCEO
Signed Date12/26/2016