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

Idaho (DisAbility Rights Idaho, Inc.) - H240A180013 - FY2018

General Information

Designated Agency Identification

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

Part I. Non-Case Services

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

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas10
2. Individuals receiving I&R outside PAIR priority areas314
3. Total individuals receiving I&R (lines A1 + A2)324

B. Training Activities

1. Number of trainings presented by PAIR staff31
2. Number of individuals who attended training (approximate)724

B. TRAINING ACTIVITIES: Five (5) trainings were provided by power point (PP) and lecture format to 56 Transition-aged students, parents, teachers & providers at the annual Tools for Life Transition Conference providing life skills training about employment and disability; rights protections; processes of developing self-advocacy skills & life skills development for independent living; Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) eligibility after 18, understanding rights after 18, Individualized Education Plans (IEPs) & Transition Planning, voting rights, and Supported Decision Making (SDMing) alternative to guardianship conservatorship (G&C). Seven (7) SDMing trainings were provided to 288 attorneys, judges, Idaho Department of Health & Welfare (IDHW) staff, people with disabilities (PWDs), parents, providers, Special Ed teachers & Directors, and mothers of children with mental illness (MI) and learning disabilities providing information about SDM as an alternative to guardianship (GDS) & Conservatorship (CS) so that PWDs can attain or retain legal rights; One (1) Idaho Supreme Court (ISC) Guardianship Committee WINGS grant sponsored PP CLE training was developed & provided by DRI Legal Director (LD) to 100 attorneys and Social Workers (SW) regarding lawyer ethics in SDMing, information on alternatives to guardianship, and the steps involved. A Steps in Support-Decision Making quick sheet was also developed and disseminated; and a training on the consequences of gun ownership for people under guardianships was provided to twenty (20) Idaho Supreme Court Guardianship Committee members which included judges, attorneys, private paid guardians. A training discussing funding sources for Assistive Technology (AT) and Speech & Language Pathology (SLP) was provided to 30 Idaho State University (ISU) SLP students; a Cultural Competency, Diversity & Developmental Disabilities (DD) (using the Georgetown University Disparity Leadership Power point with permission) training was provided to ten (10) Governor’s Office staff, legislators and Idaho Council on Developmental Disabilities Council (ICDD) staff); DRI attorney co-presented at the 2018 National Disability Rights Network (NDRN) annual conference during the “Protection & Advocacy (P&A) Access Update” session to 30 P&A Attorneys and Advocates on accessing videos & reports from other investigative agencies; and a training about Protection & Advocacy (P&A) Systems, DisAbility Rights Idaho (DRI) services and how DRI can help vulnerable adults was provided to twelve (12) Justice Alliance for Vulnerable Adults (JAVA) members which included guardians, Area Agency on Aging (AAA), educators, advocates & providers. A Work Incentives and Employment training was provided to twelve (12) Housing Authority recipients and SWs; eleven (11) trainings were provided to 152 Transition students, teachers & aids, Special Education Directors, parents, and providers on the topics of transitioning to adulthood & plan development; and DRI provided an internal training session to its fourteen (14) DRI administrative staff, Advocates, and Attorneys on the topics of LGBTQ Inclusivity, Assistive Technology updates, SDMing, monitoring at select facilities, Crisis Prevention Intervention Restraint Method, People First updates, Self-Care for Secondary Trauma, Adult Protection Services (APS), and updates on SWITC’s (state ran Intermediate Care Facility for the Intellectually Disabled (ICF/ID) systemic abuse and neglect (A&N) investigation.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff1
2. Newspaper/magazine/journal articles6
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website25,450
5. Publications/booklets/brochures disseminated6,246
6. Other (specify separately)21,667

Narrative

21667 Blog & Facebook hits. 3 articles were written and posted on DRI's Blog: 1. Comments on Idaho State Innovation 1115 Medicaid Waiver in which DRI supported since this Waiver was a significant first step in shrinking the coverage gap & providing an appropriate range of long term services & supports for some Idahoans with certain conditions that result in high medical costs; 2. The Idaho Health Care Plan Using State Innovation Waivers to Increase Access to Health Care providing additional information about 1115 Waiver proposal; 3. Community-Based Rehabilitation Services (CBRS): Availability to Idaho Youth on Medicaid discussing the significant reduction of CBRS; difficulties identified with accessing; and strategies to utilize to increase access.

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)2
2. Additional individuals served during the year24
3. Total individuals served (lines A1 + A2)26
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 5

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility2
2. Employment0
3. Program access5
4. Housing2
5. Government benefits/services0
6. Transportation0
7. Education0
8. Assistive technology1
9. Voting0
10. Health care1
11. Insurance0
12. Non-government services1
13. Privacy rights0
14. Access to records0
15. Abuse4
16. Neglect7
17. Other4

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor12
2. Other representation found1
3. Individual withdrew complaint2
4. Appeals unsuccessful0
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 resources0
8. Individual case lacks legal merit6
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-advocacy3
2. Short-term assistance14
3. Investigation/monitoring3
4. Negotiation2
5. Mediation/alternative dispute resolution0
6. Administrative hearings0
7. Litigation (including class actions)0
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 41
2. 5 - 220
3. 23 - 5913
4. 60 - 644
5. 65 and over8

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females14
2. Males12

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race1
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American0
5. Native Hawaiian or Other Pacific Islander0
6. White18
7. Two or more races2
8. Race/ethnicity unknown5

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent12
2. Parental or other family home2
3. Community residential home7
4. Foster care0
5. Nursing home4
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center0
9. Homeless0
10. Other living arrangements1
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment2
2. Deaf/hard of hearing2
3. Deaf-blind0
4. Orthopedic impairment7
5. Mental illness2
6. Substance abuse0
7. Mental retardation0
8. Learning disability0
9. Neurological impairment5
10. Respiratory impairment1
11. Heart/other circulatory impairment0
12. Muscular/skeletal impairment0
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury2
16. Other disability5

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities13

2. Number of individuals potentially impacted by policy changes300,838

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

1. During FY 2018 DisAbility Rights Idaho (DRI) was requested by the Idaho Department of Labor (IDOL) to participate in stakeholders’ meetings to provide input on developing guidelines that better comply with ADA standards and to develop rule changes that would allow PWDs unable to work 40 hours weekly to qualify for unemployment benefits. Stakeholder members included IDOL, Idaho Human Rights Commission, ADA Task Force and DRI. The rules drafted now allow the required work hours to be customized for unemployment applicants with a disability. This language will be introduced during the 2019 Idaho Legislative session for approval and final rule change. This effort will result in affecting increased accessibility for individuals with disabilities participating in the unemployment program. Estimated impact is 1,722 persons (based on Bureau of Labor Statistics for Oct 2018 of individuals who are unemployed and disabled based on 7.7 percent of total unemployed reporting having a disability). 2. DRI’s Legal Director (LD) and Executive Director (ED) has been working with Department of Health and Welfare (IDHW) Medicaid Administrators and staff presenting concerns explaining how Idaho had violated federal regulation requirements in its provision of the Early, Periodic, Screening, Diagnostic, and Treatment (EPSDT) Medicaid Program. EPSDT Medicaid paid benefits provides comprehensive and preventive health care services for children under the age of 21 enrolled in Medicaid and is the key to ensuring that children and adolescents receive appropriate preventive, dental, vision, mental health, developmental, and specialty services. During FY 2017, DRI’s LD researched, drafted, and provided IDHW’s Medicaid Division a sample EPSDT policy that met EPSDT compliance regulations. Medicaid Administrators agreed to implement these changes in lieu of litigation that DRI would have pursued if regulation compliance efforts were not enacted. During FY 2018, DRI’s LD continued her participation on Medicaid’s Children’s Partnership Committee to monitor recent changes being implemented in the provision of EPSDT services to Medicaid eligible children in Idaho. Changes to the provision of EPSDT services, effects every child on Medicaid in Idaho totaling 222,651. Statistics taken from page 83 of IDHW’s 2017-2018 Facts, Figures, and Trends publication located at: https://healthandwelfare.idaho.gov/Portals/0/AboutUs/Publications/FFT2017_2018.pdf Case summary: DRI provided legal representation for a Medicaid Administrative Fair Hearing on behalf of a five-year-old PAIR eligible child with physical/orthopedic impairments funded under the Protection & Advocacy for Assistive Technology (PAAT) grant who had been denied access to needed Durable Medical Equipment. Legal representation was provided throughout the administrative proceedings with a favorable decision on petition for Director's review. This case allowed DRI to educate Hearing Officers as well as Medicaid Administrators regarding Medicaid eligible children’s access to medically needed services such as durable medical equipment. 3. DRI negotiated with Magic Valley Cinema in Twin Falls, Idaho resulting in closed captioning devices being corrected. Case summary: DRI provided legal representation negotiating on behalf of a 42-year-old female with hearing impairments requiring closed captioning (CC) to understand what was being communicated at Magic Valley Cinema in Twin Falls Idaho. DRI’s attorney identified the theatre’s corporate management and contacted them presenting the problem providing information on ADA Title III Reasonable Accommodation protections. A letter was sent with this information including information that a U.S. Department of Justice complaint could be filed if not corrected. The theatre corrected the problem as well as sent movie gift cards for the client and her family. She and other individuals with hearing impairments now enjoy watching movies at Magic Valley Cinema with closed captioning devices working correctly. (Case summary noted in Part V: Priorities and Objectives under the Disability Discrimination Section) Estimated impact is 419 people with hearing impairments residing in Twin Falls County. Statistics taken from the University of Montana’s Research and Training Center on Disability in Rural Community (RTC-Rural) based on a 4.2 percentage rate of people with hearing loss out of total disability population percentages located at http://rtc.ruralinstitute.umt.edu/geography/index.aspstep1 4. DRI’s efforts to promote the rights of people with disabilities who are, or may be, subjected to guardianship and conservatorship appointments is showing a systemic impact. DRI’s Legal Director (LD) continued her membership on the Idaho Supreme Court Committee on Guardianships and Conservatorships and serves on its Supported Decision Making and Rules and Legislation subcommittees. Through this membership, she has 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. During FY 2018, the Committee created bench cards (cheat sheets) for Magistrate Judges to use for Uniform Probate and Developmental Disabilities Guardianship appointments and when considering Supported Decision-Making as an alternative. DRI’s LD created, and disseminated the bench cards for Supported Decision-Making to all Idaho Magistrate Judges. DRI’s LD participates on the Committee’s Rules & Legislation Subcommittee and during FY 2018 provided comment clarifying the type of notice to be given to parents in minor Guardianship proceedings and for the need to create a court rule to resolve visitation disputes. She is the leading member of the Committee’s Supported Decision-Making Subcommittee and created a continuing legal education (CLE) power point training on lawyer ethics and Supported Decision-Making presented at the 2018 Idaho State Bar annual conference to attorneys and social workers. She also developed and presented training to the Committee on the consequences of gun ownership for those under a guardianship. Supported Decision-Making trainings were presented throughout Idaho educating about this alternative to full guardianship appointments given to people with disabilities (PWDs), students, parents, attorneys, judges, social workers, providers, and IDHW staff. Legal representation and assistance have been provided enabling DRI to demonstrate to judges, attorneys, Guardian ad litem (GALs), court visitors, IDHW Evaluation Committee, family members, and providers that limited guardianships and alternatives better protect the rights of PDWs involved in guardianship proceedings. Case summaries showing the litigation that DRI has provided during guardianship proceedings is provided below in part B. Litigation/Class Actions of this section. There are currently 5,121 adults under guardianship and/or conservatorships presently in Idaho that can be impacted from DRI’s efforts. These statistics were provided by the Idaho Supreme Court Guardianship Monitoring Program Administrator, Nanci Thaemert. 5. During FY 2018, DRI’s ED drafted comment and testified on the potential harm to people with disabilities posed by House Bill H615 which would have required IDHW to impose work requirements for adult Medicaid recipients, and place lifetime eligibility limits. After DRI’s testimony, the bill was defeated because a committee voted to hold the bill. This effort potentially impacts an estimated 46,002 Medicaid beneficiaries on the Adult Enhanced and Coordinated Medicaid Plans. Statistics taken from IDHW’s 2017-2018 Facts, Trends, and Figures publication, page 83. 6. For years, DRI has advocated for reinstating Medicaid paid dental coverage and previously these benefits were added to Idaho’s HCBS A&D and DD waivers, but not added to the state’s Basic Medicaid plan still effecting some people with disabilities (PWDs). During FY 2018, DRI’s ED provided testimony to Legislators regarding the impact this bill would have on PWDs and informing how much money the state would save since often those not having dental coverage access results in other costly health treatment. This bill passed affecting an estimated 32,186 Basic Medicaid recipients now having access to adequate dental coverage. Statistics were taken from page 83 of IDHW’s 2017-2018 Facts, Figures and Trends publication listing the number of adults on the Medicaid Basic Plan. 7. House bill H695 was introduced during FY 2018 appropriating $200,000 to be used for purposes of improving the Medicaid paid Non-Emergency Medical Transportation (NEMT) program operated under a Managed/Coordinated Care contract. This money is to be used for the hiring of an outside entity to conduct an audit of the NEMT program; to support rate review activities for NEMT providers; and to develop and implement a training program that meets the needs of all provider types, the contracted broker, IDHW, and for Idahoans participating in this program. The training program and rate review are to be developed in collaboration with relevant stakeholder groups including, but not limited to, NEMT providers and disability advocacy groups. DRI informed legislators of current problems with the NEMT contractor and how best this money can be used. The bill passed and needed money will be spent to improve the NEMT program. This effort potentially impacts all 300,838 Medicaid recipients (on both Basic and Enhanced Plans) when no other means to get to medical appointments are available. Statistics are taken from page 83 of IDHW’s 2017-2018 Facts, Figures, and Trends publication. 8. DRI’s Advocacy Director (AD) & CAP Coordinator participates and is a leading member of a subcommittee of the Consortium for Idahoans with Disabilities (CID) addressing issues within the Medicaid for Workers with Disabilities (MWD) program. During FY 2018, the work group successfully addressed Idaho Medicaid's erroneous practice that participants in the MWD program must also meet separate income eligibility requirements for other Medicaid programs, in either the Developmental Disabilities (DD) or the Aged & Disabled Medicaid (A&D) Waivers. DRI’s position was that this negated the purpose of MWD, and conflicted with the federal intent and purpose of the program. On July 17, 2018, Subcommittee members contacted the Centers for Medicaid and Medicaid Services (CMS) for guidance and regulation clarification. CMS concluded that Idaho’s A&D and DD waivers are set up to align with the original intent of the Idaho Statute for MWD, thus anyone who is eligible for MWD automatically meets the income/resource eligibility requirements of the HCBS waivers, and is not subject to a share of cost. They just have to meet the level of care requirements. Medicaid staff practice manuals have been updated, and the subcommittee is assisting Medicaid in identifying individuals who may have been wrongly denied services or turned away based on this error. This effort potentially impacts roughly 2000 participants on the MWDs program as reported by Camille Schiiller, the IDHW Program Director of the Self-Reliance Program. 9. With the renewed focus on cultural and linguistic competency, DRI/P&A and CAP have made significant progress in re-building relationships with the Tribal Vocational Rehabilitation/121 Programs in Idaho. Idaho has four (4) Tribes with their own vocational programs, and DRI & CAP has successfully provided information and training to three (3) of the programs on the Coeur d'Alene, Nez Perce, and Shoshone-Bannock reservations. During FY 2018, DRI was able to facilitate talks between the Coeur d'Alene and Nez Perce programs, to review policies and update policy manuals as needed for the Nez Perce Vocational Rehabilitation policy manual to become RSA compliant. This effort could potentially impact roughly 214 Nez Perce unemployed individuals. Statistics taken from the Center for Indian Country development showing an 8.62% unemployment rate out of a total population of 2,490 located at: https://www.minneapolisfed.org/indiancountry/resources/reservation-profiles/nez-perce-reservation 10. A Memorandum of Agreement (MOA) between the IDHW’s Developmental Disabilities (DD) Bureau Chief and DRI has been in place since FY 2014 as a result of the Bureau Chief’s concerns that facilities and providers serving people with DD are not all required to report deaths to IDHW. The DD Bureau receives most death reports occurring at Certified Family Homes (CFHs), at Residential Assisted Living Facilities (RALFs), and for persons receiving Residential Habilitation services for both DD and A&D waiver recipients. So, the deaths of some PAIR clients are on occasion reported to DRI. During FY 2018, DRI received two (2) reports on behalf of PAIR clients in which preliminary investigations were completed. Case sample: DRI received a report from IDHW’s DD Bureau regarding the death of an older male residing in a Residential Assisted Living Facility (RALF). After DRI reviewed reports from the Bureau, and information from the RALF, his death was determined to be a result from a fall fracturing his hip resulting in aspiration from complications due to Alzheimer's. DRI concluded that his death was not suspicious or a result of abuse, so a full investigation was not warranted and this investigation was closed. This death reporting collaboration has resulted in DRI identifying and addressing the lack of death reporting requirements in facilities that serve PADD, PAIMI, PATBI, and PAIR clients. A priority was included in FY2017 and 2018 to investigate death reporting requirements for residential habilitation (Res Hab), CFHs, and RALFs. Since RALF and Res Hab rules already required death reporting, DRI petitioned and proposed necessary death reporting rule changes for CFHs approved by the legislature during the 2018 legislative session so this priority was not needed to be carried over to FY 2019’s priorities. 3409 CFH residents will be impacted by this effort with the increased Licensing and Certification oversight. Statistics were taken from the Community Care Advisory Council’s (CCAC) annual 2018 Legislative Report to be submitted during the 2019 legislative session. 11. During FY 2017, IDHW’s Division of Licensing and Certification announced that they were reviewing the Res Hab rules for possible change. DRI participated in the rule making process during FY’s 2017 and 2018 by reviewing all of the proposed Res Hab rule changes providing suggested language and comments. DRI provided suggestions to improve protections from abuse, neglect, and rights violations which included: removing references to chemical restraint, mechanical restraint, and seclusionary time-out from the rules; adding a de-briefing requirement to the use of physical restraints; making substantial changes to the residents rights section, including the addition of the right to “choose or refuse services,” the right to “choose one’s roommate,” and the addition of other rights such as the right to live in the least restrictive setting, communicate by sealed mail, receive visitors; adding a requirement that Res Hab agencies (when acting as the Rep Payee) maintain a separate transaction record for each participant including receipts for each expenditure paid for using participant funds (regardless of dollar amount) as well as documentation requirements regarding the dispersion of the participant’s personal spending money (including requiring that the participant acknowledge in writing when personal spending money is received). DRI’s suggestions were incorporated with some minor language changes into the revised rule draft. Even though Res Hab agencies primarily serve people with DD, Res Hab services are also provided to PAIR clients since this is also a service provided under the A&D Medicaid Waiver program. According to IDHW’s 2017-2018 Facts, Figures, and Trends, there are 67 residential habilitation agencies operating 105 businesses throughout the state. 12. During FY 2017 and into FY 2018, DRI participated in the rule-making process for CFHs ensuring that death reporting was incorporated. In addition to ensuring death reporting requirements were incorporated, DRI reviewed the entire proposed CFH rule changes providing language and comment. On October 3, 2017, IDHW Licensing & Certification (L&C) sent a response notifying that they adopted most of DRI’s proposed language including DRI’s suggestions for another section to be added so that all reporting requirements suggested by DRI are included. Additional DRI rule comments that were adopted included: adding a definition of “vulnerable adult”; requiring that a notice of pending investigations or charges must immediately be reported to the department for any family member or participant; added a requirement that the participant or his legal representative must sign any changes to their individual support plan; added a requirement that all personal funds and all medications belonging to the participant must be returned immediately upon discharge; defined the word “incident” so that providers are not left to interpret what they believe may qualify; and included a requirement that CFH providers cannot loan money to participants to better protect from potential financial exploitation. 3409 CFH residents will be impacted by this effort with increased L&C oversight into abuse, neglect and rights violations. Statistics were taken from the Community Care Advisory Council’s (CCAC) annual 2018 Legislative Report to be submitted during the 2019 legislative session. 13. During FY 2016 & 2017, DRI conducted an investigation into restraint and seclusion (R&S) practices being conducted at State Hospital North (SHN), a state-run psychiatric facility identifying concerns with its R&S policies and practices. SHN is not an accredited Centers for Medicaid and Medicare Services (CMS) facility. Therefore, its licensure is under Idaho Hospital rules, not under Psychiatric Facility rules. After DRI’s review of Hospital rules, it was determined that DRI would pursue revising these rules to bring them into alignment with current best practices implemented in most accredited psychiatric facilities. DRI facilitated a stakeholder’s group in FY 2017 to develop and propose improved R&S hospital rules. DRI identified best practices regarding R&S in hospitals & convened a stakeholder’s group including members from the State Independent Living Council (SILC), American Civil Liberties Union (ACLU), Idaho Hospital, Nursing, and Psychological & Psychiatric Associations to pursue rule changes. Eventually, this stakeholder’s group aligned efforts with IDHW L&C staff and its Deputy Attorney General (DAG), and with Medicaid Health & Human Services staff, negotiating that current Hospital R&S minimum standards rules align with best practices incorporating Trauma Informed Care processes and eliminating prone usage. Rules have been drafted and rulemaking procedures are being completed. An IDHW Rule Docket was published in the September 2018 Administrative Bulletin providing a timeline for comments which DRI submitted. The L&C Director informed DRI and its stakeholder’s group that after rulemaking processes are completed, the changes will be presented to IDHW’s Board and if approved presented to the Legislature for approval during the 2019 Session. This effort will affect roughly 206 residents at SHN yearly from inappropriate restraint and seclusionary practices (in addition to hospital patients). Statistics taken from page 28 of IDHW’s 2017-2018 Facts, Figures, and Trends publication. All systemic activities are also captured in Part V: Priorities and Objectives.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts3
2. Number of individuals named in class actions0

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

DRI’s efforts to promote the rights of people with disabilities who are or may be subjected to restrictive Guardianship and Conservatorships appointments is continuing to show systemic impact. DRI’s 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. 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. Through this representation, DRI has modeled to the court, attorneys, court visitors, Guardian Ad Litems (GALs), and paid Guardians & Conservators how to ethically represent people with disabilities during Guardianship proceedings. DRI provided legal representation to three (3) individuals with disabilities during FY2017 carried over to FY 2018. One (1) of these litigated cases opened is assisting a PAIR client whose rights are better protected after the court appointed DRI to serve as her guardian ad litem (GAL) addressing concerns with financial exploitation. This case was carried over from FY2017 and is carried over to FY2019 since GAL appointments are ongoing, unless terminated by the court. One (1) of the cases carried over resulted in the Guardianship being terminated, and the other case resulted in both the Guardianship and Conservatorship being terminated. Three (3) case summaries are provided showing the impact: DRI was appointed by the court as Guardian Ad Litem (GAL) on behalf of a white female currently 65-year-old with a developmental disability (DD) and mental illness (MI). In 2015, DRI staff Attorney upon taking over the case discovered that the woman’s Conservator also a Co-Trustee had been charging themselves a large amount of fees, resulting in her Conservatorship and Supplemental/Special Needs Trust running out of funds. She also had a paid Guardian receiving large fees for services not documented as provided. Additionally, the Conservator/Co-Trustee secured a $20,000.00 loan/encumbrance on the woman’s property in order to have funds available to continue to pay their fees, without any sort of plan or ability to repay the loan. DRI’s attorney became increasingly concerned that the woman’s home may be lost in foreclosure proceedings if the loan was not repaid and filed three separate GAL reports to the Court expressing concerns about the unreasonable fees and loan. The court ordered that the Co-Trustees/Conservator acted inappropriately in regards to the $20K loan placed on the client’s home and ordered that they repay the Trust with any money applied to their own interest such as the fees associated with getting the loan and the money, they spent paying themselves. The Trustees and Guardian were replaced by a family member also managing the client’s finances so the Conservatorship is no longer needed. Once reimbursement from the removed Trustees and Conservator are repaid, the new Trustee/Guardian will make arrangements to resolve the outstanding debts. The client’s home was not sold and remains her residence. The court is moving forward with terminating the Conservatorship, after orders are filed. This case will be carried over since DRI is still acting GAL. (This case is also captured under Part V PAIR Priorities and Objectives under the Guardianship Section). DRI provided legal representation to a 24-year-old white female with ADD/ADHD, reactive attachment disorder, bi-polar disorder, conduct disorder, anxiety disorder, and developmental coordination disorder with terminating or modifying her Guardianship and Conservatorship. The client had graduated from high school and had been receiving Residential Habilitation (Res Hab) services since turning eighteen (18). She had worked independently, was responsible for making her own medical appointments, and her Social Security (SS) funds were managed by her Representative Payee, also the Guardian and Conservator. Since she did not have a Special Needs Trust or assets, a Conservatorship was not necessary. The client’s mother had been her Guardian and Conservator since she turned 18 and had indicated that she did not want to continue, but was not willing to step down voluntarily. The client’s Guardian Ad Litem (GAL) would not recommend terminating or modifying the Guardianship and Conservatorship without medical evidence or a new evaluation by the Developmental Disabilities (DD) Evaluation Committee supporting termination or modification. DRI staff attorney coordinated with the Guardian’s attorney and the client’s GAL and all stipulated to having the Court order an updated Evaluation Committee assessment. DRI’s Attorney worked with the Idaho Department of Health and Welfare’s (IDHW) Deputy Attorney General (DAG) and a new evaluation was ordered to be completed by December 2017 (during FY 2018) so the case was carried over. After the evaluation committee issued their report, the court ordered both the Guardianship and Conservatorship to be terminated. The GAL filed with the court and was ordered to be removed since she no longer has a Guardian or Conservator. The client is now living independently in the community with the supports she needs making her own choices so DRI closed this case. DRI provided legal representation to a 23-year-old white female with autism, epilepsy, respiratory disorders, ADD/ADHD, anxiety, and learning disabilities. Her case had been forwarded to DRI by a Medicaid Quality Assurance (QA) Specialist who was investigating allegations of misuse/fraud of Medicaid funds by the client’s Guardian. Her mother was her court appointed Guardian also her Certified Family Home (CFH) provider and SS Representative Payee. The client was alleging that her CFH provider/Guardian was not preforming the services she was getting paid to provide. Medicaid QA Specialist had encouraged the client to file a complaint against her Guardian with the Idaho Supreme Court (ISC). After the client filed this complaint, a confirmation letter was sent to the client’s CFH which her Guardian/provider/mother opened. After discovering that the complaint had been filed, she was asked to leave this placement resulting in her moving in with boyfriend. After moving, she contacted DRI who agreed to provide her with legal representation to terminate her Guardianship. The client worked with her support broker and IDHW staff to amend her Support and Budget Plan, as she not been allowed previously. Her boyfriend applied to become her CFH provider and her Representative Payee which were eventually approved. The Guardian filed a Notice of Non-Objection, indicating that she would not object to the Guardianship termination. DRI Attorney and the client met with Guardianship Monitor staff to discuss her concerns and why she no longer needed a Guardian. DRI Attorney was able to get a Stipulation to Terminate signifying that her Guardianship could be terminated without objection. The case went to hearing, at which time her Guardianship was terminated. The client now resides in the CFH of her choice with the supports she needs on her Support Plan that she directed so DRI closed this case. (Potential systemic impact regarding DRI’s Guardianship priorities/efforts discussed in further detail above in Part IV. Section A. Systemic Activities).

Part V. PAIR'S Priorities and Objectives

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

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

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

Fiscal Year 2018 PAIR Priorities ASSISTIVE TECHNOLOGY 1. People with disabilities will have access to assistive technology (AT) devices and services that they need. 2. Access to AT. 3. Provide systemic advocacy to ensure access to AT devices and services. 4. DRI collaborated with the Idaho Department of Labor (IDOL), Idaho Human Rights Commission (IHRC), the ADA Task Force at stakeholder’s meetings to develop accessibility guidelines and rule changes. 5. 0 cases since not case driven and no class actions. 6. Priority work summary: As a result of a DRI client in 2017 being denied access to unemployment services due to lack of adequate accessibility when filing his/her unemployment claim, DRI contacted the Idaho Department of Labor (IDOL) Unemployment Division Bureau Chief presenting concerns. DRI provided suggestions on how its staff can better meet the needs of people with disabilities (PWDs) needing assistance and services to access unemployment benefits. As a result of this contact, DRI was requested during FY 2018 to participate in stakeholders’ meetings to provide input on developing guidelines that better comply with ADA standards and to develop rule changes that will allow PWDs unable to work 40 hours weekly to qualify for unemployment benefits. Stakeholder members included IDOL, Idaho Human Rights Commission (IHRC), the American with Disabilities Act (ADA) Task Force, and DRI. The rules drafted now allow the required work hours to be customized for unemployment applicants with a disability. This language will be introduced during the 2019 Idaho Legislative session for approval and final rule change. 1. People with disabilities will have access to assistive technology (AT) devices and services that they need. 1. Access to AT. 2. Accept cases regarding denials for AT devices and services as resources allow. 3. No collaboration occurred. 5. 0 cases were opened using PAIR funding and no class actions were filed. 6. A 5-year-old PAIR female client with physical/orthopedic impairments received DRI legal representation for a Medicaid Administrative Hearing funded under the Protection & Advocacy for Assistive Technology (PAAT) grant who had been denied access to needed Durable Medical Equipment discussed in Part IV. Systemic Activities and Litigation. DISABILITY DISCRIMINATION 1. Public or private entities will not discriminate against people with disabilities in violation of the Americans with Disabilities Act. (ADA), or Section 504 of the Rehabilitation Act. 1973. 2. Accessibility. 3. Accept cases of discrimination against people with disabilities in violation of Title II or Title III of the ADA, or Section 504 of the Rehabilitation Act of 1973 as resources allow. 4. No collaboration needed. 5. Seven (7) cases were addressed during FY 2018 and two (2) cases were carried over to FY 2019 and no class actions were filed. 6. Case summary: DRI provided legal representation negotiating on behalf of a 42-year-old female with hearing impairments requiring closed captioning to understand what was being communicated at Magic Valley Cinema in Twin Falls Idaho. The CC device did not start until after the movie began requiring her to leave during the movie to request another device which also did not work. After asking the theatre for a refund she was told that she had to "write a letter" in order to get her money back at which point she demanded to see the manager who only acknowledged the problem stating that the CC boxes weren't set up correctly. Her money was not refunded and the manger did not tell her that they would correct the problem. DRI’s attorney identified the theatre’s corporate management and contacted them presenting the problem providing information on ADA Title III Reasonable Accommodation protections. A letter was sent with this information including information that a U.S. Department of Justice complaint could be filed if not corrected. The theatre corrected the problem as well as sent movie gift cards for the client and her family. She and other individuals with hearing impairments requiring closed captioning devices now enjoy watching movies at Magic Valley Cinema with closed captioning devices working correctly. EDUCATION 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 access appropriate transition services under the Individual with Disabilities Education (IDEA), Section 504, and the Workforce Innovation and Opportunity Act (WIOA). 4. No collaboration occurred. 5. 0 cases were opened and no class actions filed. 6. No calls from PAIR students requesting help with accessing appropriate transition services were received during FY 2018. 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 on the benefits of competitive, integrated employment. 4. DRI collaborated with Special Education Directors, teachers and Job Corp staff facilitating transition employment trainings. 5. 0 cases since not case driven. 6. Priority work summary: DRI participated at the Renaissance High School Transition Fair providing training on utilizing Social Security (SS) Work Incentives, and Medicaid & Vocational Rehabilitation Services when pursuing employment to 34 transition-aged students, parents and teachers. DRI provided transition training education about community services & resources, the importance of Transition Employment Goal Planning; Idaho Vocational Rehabilitation Services(IDVR) access, and Individual Plan of Employment (IPE) development and how SS Work Incentives and Medicaid services can support employment goals at seven (7) high school classes and at a Job Corp program to 77 students and educators. Information about P&A services and how DRI can help with transition planning & appropriate IDVR access were reviewed. Brochures with DRI and Client Assistance Program (CAP) contact information provided. At the 2018 Tools for Life Transition Fair, DRI provided "Hot Topics in Employment- Rights of Workers with Disabilities" training to 25 students, parents, providers and teachers, educating about the rights of workers with disabilities under the Americans with Disabilities Act (ADA), Title I, Section 504, and the Workforce Innovation and Opportunities Act (WIOA). Hot topics included the right to reasonable accommodations, often needed to attain & retain competitive integrated employment and how to access them; wage/hour issues, overtime, contractors vs employees, and marijuana testing in legalized states. GUARDIANSHIPS 1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Free from unnecessary guardianships or conservatorships. 3. Participate on the Idaho Supreme Court Committee on Guardianships and Conservatorships to represent the rights and perspectives of people with disabilities regarding guardianships or conservatorships. 4. DRI is a member of the Idaho Supreme Court Committee on Guardianships and Conservatorships collaborating with judges, attorneys, trial court administrators, legislators, Idaho Legal Aid services, Commission on Aging Administrator, and Mental Health Court & Veterans Court Coordinators in efforts to improve Idaho Guardianship & Conservatorship protections. 5. 0 cases since not case driven. 6. Priority work summary: DRI’s Legal Director continued her membership on the Idaho Supreme Court Committee on Guardianships and Conservatorships. This committee is tasked with revising Idaho’s guardianship and conservatorship statutes to better protect Idahoans. Through this membership, she has 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. During FY 2018, as a result of the WINGS Grant (Working Interdisciplinary Networks of Guardianship Stakeholders Grant from the American Bar Association) that DRI’s Legal Director helped secure in which DRI wrote a letter of support, the Committee created bench cards for Uniform Probate & Developmental Disabilities Guardianship appointments and for Supported Decision-Making. Bench cards are cheat sheets for judges on the elements of a legal concept. DRI’s Legal Director was asked to, created, and disseminated the bench card to all Idaho Magistrate Judges to use when considering Supported Decision-Making in lieu of full or limited guardianship appointments. DRI’s Legal Director also participates on the Committee’s Rules & Legislation Subcommittee and during FY 2018 provided comment clarifying the type of notice to be given to parents in minor guardianship proceedings and for the need to create a court rule to resolve visitation disputes. She also developed and presented training to the Committee on the consequences of gun ownership for those under a guardianship. 1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Free from unnecessary guardianships or conservatorships. 3. Advocate for the implementation and use of the supported decision-making model as an alternative to guardianships. 4. DRI’s Legal Director (LD) collaborates with Idaho Supreme Court Committee on Guardianships and Conservatorships Supported Decision-Making Subcommittee members developing Supported Decision-Making judicial practices and educating the community. 5. 0 cases since not case driven. 6. Priority work summary: DRI’s LD is the leading member of the Idaho Supreme Court Committee on Guardianships and Conservatorships’ Supported Decision-Making Subcommittee. As a result of the Committee receiving an American Bar Association WINGS Grant, during FY 2018 she was asked to and created a continuing legal education (CLE) Power Point training on lawyer ethics and Supported Decision-Making. She presented this CLE training at the 2018 Idaho State Bar annual conference to attorneys and social workers. The training was professionally recorded and posted for access. She also created and disseminated a Supported Decision-Making handout titled A Practical Tool for Lawyers: Steps in Supported Decision Making. Power Point copies and the handout were disseminated to 100 attorneys and social workers. As noted in the above priority, she also created Supported-Decision Making bench cards and disseminated to all Idaho Magistrate Judges. In addition to the CLE Supported Decision-Making training presented at the 2018 Idaho State Bar annual conference, eight (8) additional Supported Decision-Making trainings were provided statewide throughout FY 2018 to 199 people. These trainings were provided at the 2018 Tools for Life Transition Conference to transition-aged students; at the Community Partnerships Conference co-presenting with two (2) IDHW Developmental Disabilities Evaluation Committee members to people with disabilities (PWDs) and providers; to a 6th District Family Law group; to the Judicial Trust Estates Probate section; to State Department of Education staff and a Medicaid Advisory Group; to a Latino contingency of Partner’s in Policymaking; at the Boise School District’s Special Education Teachers and Directors In-Service training with the Idaho Attorney General and the Head of IDHW’s Developmental Disabilities Evaluation and Crisis Services teams; and to a group of mothers of children with mental illness (MI) & learning disabilities. 1. People with disabilities will be free from abusive or unnecessary guardianships or conservatorships. 2. Free from abusive or unnecessary guardianships or conservatorships. 3. Provide legal representation to people with disabilities to modify or terminate abusive or unnecessary guardianships or conservatorships as resources allow. 4. No collaboration occurred. 5. 2 cases were addressed during FY 2018 and no class actions were filed. 6. Case summaries: DRI was appointed by the court as guardian ad litem (GAL) on behalf of a female currently 65-year-old with a developmental disability (DD) and MI. In 2015, DRI staff attorney upon taking over the case discovered that the woman’s Conservator and Co-Trustee’s had been charging themselves a large amount of fees, resulting in her Conservatorship and Supplemental/Special Needs Trust running out of funds. She also had a paid guardian receiving fees. Additionally, the Conservator and Co-Trustee secured a $20,000.00 loan/encumbrance on the woman’s property in order to have funds available to continue to pay their fees, without any sort of plan or ability to repay the loan. The DRI attorney became increasingly concerned that the woman’s home may be lost in foreclosure proceedings if the loan was not repaid and filed three separate Guardian ad Litem Reports to the Court expressing concerns about the unreasonable fees and loan. The court has ordered that the Co-Trustees and Conservator acted inappropriately in regards to the $20K loan they placed on the client’s home and ordered that they repay the Trust with any money applied to their own interest such as the fees associated with getting the loan and the money they spent paying themselves. The trustee and guardianship was replaced by a family member also managing the client’s finances so the Conservatorship is no longer needed. Once the reimbursement from the removed trustees and Conservator are repaid, the new trustee/guardian will make arrangements to resolve the outstanding debts. The client’s home was not sold and remains her residence. The court is moving forward with terminating the Conservatorship after orders are filed. This case will be carried over since DRI is still acting GAL. An 81-year-old male with physical/orthopedic impairments and neurological deficits called DRI seeking assistance with removing his guardianship since he disagreed with the amount of money he received for personal allowance and because his guardian removed his guns and sold his car. He was unable to provide the name of his guardian and their contact information. After interviewing the client, DRI was unable to identify allegations of abuse or that his guardianship was unnecessary in order to qualify for DRI legal representation. DRI reviewed the Idaho Repository locating his guardianship case concluding that his guardianship was an appointment from his County Board of Community Guardians Program and contact information provided. An Idaho Supreme Court (ISC) complaint with the appointing court had already been filed, an upcoming hearing scheduled, and a GAL had already been appointed. GAL contact information and suggestions for self-advocacy provided. Since court oversight was already occurring and because he was appointed an attorney acting as a GAL, DRI closed his case. MEDICAID 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services. 3. Advocate that the Idaho Department of Health and Welfare (IDHW) comply with Centers for Medicare and Medicaid Services (CMS) person-centered planning rules for the Home and Community Based Services (HCBS) Aged and Disabled Waiver. 4. DRI collaborates with people with disabilities (PWDs), providers, Idaho Vocational Rehabilitation (IDVR), the State Independent Living Council (SILC) and the Idaho Council on Developmental Disabilities (ICDD) as members of a Community NOW! Subcommittee developing recommendations for the IDHW Division of Medicaid regarding services for people accessing HCBS Services. 5. 0 since priority not case driven 6. Priority work summary: During FY 2018, DRI’s Executive Director (ED) and Advocacy Director continued participation on the Community NOW! Project Committee developed in 2017 in response to a class action settlement in the KW v. Armstrong lawsuit brought by the American Civil Liberties Union of Idaho on behalf of Idaho adults with developmental disabilities addressing disparities in IDHW’s tools used for determining eligibility & budget allocation. DRI’s ED also participates on a Subcommittee of Community NOW! addressing the array of services to include in Personal Centered Planning and IDHW’s obligation to meet CMS Personal Centered Planning requirements mandated for all Home and Community Based Services (HCBS) participants. This subcommittee developed a plan with DRI ED’s guidance that meets the CMS HCBS Personal Centered Planning requirements for the Developmental Disabilities Waiver recipients. The Administrator for Idaho Medicaid Services informed Subcommittee members that these developed Personal Centered Planning requirements will also be incorporated into the Aged & Disabled (A&D) HCBS Medicaid Waiver and the Children’s HCBS Redesign Waiver programs. Since no formal written agreement was received, during FY 2019, DRI will monitor to determine compliance. OUTREACH/TRAINING 1. People with disabilities will have increased awareness about the services offered by DRI including the Client Assistance Program (CAP). 2. Access to P&A advocacy. 3. Conduct outreach to transition-age youth with disabilities, including transition-age youth in facilities. 4. DRI is a member of the Idaho Interagency Council on Secondary Transition collaborating with the Idaho State Department of Education, Idaho Vocational Rehabilitation, Idaho Assistive Technology Project, the Idaho Council on Developmental Disabilities, providers and businesses to improve transition services and helped in planning the annual Tools 4 Life conference to transition-aged students. 5. 0 since not case driven. 6. Priority work summary: DRI as a member of the Idaho Interagency Council on Secondary Transition collaborates with the Idaho Department of Education (IDE), Idaho Assistive Technology Project (IATP), Idaho Council on Developmental Disabilities (CDD), providers, and businesses involved in the education and employment of transition age youth. The Council is currently revising the Moving On Binder, which provides transition information and training curriculum to transition age youth, to be used hopefully in conjunction with transition goals and activities provided by the student's school. The group reviews data regarding transition services and post school outcomes for youth, provides input to the SDE, and shares information from the member agencies on programs, projects, and services for transition age youth. DRI is also a member of the Council’s Planning Committee for the annual Tools for Life Transition Fair in partnership with IATP providing workshops and information to transition age students, their parents, school staff and service providers. DRI conducted several presentations and outreach at the 2018 Tools for Life Transition Fair in Moscow, ID in March 2018. Approximately 270 high school and college students, parents, professionals, and others attended the event. DRI set up a display booth providing information about DRI, its services and how DRI can help with transition planning and accessing needed Vocational Rehabilitation and community services. P&A and CAP brochures were disseminated. In addition to the “Hot Topics in Employment” presentation noted under the education priority above, DRI provided four (4) more presentations discussing life skills training development; processes of developing self-advocacy skills for independence; developing transition planning; understanding rights after 18; and Supported Decision-Making as an alternative to guardianship & conservatorship. DRI provided outreach to high school and college students (the majority were students of color, Native American, and low-income students from rural Idaho) during multiple Love the Law! events co-facilitated by a DRI staff attorney who is the co-chair and sponsored by the Diversity Section of the State Bar. This program encourages disenfranchised students to consider entering the legal field as a career option, and provides opportunities for scholarship, mentoring and assistance with test preparation. DRI attorney is also on the scholarship committee which offered 3 scholarships during FY 2018 covering the costs of LSAT testing fees, Law School admission costs for Idaho Law Schools, and LSAT study materials for students from diverse backgrounds. Approximately 250 students attended these events. Outreach about DRI, its services, and CAP were provided to transition-aged students at 2 transition fairs, and nine (9) workshops at Highland High School, Renaissance High School, Rocky Mountain High School, Boise State University, Job Corps, and the Idaho State Independent Living Council Youth Leadership Forum. Information on transitioning planning, accessing Vocational Rehabilitation services, higher education and training, voting, were discussed with students (in addition to information about the benefits of competitive, integrated employment). Students had opportunities to ask questions how DRI can help with accessing Vocational Rehabilitation, community services, Medicaid and SS benefits. Students practiced voting on ballot marking devices and were assisted with voter registration. Attendees were primarily youth ages 16-26, with some parents, teachers and staff in attendance. 1. People with disabilities will have increased awareness about the services offered by DRI including CAP. 2. Access to P&A advocacy. 3. Conduct outreach in the community to increase awareness of services offered by DRI. 4. DRI collaborates with the Consortium for Idahoan’s with disabilities (CID), Idaho Council on Developmental Disabilities (ICDD), State Independent Living Council (SILC), Centers for Independent Living, Idaho Vocational Rehabilitation (IDVR), and Idaho Department of Health and Welfare (IDHW) in facilitating and participating in various persons with disabilities (PWDs) focused events throughout Idaho. 5. 0 since not case driven. 6. Priority work summary: DRI outreached at the CID sponsored Disability Advocacy Day at the Capitol. DRI set up a display booth providing information about DRI & CAP services. Approximately 125 people including legislators, PWDs, providers, parents, & disability agencies attended. DRI Executive Director and Advocacy Director were members and attended meetings at the Community of Purpose/We Choose All of Us Work Group (WG) sponsored by the Idaho Coalition Against Sexual and Domestic Assault. Representative from 20 non-profits, social justice organizations, activists & disability organizations participated to exchange information about each organization and to identify unmet needs in Idaho. It is one (1) of the first intersectional work groups in Idaho combining Lesbian, Gay, Bisexual, Transgender & Transsexual, and Queers (LGTBQ), low-income & racial/ethnic groups with disability organizations. DRI outreached at Service Dog Awareness Day sponsored by Idaho Service Dog Advocates promoting education about service dogs, legal protections and needed Idaho Service Animal Statutory changes. DRI provided information about its services and CAP and disseminated Technical Assistance materials developed by DRI’s Legal Department regarding service animals, and legal protections to attendees and event facilitators. Approximately 75 people with disabilities and providers attended. DRI attended the Idaho Fair Housing Council Summit in celebration of the Fair Housing Council 50th Anniversary. Topics included Aging in Place, Cultural Competency including disability, Fair Housing Act (FHA) violations & training on rights to support & service animals. DRI outreached to attendees providing information about the P&A and its services to approximately 25 people with disabilities, providers and disability agencies. DRI outreached at the Empowering Independence Independent Living Conference and set up a display booth providing information on DRI Services and CAP to people with disabilities, providers, and state and non-profit agencies. Approximately 150 people attended. DRI participated at an ADA Kick Off event sponsored by the Northwest ADA Task Force in Boise, highlighting current ADA issues in Idaho and the Pacific Northwest. 25 attendees participated including representatives from the Idaho Human Rights Commission, Centers for Independent Living, State Independent Living Council, and Idaho Vocational Rehabilitation. Outreach occurred to Intermountain Fair Housing Council staff, board members and other partners discussing DRI and CAP services. Approximately 25 people attended. DRI outreached providing information on its P&A and CAP services to the Idaho Commission for the Blind and Visually Impaired and staff at the three (3) Centers for Independent Living (CILS) statewide: Living Independent Living Services (LINC) in the Treasure Valley (Boise) area; Living Independent for Everyone (LIFE) in the eastern part of the state, and Disability Action Center (DAC) in northern Idaho. FY 2018 Statement of Priorities and P&A and CAP CIL brochures were provided. DRI celebrated its 40th Anniversary by hosting an open house simultaneously at both offices located in Boise and Pocatello. Information about DRI’s history, photos, and discussion/outreach was provided to former/current clients, local agencies, partners, and current/former Board, and staff members. Approximately 40 people attended. 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 other rights information to people with disabilities residing on the Fort Hall and Coeur d’Alene Indian Reservations. 4. Collaboration occurred with Tribal Vocational Rehabilitation Services Directors and staff, and Tribal Council members assisting with facilitating outreach efforts. 5. 0 since not case driven. 6. Priority work summary: DRI Advocate (a Native American) facilitated outreach to the Nez Perce Reservation during FY 2018. She facilitated then met with the Nez Perce Vocational Rehabilitation (NPVR) Administrator and two (2) counselors. Information about DRI P&A & CAP services were reviewed. NPVR staff talked about barriers that the tribe face with attaining and retaining employment, as resources are scare on the reservation. NPVR disclosed the primary issue they face which is the need to revise and ensure that their Vocational Rehabilitation (VR) policy manual meets federal compliance standards. After the Rehabilitation Services Administration (RSA) determined that the NPVR policy manual was not sufficient, NPVR requested RSA guidance and training to ensure policy revision compliance. Its Council adopted a resolution that until NPVR completes the revised manual, all concerns are addressed through the Tribal Council & Courts. DRI determined that NPVR was actively working on correcting this problem and determined that appropriate assistance and monitoring were being provided to ensure that client’s rights were not being violated. 50 P&A & CAP brochures were provided. DRI outreached to the Coeur d’Alene Reservation & met with its VR Administrator, two (2) counselors, and one (1) elder providing information about P&A and CAP services and contact information was exchanged. DRI Advocate was given a tour of the Coeur d’Alene VR facility and the Health & Wellness Center. Coeur d’Alene VR explained that they work closely with the Tri-Cities (Kennewick, Pasco, and Richland, WA) CAP programs and have a Memorandum of Understanding (MOU). The Tri-Cities area employs most of their VR clients so VR concerns are usually addressed with the Tri-cities CAP program. Some within the tribe choose the Tribal Council to resolve problems. Coeur d’Alene completed their VR Policy Manual which the DRI Advocate reviewed. DRI Advocate asked if the NPVR could review to possibly “adopt” their manual policies. All were in favor of this, and scheduled a time for NPVR to visit the Coeur d’Alene VR. This meeting and collaboration facilitated from DRI’s Advocate, occurred between the 2 tribes during FY 2018. 50 CAP and P&A brochures were provided. DRI Advocate contacted Fort Hall (Shoban) VR suggesting that a meeting with surrounding VR programs of Pocatello, Preston, Blackfoot and Blackfoot Correction meet with the DRI Advocate and Fort Hall VR staff. Initially, Fort Hall VR did not believe Non-Native VR programs would travel to the Reservation. However, invitations were sent & a meeting was scheduled to occur during FY 2019 in October. 100 CAP brochures were requested and sent to the Fort Hall VP program. DRI had a display booth at the Compassionate Communities Conference at Boise State University (BSU) providing information about DRI and its services to approximately 200 attendees which included Latinos, refugees, Native Americans, African Americans, people with disabilities (PWDs), social services & advocacy agencies & providers. Topics discussed at this conference included cultural competency, white privilege & fragility, sexual and domestic abuse prevalence for PWDs, and historical trauma. 1. Conduct outreach to unserved and underserved populations with disabilities. 2. Access to P&A advocacy 3. Provide outreach about services offered by DRI and other rights information to Latinos with disabilities and their families. 4. Collaboration occurred with the We Choose All of Us Coalition in planning its conference and exchanging services information and with Idaho Council on Developmental Disabilities (ICDD) identifying Latinx (the gender-neutral alternative term for Latino) individuals to gather information about their advocacy needs. 5. 0 since priority not case driven. 6. Priority work summary: In addition to the Compassionate Communities Conference, DRI outreached at the We Choose All of Us quarterly convenings. In attendance were leaders in the Latinx community, with some family members of people with disabilities and transition age youth. DRI’s Advocacy Director participated in a Diversity Project by Georgetown University National Center for Cultural Competence as part of its Leadership Institute for Cultural Diversity and Cultural and Linguistic Competence. As part of this project, she met with members of the Latinx community, providing information about CAP and DRI’s P&A services, and ultimately developed 4 videos (in English and Spanish) about the importance of addressing disparities in services to the Spanish speaking community in Idaho. A Supported Decision-Making presentation was given to Latinx family contingency with the DD Council’s Partners in Policy Making to 15 Spanish Speaking members. A 2018 Focus Group was conducted with 34 Spanish Speaking individuals facilitated with the Idaho Council for Developmental Disabilities (ICDD) identifying issues and concerns that the Latinx community needs help with, which included: education, housing, transportation, and knowing and understanding their rights. PUBLIC POLICY/SYSTEMS ADVOCACY 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Inform public policy makers of the impact that proposed changes to Medicaid will have on Idahoans with disabilities. 4. No collaboration occurred for this priority. 5. 0 since not case driven. 6. Priority work summary: DRI informed policy makers of the impact that three (3) proposed Medicaid bills making changes would have on Idahoans with disabilities, during FY 2018: House bill H464 —The Idaho Health Care Plan (IHCP) was proposed again with some changes in 2018 allowing Idaho to seek a Medicaid Innovation Waiver (ยง1115). This Waiver would have provided Medicaid eligibility for people with certain serious health problems up to an income of up to 400% of the Federal Poverty Level (FPL). At the same time Idaho would seek a waiver to the Affordable Care Act (ACA) allowing people with incomes under the FPL to receive federal premium assistance. DRI’s Executive Director (ED) drafted written comment posted on DRI’s webpage blog and provided testimony to legislators regarding the impact that this bill would have on people with disabilities (PWDs). DRI’s position was that even though IHCP was not a complete solution to the Idaho’s health coverage problems since 20,000 Idahoans would still be left in the insurance gap and because IHCP did not provide premium assistance to people who do not have taxable income under the ACA, it would have provided better coverage for Idahoans with disabilities, especially people with serious mental illness. In light of these issues, DRI supported this bill since an estimated 5,000 Idahoans with serious health conditions would gain access and another 30,000 Idahoans living below the poverty level would have access to affordable coverage on the Idaho insurance exchange (Your Health Idaho). The bill cleared the House Health and Welfare committee on a 7-5 vote. A vote by the full house was delayed and in the last few days of the session the House sent the bill back to committee without a vote, killing the bill. A proposition to expand Medicaid was on the November 2018 ballot which DRI will be monitoring to determine if new bills will be introduced expanding Medicaid depending on the proposition’s results. Another Medicaid Waiver bill-H615 was proposed which would have required the Idaho Department of Health and Welfare (IDHW) to request Medicaid Waivers imposing work requirements, and place lifetime eligibility limits on some Medicaid recipients. Even though this bill primarily targeted non-disabled beneficiaries, some Medicaid beneficiaries with disabilities would have been affected. During 2018, DRI’s ED testified on the potential harm to people with disabilities posed by this bill. The bill failed after a committee voted to hold the bill. House bill H465-restoring Medicaid Dental Coverage was introduced during 2018. This bill expanded dental coverage for Medicaid recipients in Idaho’s Basic Medicaid plan. For years, DRI has advocated for reinstating Medicaid paid dental coverage and previously these benefits were added to Idaho’s HCBS A&D and DD waivers, but not added to the state plan still effecting many PWDs. DRI’s ED provided testimony to legislators regarding the impact this bill would have on PWDs and informing how much money the state would save since often those not having dental coverage access results in other costly health treatment. This bill passed so now all Medicaid recipients will have access to adequate dental coverage. 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. 4. Collaboration occurred with service animal providers in getting revisions to Service Animal statutes; AARP in getting a caregiver training bill passed, Hospital Associations and prosecutors in identifying acceptable language for an exception to a battery of health care workers bill; and with the Idaho Council on Developmental Disabilities (ICDD) and the State Independent Living Council (SILC) in getting a committee ordered Office of Performance Evaluation (OPE) ordered for the Southwest Idaho Treatment Center. 5. 0 since not case driven. 6. Priority work summary: In addition to legislation monitored in the priority discussed above, DRI monitored, analyzed the impact of, and provided its analysis on behalf of seven (7) more bills, and/or legislative action: Senate bill S1312 - Service Dogs: Service animal trainers drafted a bill adding changes to Idaho’s service animal statute for how service dogs in training are to be treated in places of public accommodation, rules for puppy trainers, and a rule allowing for penalties for false claims of service dogs. However, the committee also printed Senate bill-S1296, which only added “mental disability” to the current statute’s definition of disability which only included persons that are blind and those with physical disabilities, not addressing many of the other issues addressed in S1312. DRI staff attorney was asked to analyze both bills and provided comment bringing S1312 into ADA compliance and determined that the two bills were primarily in conflict. DRI’s ED testified at length on the need for S1312 and explained why S1296 was not ADA compliant. In spite of praise for the effort put into the passing of S1312, the legislative committee killed this bill, and passed S1296. Even though this definition change was needed, DRI will continue advocating for Idaho’s service animal law to meet ADA standards. DRI added a priority to the 2019 FY priorities to educate legislators on the need to bring Idaho’s service animal law into ADA compliance. Senate bill S1262-AARP Caregiver Training: AARP introduced a bill requiring hospitals to give training to family caregivers who are expected to perform health care tasks at home, and on the proper way to provide home care, before discharge. The bill was printed and referred to the Senate Health and Welfare committee. DRI analyzed and provided feedback to AARP on the bill and agreed to support it. Due to drafting issues and hospital opposition, the AARP withdrew the bill without a hearing. House bill H657-Battery of Health Care Workers Exception: This bill would have created an exception to the enhanced penalty (felony) for battery against a health care worker when the battery is the result of a serious mental illness. DRI worked with parties including the Hospital Association and prosecutors to find language acceptable. The bill was scheduled for a hearing on the day that the speaker ordered the committees to cancel all hearings on new bills. Autism Services Insurance Coverage —After circulating a draft bill to mandate health insurance policies to cover autism treatments and evaluations, the sponsors decided instead to focus on obtaining an executive order to have the Department of Insurance accomplish the same thing. DRI analyzed the bill and provided comment. On April 3rd, the executive order was issued mandating coverage increasing autism treatment coverage in Idaho without passing legislation. Performance evaluation of the state ran Southwest Idaho Treatment Center (SWITC): After DRI’s investigation results into abuse and neglect allegations at SWITC, Idaho’s state ran Intermediate Care Facility for the Intellectually Disabled (ICF/ID), DRI with support from and collaboration with SILC and ICDD, requested a Joint Legislative Oversight Committee (JLOC) resolution to order the Office of Performance Evaluations (OPE) to evaluate SWITC to examine issues on abuse and neglect of residents, staffing shortages, staff training, quality of treatment, and administrative oversight. The Committee ordered OPE to conduct the evaluation, began evaluating in 2018 and its report will be published during FY 2019. House bill H587 State liability for negligent supervision of residents in state facilities; H587 would have eliminated the immunity state facilities have for damages and injuries caused by the failure to supervise the residents in state facilities. DRI analyzed and informed legislators of the benefits of the bill in the House committee hearing. It passed the House by a vote of 68-2 but was held without a hearing by the Senate Judiciary Committee chair. 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, work groups, and councils that present opportunities to advocate on behalf of people with disabilities. 4. All collaborative efforts discussed below in summary. 5. 0 since not case driven. 6. Priority work summary: DRI Executive Director (ED) is a member of the Consortium of Idahoans with Disabilities (CID) guiding its public policy agenda. 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. ED is a leading member of the Idaho Health Care for All/Close the Gap Committee advocating for Medicaid expansion analyzing proposed legislation and its impact on Idahoans with disabilities and providing this analysis to Idaho Legislators. DRI ED participates on the Idaho Behavioral Health Association (IBHA) identifying gaps and providing recommendations for improving services and access to Behavioral Health services. He is a board member for the Idaho Council on Developmental Disabilities (ICDD) helping in developing strategic planning and supporting their public policy initiatives. The ED participated on the IDHW Personal Assistance Oversight Committee addressing issues with HCBS Medicaid Waivers; and is on a work group monitoring the Homes for Adults Residential Treatment (HART) pilot project in which some Residential Assisted Living Facilities (RALFS) providers have become certified Behavioral Health providers to coordinate & provide Behavioral Health & Personal Care Services (PCSs) to persons with severe emotional disturbance (SED). Presently, RALF rules are the only rules governing HARTs which do not address the provision of Behavioral Health services being provided. During FY 2018, ED stressed the need for IDHW to develop HART specific rules during the pilot project time period and has informed IDHW that DRI will not support any legislation passing HART as a facility type until the rules are created with DRI input. DRI ED and Advocacy Director (AD) participate in a newly formed Community of Purpose coalition resulting from the “We Choose All of Us” Work Group. The purpose of the group is to build a coalition of Idaho social justice organizations, making connections, and informing of each other’s work. During FY 2018, the ED and AD continued participation on the Community NOW! Project Committee developed in 2016-2017 in response to a class action settlement in the KW v. Armstrong lawsuit brought by the ACLU on behalf of Idaho adults with DD addressing disparities in IDHW’s tools used for determining eligibility & budget allocation. The ED participated on a Subcommittee of Community NOW! addressing the array of Waiver services needed and IDHW’s obligation to meet Centers for Medicare & Medicaid (CMS) Personal Centered Planning requirements mandated for all HCBS participants. DRI AD also participates on a Community NOW! Subcommittee addressing employment access for DD Waiver recipients. DRI Legal Director (LD) is a leading member of the Idaho Supreme Court (ISC) Guardianship Committee advocating for increased rights protections in Idaho Statutes for Idahoans at risk of or those who have been appointed guardians and/or conservators. LD serves on the Committees’ Supported Decision-Making Subcommittee advocating that this alternative to guardianships be included in statute and practice; and she is a member of the Rules and Legislation Subcommittee providing comments clarifying the type of notice to be given to parents in minor guardianships and on the need to create a court rule to resolve visitation disputes, during FY 2018. LD also participates on the IDHW Medicaid Children’s Partnership Committee monitoring that Early, Periodic, Diagnostic, Screening, & Treatment (EPSDT) Medicaid services are being provided and these principles followed for children receiving Medicaid under the age of 21. DRI’s AD is a member of the U.S. Commission on Civil Rights-Idaho Advisory Committee participating in orientation training. During FY 2018, this committee determined that its next project will be conducting research on disparities and barriers to voting on Idaho Reservations, including barriers to Tribal voters with disabilities. DRI’s AD serves on a Medicaid for Workers with Disabilities (MWDs) Work Group identifying access barriers and during FY 2018 received confirmation from CMS that IDHW’s Self Reliance Workers were inappropriately applying incorrect asset requirements which was disqualifying eligibility and/or resulting in incorrect excessive Medicaid co-pays. CMS directive was presented to IDHW who has agreed to correct this barrier. The MWDs Work Group will be monitoring during FY 2019 to ensure that Self Reliance has corrected this deficiency. DRI’s AD was chosen and participated on a National Center for Cultural Competence (NCCC) Advisory Group to develop and put into practice leadership skills necessary to address disparities in services to Spanish speaking individuals and their families and developed four (4) project videos, during FY 2018. DRI is a member of the State Department of Education sponsored Idaho Interagency Council on Secondary Transition to improve the transition of Idaho students with disabilities from high school to work and/or college and participates on its Tools 4 Life Planning Committee for its annual transition conference. All DRI attorneys (including DRI AD) 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 FY 2017, DRI staff attorney served as the co-chair on the Diversity Section’s Subcommittee called “Love the Law” acting as its co-chair organizing activities focused at diverse, low income, and underserved youth. DRI staff attorney participates on IDHW’s Medical Care Advisory Council (MCAC) reviewing state Medicaid policy and providing comment on proposed rules and implementation. During FY 2018, MCAC focused on ensuring that its transition plan is working towards meeting CMS mandated HCBS requirements in order to meet the 2022 deadline. During FY 2017 & 2018, DRI staff attorney facilitated the formation of an Idaho Restraint & Seclusion Stakeholders Work Group as a result of DRI’s systemic work completed at State Hospital North’s (SHN) Psychiatric Hospital identifying concerns with its restraint and seclusion (R&S) policies and practices. Since SHN’s is licensed under hospital rules, this work group is pursuing rule changes in Licensing and Certification (L&C’s) hospital rules to better protect individuals from inappropriate and excessive R&S practices. DRI PAIR/PATBI Coordinator remains a member of the Community Care Advisory Council (CCAC) advocating for quality care and rights protections for PWDs residing in certified family homes (CFHs) and residential assisted living facilities (RALFs) providing recommendations to IDHW’s L&C Division. During FY 2018, CCAC addressed the need for increased reimbursement rates, the lack of emergency crisis placements; difficulties of attaining and retaining staffing with a record low unemployment rate; the need for secured memory care units; and how to facilitate resident input. As a result of a legislative committee ordered Office of Performance Evaluation (OPE) report in 2017, IDHW L&C and the Idaho Health Care Association (ICHA) partnered creating work groups addressing disparities in RALFs identified in the OPE report. DRI PAIR/PATBI Coordinator was asked to and participated on the Admission & Discharge Work Group created as a result of the OPE report focusing on reviewing rules and developing RALF wound care guidelines. 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 FY 2018, she provided BIAID outreach at the Centers for Independent Living (CIL) sponsored “Empowering Independence” Conference. She is also a member of the TBI Advisory Council identifying TBI specific issues statewide collaborating with the Idaho TBI Grant Lead Investigator assisting with needs assessment dissemination identifying the needs of people with TBI in Idaho. To address barriers in protecting vulnerable adults in Idaho, Idaho’s Commission on Aging created an Adult Protection Revitalization Project. DRI’s AD participated in its initial work group meetings gathering data and prioritizing gaps in services to vulnerable Idahoans. Additional work groups were developed in response to the gaps identified. DRI’s PAIR/PATBI Coordinator facilitated participation and participates on the APS Revitalization Guardianship Work Group to counterbalance APS and other agencies belief that more guardianships will better protect vulnerable adults. PAIR/PATBI Coordinator also facilitated DRI’s AD participation on the APS Revitalization Involuntary Hold Work Group since a gap identified was that there is need for statutory change allowing for people with dementia to be committed and placed in institutionalized “lock down” facilities. DRI PAAT/PAVA Coordinator participates on the Idaho Digital Accessibility Consortium (IDAC) to make changes to state websites & technology devices so that all are aligned with the WCAG 2.0 II guidelines as outlined under Title II of the ADA. He is a member of the Ada County Boise City Housing Authority’s Family Sufficiency Committee to increase access to financial assistance for home ownership for low-income individuals. He is a member of the Allies Linked for the Prevention of HIV & AIDs (A.L.P.H.A.) Coalition advocating for treatment & community integration access. He participates on the Idaho Emergency Coalition currently drafting an emergency planning functional assessment to identify needs and responses to meet the needs of PWDs in emergency preparedness efforts. He is a member of the State Independent Living Council’s Youth Leadership Forum advocating for meaningful self-determination and independence. DRI Advocates participate 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. DRI participates on the Justice and Advocacy for Vulnerable Adults Java Committee. JAVA is a professionals group associated with protecting seniors and/or vulnerable adult populations in Idaho from abuse and fraudulent activities and promoting state wide support. DRI participates on the Extended Employment Supports (EES) Work Group addressing barriers to accessing EES services often needed for PWDs who desire attaining integrated competitive employment. 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 to help 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; advocate for client’s choice, self-determination, and the desire for meaningful integration; educate the community regarding the dangerous practice of restraint and seclusion in schools and the community; address whether PWDs are receiving appropriate IDVR and IDOL services and aware of and accessing SS Work Incentives to purse competitive integrated employment; and address 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 various federal and state disability laws and protection against disability discrimination. 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 managed care programs, which arise during FY2018. 4. DRI collaborated with the Consortium for Idahoans with Disabilities (CID), the State Independent Living Council (SILC), and the Developmental Disabilities Council, in advocating for the passage of House bill H695 to receive appropriations/money needed to improve Idaho’s Non-Emergency Medical Transportation (NEMT) managed care program. 5. 0 since not case driven. 6. Priority work summary: House bill H695 was introduced during 2018 appropriating $200,000 to be used for purposes of improving Medicaid, paid the Non-Emergency Medical Transportation (NEMT) program which is operated under a Managed/Coordinated Care contract. This money was to be used for the hiring of an outside entity to conduct an audit of the NEMT program; to support rate review activities for NEMT providers; and to develop and implement a training program that meets the needs of all provider types, the contracted broker, IDHW, and for Idahoans participating in this program. The training program and rate review are to be developed in collaboration with relevant stakeholder groups including, but not limited to, NEMT providers and disability advocacy groups. DRI informed legislators of current problems with the NEMT contractor and how best this money can be used. The bill passed and needed money will be spent to improve the NEMT program. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Collaborate with the Idaho Department of Health and Welfare (IDHW) and other organizations, to create state rules to address restraint and seclusion (R&S) in home and community-based settings (HCBS) that comply with federal requirements. 4. DRI facilitated a stakeholder’s group collaborating efforts with representatives from SILC, ACLU, Idaho Hospital, Nursing, and Psychological & Psychiatric Associations & Boards eventually aligning efforts with IDHW creating rules to increase protections from inappropriate and/or unnecessary R&S practices. 5. 0 since not case driven. 6. Priority work summary: During 2017, DRI researched identifying best practices regarding R&S practices for hospitals and convened a stakeholder’s work group which included representatives from SILC, ACLU, Idaho Hospital, Nursing, Psychological & Psychiatric Associations & Boards to pursue rule changes. Eventually, this stakeholder’s group aligned efforts w/ IDHW’s Licensing & Certification (L&C) Director, their Deputy Attorney General (DAG), Medicaid, and Health & Human Services staff, negotiating that current hospital R&S minimum standards rules align w/ best practices incorporating Trauma Informed Care processes & eliminating prone usage. IDHW’s Rule Docket published in the September 2018 Administrative Bulletin announced timelines for providing comments to these R&S rule revisions which DRI drafted and submitted. IDHW’s L&C Director confirmed with DRI that after the rulemaking process is completed, these rules changes will be presented to IDHW’s Board and if approved presented for approval to the Legislature, during its 2019 Session. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights. 3. Collaborate with State Independent Living Council (SILC) and Consortium for Idahoans with Disabilities (CID) to develop person-centered planning process for people on the Medicaid HCBS/Aged and Disabled (A&D) waiver which complies with Center for Medicare & Medicaid Services (CMS) regulations. 4. DRI collaborates with SILC, the Idaho Council on Developmental Disabilities (ICDD) and provider agencies and organizations that are also members CID advocating for person-centered planning processes that comply with CMS regulation mandates. 5. 0 since not case driven. 6. Priority work summary (also noted in the Medicaid priority above): During FY 2018, DRI’s Executive Director (ED) continued participation on the Community NOW! Project Committee developed in 2017 in response to a class action settlement in the KW v. Armstrong lawsuit brought by the ACLU of Idaho on behalf of Idaho adults with developmental disabilities addressing disparities in IDHW’s tools used for determining eligibility & budget allocation. DRI’s ED also participated on a Subcommittee of Community NOW! addressing the array of services to include in Person-Centered Planning and IDHW’s obligation to meet CMS Person-Centered Planning requirements mandated for all HCBS participants. The SILC Executive Director, and some provider agencies and disability organizations of this Subcommittee, also members of the Consortium for Idahoans (CID). This subcommittee developed a plan with DRI’s ED guidance that meets the CMS HCBS Person-Centered Planning requirements for DD Waiver recipients. At the end of FY 2018, the Administrator for Idaho Medicaid Services informed Subcommittee members that these developed Person-Centered Planning requirements will also be incorporated into the A&D HCBS Medicaid Waiver and the Children’s HCBS Redesign Waiver programs. Since no formal written agreement was received, during FY 2019, DRI will monitor to determine compliance. Monitoring which will occur as a DRI staff attorney also serves on IDHW’s Medical Care Advisory Committee (MCAC) providing recommendations ensuring the quality & quantity of Idaho Medicaid services. She also participates with three (3) other MCAC members on a subcommittee developed for the purpose of ensuring IDHW’s compliance with HCBS CMS mandates, including Person-Centered Planning requirements. 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. 4. Collaboration occurs with the Developmental Disabilities Bureau Chief’s Division in which all reports of deaths in DD facilities, Certified Family Homes, and residents receiving Residential Habilitation services are sent to DRI for review. 5. Two (2) cases were opened addressing the deaths of PAIR clients and no class actions were filed. 6. Priority work and case summaries: A Memorandum of Agreement (MOA) between the IDHW’s Developmental Disabilities (DD) Bureau Chief and DRI has been in place since FY2014 as a result of the Bureau Chief’s concerns that facilities and providers serving people with DD are not all required to report deaths to IDHW. The DD Bureau receives most death reports occurring at Certified Family Homes (CFHs), at Residential Assisted Living Facilities (RALFs), and for persons receiving Residential Habilitation services for both DD and A&D waiver recipients. So, the deaths of some PAIR clients are on occasion reported to DRI. During FY 2018, DRI received two (2) reports on behalf of PAIR clients in which preliminary investigations were completed. Case sample: DRI received a report from IDHW’s DD Bureau regarding the death of an older male residing in a Residential Assisted Living Facility (RALF). After DRI reviewed reports from the Bureau, and information from the RALF, his death was determined to be a result from a fall fracturing his hip resulting in aspiration from complications due to Alzheimer's. DRI concluded that his death was not suspicious or a result of abuse, so a full investigation was not warranted and this investigation was closed. This death reporting collaboration has resulted in DRI identifying and addressing the lack of death reporting requirements in facilities that serve PADD, PAIMI, PATBI and PAIR clients. A priority was included in FY2017 to investigate death reporting requirements for residential habilitation, CFHs, and RALFs. Since RALF rules already required death reporting, DRI petitioned and during FY 2018 proposed necessary death reporting rule changes for CFHs. (After determining that Residential Habilitation (Res Hab) providers were already required to report deaths, DRI still reviewed the proposed Res Hab rule changes, providing comment reported on below). 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities. 3. Propose changes to rules for residential habilitation, residential assisted living facilities and certified family home providers to report deaths to the Idaho Department of Health and Welfare, and participate in the rule-making process. 4. Collaboration with the Idaho Department of Health and Welfare’s (IDHW) Division of Licensing and Certification (L&C) occurred during rule-making processes. 5. 0 since priority not case driven. 6. Priority work summary: During 2017, DRI researched the rules for residential habilitation (Res Hab), residential assisted living facilities (RALFs) and certified family homes (CFHs) determining that death reporting requirements were included in Res Hab and RALF rules, but not required in CFH rules. During FY 2017, a petition was filed with L&C to include death reporting in the CFH rules. Since L&C was already reviewing the rules for possible change for CFH and Res Hab rules, DRI participated in the rule making process by reviewing all of the proposed rule changes for both CFH and Res Hab, and provided suggested language and comments.

The Res Hab rules that DRI provided comment and language to improve protections from abuse, neglect, and rights violations included: removing references to chemical restraint, mechanical restraint, and seclusionary time-out from the rules; adding a de-briefing requirement to the use of physical restraints; making substantial changes to the residents rights section, including the addition of the right to “choose or refuse services,” the right to “choose one’s roommate,” and the addition of other rights such as the right to live in the least restrictive setting, communicate by sealed mail, receive visitors; adding a requirement that Res Hab agencies (when acting as the Rep Payee) maintain a separate transaction record for each participant including receipts for each expenditure paid for using participant funds (regardless of dollar amount) as well as documentation requirements regarding the dispersion of the participant’s personal spending money (including requiring that the participant acknowledge in writing when personal spending money is received). DRI’s suggestions were incorporated with some minor language changes into the revised rule draft. During FY 2017 and into FY 2018, DRI’s participated in the rule-making process for CFHs ensuring that death reporting was incorporated. In addition to ensuring death reporting requirements were incorporated, DRI reviewed the entire proposed CFH rule changes providing language and comment. On October 3, 2017, IDHW L&C sent a response notifying that they adopted most of DRI’s proposed language including DRI’s suggestions for another section to be added so that all reporting requirements suggested by DRI are included. Additional DRI rule comments that were adopted included: adding a definition of “vulnerable adult”; requiring that a notice of pending investigations or charges must immediately be reported to the department for any family member or participant; added a requirement that the participant or his legal representative must sign any changes to their individual support plan; added a requirement that all personal funds and all medications belonging to the participant must be returned immediately upon discharge; defined the word “incident” so that providers are not left to interpret what they believe may qualify; and included a requirement that CFH providers cannot loan money to participants to better protect from potential financial exploitation. During FY 2018, the rule changes for CFHs and Res Hab were approved by IDHW’s Board and then the two (2) rulemaking dockets were submitted for approval during the 2018 Legislative session. Both the House and Senate approved the proposed rule changes which became effective on 7/1/2018 increasing oversight protections for residents residing in CFHs and for participants receiving Res Hab services. CFH providers as well as Res Hab providers, and RALFs are now all required to report deaths. Furthermore, with the revised rule changes, residents residing in CFHs and participants of Res Hab are better protected against, abuse, neglect and rights violations. 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 the abuse and neglect based on case selection criteria. 4. No collaboration occurred. 5. Two (2) cases were handled under this priority and no class actions were filed. 6. Case summary: DRI opened a case on behalf of a five (5) year old white male to investigate allegations of inappropriate restraints after his mother called DRI reporting that his school had restrained her son several times without her knowledge or permission. She was not informed until after she attended a recent IEP meeting when his school attempted to implement restraints into his behavior plan. Her son was refusing to go to school and she pulled him out because she did not believe he was safe. DRI was already conducting a systemic investigation into this school district’s restraint and seclusion (R&S) practices because several parents had already called DRI reporting concerns. Needed release and services agreement forms were sent for his mother’s signature so DRI could proceed with the investigation, but were not returned. After the DRI advocate contacted the mother requesting an update on when she would receive the signed forms, the client’s mother reported that she had been contacted by the District’s Special Education Coordinator and had decided to work with her to address her concerns, and had reenrolled him. DRI sent the mother a Technical Assistance (TA) letter with information about restraints in schools, advocacy development suggestions, and complaint procedures she can pursue if her concerns are not sufficiently addressed, and closed this case. DRI continued investigating this school district’s practices on behalf of other students and a systemic investigation case was opened. DRI’s systemic investigation identified concerns with the district’s R&S usage and policy and sent recommendations to the district and their attorney to consider and implement. 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities. 3. Collaborate with stakeholders to propose hospital licensing rules regarding restraint and seclusion. 4. Collaboration occurred with getting hospital licensing rules revised with stakeholder group members which included representatives from SILC, ACLU, Idaho Hospital, Nursing, Psychological & Psychiatric Associations, and IDHW. 5. 0 since not case driven. 6. Priority work summary: During FY’s 2016 & 2017, DRI conducted an investigation into restraint and seclusion (R&S) practices being conducted at State Hospital North (SHN), a state-run psychiatric facility identifying concerns with its R&S policies and practices. SHN is not an accredited Centers for Medicaid and Medicare Services (CMS) facility. Therefore, its licensure is under Idaho Hospital rules, not under Psychiatric Facility rules. After DRI’s review of Hospital rules, it was determined that DRI would pursue revising these rules to bring them into alignment with current best practices implemented in most accredited psychiatric facilities. DRI facilitated a stakeholder’s group in FY 2017 to develop and propose improved restraint and seclusion (R&S) Hospital rules. DRI identified best practices regarding R&S in hospitals & convened a stakeholders group including members from SILC, ACLU, Idaho Hospital, Nursing, and Psychological & Psychiatric Associations to pursue rule changes. Eventually, this stakeholder’s group aligned efforts with IDHW Licensing & Certification (L&C) staff and Deputy Attorney General (DAG), and with Medicaid Health & Human Services staff, negotiating that current Hospital R&S minimum standards rules align w/ best practices incorporating Trauma Informed Care processes and eliminating prone usage. Rules have been drafted and rulemaking procedures are being completed. An IDHW Rule Docket was published in the September 2018 Administrative Bulletin providing a timeline for comments which DRI submitted. The L&C Director informed DRI and its stakeholder’s group that after rulemaking processes are completed, the changes will be presented to IDHW’s Board and if approved presented to the Legislature for approval during the 2019 Session. 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 the abuse and neglect, based on case selection criteria. 4. DRI collaborated with an Idaho Veteran’s Home social worker (SW) in efforts to get a PAIR client discharged. 5. Seven (7) cases were addressed under this priority and no class actions were filed. 6. Case summary: DRI assisted a 41-year-old old white female Veteran with brain damage from an aneurysm (causing left side paralysis) who resided on the Boise Veteran's Home nursing facility unit, with getting discharged into a lesser restrictive community placement. DRI Advocate contacted the SW at the Veteran’s Home and discussed possible appropriate placements such as a CFH or RALF. This SW would not agree to exploring a RALF placement since she did not believe a RALF could meet the client’s needs. Rather, she agreed to helping with a discharge into a CFH, which the client preferred. The SW had heard about CFHs since these homes were the same certified facility type as VA Medical Foster Homes. The SW was unaware about Medicaid eligibility categories and did not understand the need for the client to become Aged & Disabled (A&D) Medicaid Waiver eligible in order for Medicaid to pay for Res Hab services. Nor was the SW aware that eligibility for Medicaid for this client was only possible through the A&D Waiver, since the client’s monthly unearned income from her Social Security Disability Insurance (SSDI) benefits was too high to qualify for basic Medicaid. DRI educated this SW about A&D Waiver eligibility requirements and application processes. A CFH provider that could meet her needs was located, the client met the provider, inspected the home and decided she wanted to pursue this placement. With the SW’s assistance, the client's application for the A&D waiver was completed, her eligibility was approved and she was discharged into the CFH of her choice meeting her needs. 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 the rights violation based on case selection criteria. 4. Collaboration occurred with the client’s mother in efforts to locate an appropriate placement 5. Three (3) cases were opened addressing rights violations during FY 2018, two additional cases were opened carried over to FY 2019, and no class actions were filed. 6. Case summary: DRI assisted a 57-year-old white male A&D HCBS Medicaid Waiver beneficiary with Neurofibromatosis-tumors, Dyslexia, and a stroke needing assistance with an eviction from a residential assisted living facility (RALF). The basis for the eviction was that he had purchased and taken across-the-counter medications. DRI Advocate collected and reviewed the eviction notice determining that the notice included all of the required information to be valid. A review of RALF rules was completed showing that residents are not allowed to take any medications not prescribed by a doctor, including over the counter medications, while under a RALF’s care; and she determined that Idaho RALF rules currently meets Idaho Landlord/Tenant laws required under CMS’s mandated HCBS requirements. The facility policy also listed restrictions regarding prohibitions to medications other than those prescribed. Because the facility provided an appropriate written notice and since the basis for his termination was not a violation of rules or policy, DRI was not able to challenge his eviction. Since the client was on the sexual registry, locating a placement was difficult. The DRI Advocate located possible placement options and provided contact information to both the client and his mother, as he requested. DRI also provided suggestions on getting appropriate medical care for his sleeping difficulties. The client located a placement that admitted him and reported that he believed this placement better met his needs and will work with his primary care physician to address his sleeping difficulties. 1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities 3. Conduct monitoring of up to six selected facilities, including facilities housing children with disabilities. 4. No collaboration occurred. 5. 0 since not case driven. 6. Priority work summary: DRI conducted eleven (11) monitoring visits during FY year 2018 at facilities holding PAIR eligible individuals. DRI conducted a monitoring visit at North West Children’s Home (NWCH) in Lewiston, Idaho. NWCH is a private facility housing juvenile with behavioral issues placed by the court as a result of juvenile criminal proceedings or through commitment. DRI met with Administration, and talked with residents and staff. DRI concluded that NWCH has incorporated Trauma Informed Care practices into its operation. DRI posters were posted in visible locations and P&A brochures were disseminated. Advocates talked with residents and provided information about DRI services and rights protection information. Additionally, the P&A conducted monitoring visits at ten (10) skilled nursing facilities (SNFs) in the Treasure Valley and surrounding counties. More PAIR individuals are living in SNFs that could safely reside in a lesser restrictive Residential Assisted Living Facility (RALF) but since many PAIR residents are low-income individuals, they cannot afford RALF placements. Unfortunately, in Idaho there are only a few RALFs that currently accept Medicaid payment. DRI observed that most of the SNFs monitored have prioritized making their facilities more home like, and all SNFs visited had active Patient Rights Committees. Prior to monitoring each SNF, a review of the L&C’s Bureau of Facility Standards surveys were completed identifying the deficiencies cited and the SNF’s submitted Plan of Corrections (POCs). DRI met with several residents, disseminated brochures, and provided information about DRI services and how we help with protecting PWDs’ rights including the right to be free from abuse and neglect. At each SNF visited, DRI met with the Administrator collecting information on policies, grievances procedures, and rehabilitation services offered for both Long-term and Short-term residents. DRI met with social workers (SWs), Recreational Activities Directors, talked to certified nursing assistants (CNAs), and nursing staff. No residents presented concerns qualifying for priority case assistance but Information and Referral (I&R) services were provided to several residents. DRI posters were provided and all Administrators and/or SWs agreed to post in visible locations so that residents have DRI contact information. In addition to monitoring PAIR facilities, DRI continues monitoring Idaho’s three (3) state-run facilities: Southwest Idaho Treatment Center (SWITC), the state-run Intermediate Care Facility for the Intellectually Disabled (ICF/ID) located in Nampa, Idaho; State Hospital North (SHN) located in Orofino, Idaho, and State Hospital South (SHS) located in Blackfoot, Idaho, both Psychiatric Facilities. DRI currently has a systemic secondary investigation case opened addressing abuse and neglect issues identified at SWITC. DRI is also addressing concerns previously identified with restraint & seclusion (R&S) practices occurring at SHN. Even though some of SHN’s R&S policies were revised and some practices changed, concerns with R&S are still occurring in which DRI developed a stakeholder’s group to propose rule changes that will better protect against R&S. 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 (P&A) system’s access to residents in facilities and records subject to P&A federal access authority. 4. No collaboration occurred. 5. 0 6. No denials of the P&A’s access authority on behalf of PAIR clients occurred during FY 2018.

B. Priorities and Objectives for the Current Fiscal Year

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

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

Fiscal Year 2019 PAIR Goals and Priorities ASSISTIVE TECHNOLOGY 1. People with disabilities will have access to assistive technology (AT) devices and services that they need. 2. Access to AT 3. Provide systemic advocacy to ensure access to AT devices and services. 1. People with disabilities will have access to assistive technology (AT) devices and services that they need. 2. Access to AT 3. Accept cases regarding denials for AT devices and services as resources allow. DISABILITY DISCRIMINATION 1. Public or private entities will not discriminate against people with disabilities in violation of the Americans with Disabilities Act. (ADA), or Section 504 of the Rehabilitation Act. 1973. 2. Accessibility 3. Accept cases of discrimination against people with disabilities in violation of Title II or Title III of the ADA, or Section 504 of the Rehabilitation Act of 1973 as resources allow. 1. Public or private entities will not discriminate against people with disabilities in violation of the Americans with Disabilities Act. (ADA), or Section 504 of the Rehabilitation Act. 1973. 2. Accessibility 3. Provide presentations and written information to people with disabilities regarding their rights under Title II or Title III of the ADA, or Section 504 of the Rehabilitation Act of 1973. EDUCATION 1. Students with disabilities in Idaho public schools will not be subjected to actions that violate their rights under the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973 (Section 504). 2. Rights violations preventing access to Free and Appropriate Public Education (FAPE) 3. Provide assistance to parents and students to prevent or stop the use of suspension and expulsion that violate IDEA or Section 504. 1. Students with disabilities in Idaho public schools will not be subjected to actions that violate their rights under the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973 (Section 504). 2. Rights violations preventing access to Free and Appropriate Public Education (FAPE) 3. Petition the Idaho State Department of Education for the adoption of rules governing the use of restraint and seclusion in public school settings. GUARDIANSHIPS 1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Free from unnecessary guardianships or conservatorships. 3. Participate on the Idaho Supreme Court Committee on Guardianships and Conservatorships to represent the rights and perspectives of people with disabilities regarding guardianships or conservatorships. 1. Promote the rights of people with disabilities who are, or may be, subjected to a guardianship or conservatorship. 2. Free from unnecessary guardianships or 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 or conservatorships 3. Provide legal representation to people with disabilities to modify or terminate abusive or unnecessary guardianships or conservatorships as resources allow. MEDICAID 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services 3. Ensure Medicaid for Workers with Disabilities participants are not excluded from Aged and Disabled Waiver Services because of earned income. 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services 3. Provide representation to children who are denied Medicaid services pursuant to case selection criteria and as resources allow. 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services 3. Propose changes to Idaho Medicaid rules for clarification of Early Periodic Screening Diagnostic Treatment (EPSDT) medical necessity definitions and standards. 1. People with disabilities will have access to appropriate Medicaid services. 2. Access to appropriate medical services 3. Provide information to families of Medicaid eligible children regarding rights and obligations in the fair hearing process. OUTREACH/TRAINING 1. People with disabilities will have increased awareness about the services offered by DRI including CAP. 2. Access to P&A advocacy 3. Conduct outreach in the community to increase awareness of services offered by DRI. 1. People with disabilities will have increased awareness about the services offered by DRI including CAP. 2. Access to P&A advocacy 3. Conduct Outreach to Rehabilitation Services Administration (RSA) authorized agencies and clients. 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 other rights information to people with disabilities residing on the Fort Hall, Nez Perce, and Coeur d’Alene Indian Reservations. 1. Conduct outreach to unserved and underserved populations with disabilities. 2. Access to P&A advocacy 3. Provide outreach about services offered by DRI, including the CAP and other rights information, to unserved and underserved people with disabilities and their families. PUBLIC POLICY/SYSTEMS ADVOCACY 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Participate with other stakeholders and disability groups on task forces, work groups, 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 of people with disabilities 3. Review and analyze proposed legislation affecting people with disabilities, and inform legislators, disability organizations and others of the impact of the legislation. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Work in partnership with the Consortium for Idahoans with Disabilities (CID) to address public policy issues affecting Idahoans with disabilities. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Inform public policy makers of the impact that proposed changes to Medicaid will have on Idahoans with disabilities. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Inform Legislators of the effect of proposed changes to Idaho landlord/tenant laws on people with disabilities. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Inform Legislators of the effect of enhanced penalties on Idahoans with disabilities for simple battery on health care workers. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Inform policy makers of the need for improved hospital licensing rules concerning restraint and seclusion. 1. Participate in systemic advocacy that protects and promotes the rights of people with disabilities. 2. Protect and promote rights of people with disabilities 3. Provide information on legislation concerning use of service animals. RIGHTS IN FACILITIES 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities 3. Investigate deaths 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 allegations of abuse of people with disabilities in facilities according to the abuse and neglect based on case selection criteria. 1. People with disabilities in facilities will live free from abuse. 2. Abuse in facilities. 3. Collaborate with stakeholders to propose hospital licensing rules regarding restraint and seclusion. 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 the abuse and neglect 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 the rights violation based on 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 six (6) selected facilities, including facilities housing children with disabilities. 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 (P&A) system’s access to residents in facilities and records subject to P&A federal access authority. 1. People with disabilities in facilities will have their rights protected. 2. Rights violations in facilities 3. Enter into a Memorandum of Agreement with the Senior Ombudsman Program to coordinate services.

Part VI. Narrative

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

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

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

PART VI — NARRATIVE PART VI — NARRATIVE A. Sources of funds received and expended Federal 173,090 State 0 All other funds 0 Total from all sources 173,090 B. Budget for the fiscal year covered by the report Category FY2018 Actual FY2019 Budget Wages/salaries 92,749 103,001 Fringe Benefits 43,472 47,053 Materials/Supplies 8,666 8,485 Postage 588 700 Telephone 1,115 1,180 Rent 10,564 10,955 Travel 5,299 4,999 Copying 216 1,035 Bonding/insurance 460 1,018 Equipment 0 0 Legal services 0 0 Indirect costs 0 0 Misc. 9,974 8,648 Total (from all sources) 173,104 187,074 Note: 2018 Actual Expenses includes carryover from FY2017 (10/1/2016-9/30/2017) 2019 Budget includes carryover from FY2018 (10/1/2017-9/30/2018) C. Description of PAIR staff Type of Position FTE % Yr Filled Person-Years Professional 1.10 99.62% 1.10 Full-time N/A N/A N/A Part-time 1.10 .35% 0.00 Vacant .04 .35% 0.00 D. Involvement with advisory boards (This involvement is also noted above in Part V. Priorities and Objectives in the Public Policy section). DRI’s PAIR/PATBI 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), providing recommendations to IDHW’s Licensing & Certification (L&C) Division. This allows her the opportunity to advocate on behalf of PAIR clients since many reside in these placements, including the elderly population. During FY 2018, CCAC addressed the need for increased reimbursement rates, the lack of emergency crisis placements; difficulties of attaining and retaining staffing with a record low unemployment rate; the need for secured memory care units; and how to facilitate resident input. As a result of a Legislative Committee ordered Office of Performance Evaluation (OPE) report in 2017, L&C and the Idaho Health Care Association (ICHA) partnered creating work groups addressing disparities in RALFs identified in the OPE report. DRI’s PAIR/PATBI Coordinator was asked to and participated on the Admission & Discharge Work Group created as a result of the OPE report focusing on reviewing rules and developing RALF wound care guidelines. During FY 2018, IDHW submitted CFH rule changes with DRI’s input adding a mandatory death reporting and investigation requirement and strengthened protections against abuse, neglect, and rights violations to legislators, approved during the 2018 Legislative session becoming effective on July 1, 2018. DRI’s Advocacy Director (AD) and CAP Coordinator continued her membership and is the Vice-Chair on the State Rehabilitation Advisory Council (SRC), as the CAP representative. During FY 2018, she attended the Vocational Rehabilitation In-service program; and attended the Council for State Administrators of Vocational Rehabilitation and National Council of State Rehabilitation Councils meetings in Washington, DC. She brought back information to the SRC regarding new training and orientation materials, information about the evolving role of SRCs, and how to ensure the SRC voice is heard and is an equal partner to Vocational Rehabilitation in WIOA required activities. As a result of the information obtained and presented by her, the SRC made plans to have a strategic planning/advanced orientation meeting with a professional facilitator scheduled for the October 2018 meeting. In addition, DRI/CAP provided input regarding proposed changes to Idaho Vocational Rehabilitation (IDVR) rules regarding extended employment supports, order of selection and others. DRI’s PAIR/PATBI Coordinator is a member of the TBI Advisory Council 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 or limited. DRI’s AD is a member of the U.S. Commission on Civil Rights-Idaho Advisory Committee participating in orientation training. During FY 2018, this committee determined that its next project will be conducting research on disparities and barriers to voting on Idaho Reservations, including barriers to Tribal voters with disabilities. DRI staff attorney participates on IDHW’s Medical Care Advisory Council (MCAC) reviewing state Medicaid policy and providing comment on proposed rules and implementation. During FY 2018, MCAC focused on ensuring that its transition plan is working towards meeting Centers for Medicare & Medicaid (CMS) mandated HCBS requirements in order to meet the 2022 deadline. A DRI Attorney serves on IDHW’s Medical Care Advisory Council (MCAC) reviewing state Medicaid policy and providing comment on proposed rules and implementation. During FY 2018, MCAC focused on ensuring that its transition plan is working towards meeting CMS mandated HCBS requirements in order to meet the 2022 deadline. E. Grievances filed. Two (2) grievances were filed by PAIR clients during FY, 2018. A 61-year-old male contacted DRI requesting help with a rental termination. Since this issue is out of priorities, he was sent a letter with appropriate referrals and information including DRI grievance information. Even though he did not contact DRI’s Advocacy Director (AD) to present his concerns as noted, he presented concerns in a survey he completed and returned. The AD made repeated attempts to contact the caller but closed this grievance after he never returned her calls or responded to her email. A 61-year-old male (not the same as above) contacted DRI requesting legal representation with a personal injury claim against a local hospital. A referral to the Idaho State Bar was provided in which the caller filed a grievance in disagreement with this decision. DRI’s Advocacy Director processed his grievance but had to withhold the decision to not provide legal representation for his malpractice claim. She better explained that this issue is not within DRI’s priorities needed to qualify for legal representation, and disclosed that because DRI does not practice personal injury litigation, therefore, does not have the expertise to represent. Even though DRI’s AD upheld the decision that he did not qualify under DRI’s priorities providing representation, further explanation was provided informing that by contacting the Idaho State Bar for an appropriate attorney referral, he would be eligible for a $35.00 half-hour legal consultation to determine if he had a valid case. F. 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: Idaho’s Client Assistance Program (CAP), along with PAIR, are both housed within Disability Rights Idaho, Idaho’s P&A system which also operates under the PADD, PAIMI, PAAT, PATBI, PABSS and PAVA programs. Most of the staff work in two or more of these 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 developmental disabilities may be served under PAIR when their developmental disability (DD) does not result in three (3) functional limitations. Individuals with MI with other disabilities may qualify under PAIR when the issues are not facility related and not directly related to the individual’s MI. Furthermore, many clients served under PAIR are served also under CAP and PABSS when needing assistance with getting appropriate vocational rehabilitation (VR) services and addressing employment barriers for Social Security beneficiaries. As noted above, DRI’s AD continues membership on the State Rehabilitation Advisory Council as the CAP representative and Coordinator providing input for improvement. Outreach, monitoring, public awareness and system advocacy activities are examples of how DRI coordinates with and the Idaho Long Term Care Senior Ombudsman Program operated under the Idaho Commission on Aging. DRI had a memorandum of agreement (MOA) with the Idaho Long-Term Care Senior Ombudsman Program covering mutual referrals, exchange of information and confidentiality. The Long-Term Care Senior Ombudsman and DRI have agreed to revise this (MOA). DRI drafted a MOA revision incorporating both the Senior Ombudsman Program and Adult Protection Services (also under the Idaho Commission on Aging) interchangeably in the same MOA. After regulation changes were implemented more clearly separating the Senior Ombudsman and Adult Protection Services Programs, the Senior Ombudsman suggested that DRI draft separate MOAs for each program, during FY2017. During FY 2018, a meeting was scheduled with the Senior Ombudsman Program to review the revised MOA for additional feedback but unfortunately this meeting had to be rescheduled for FY 2019, after the Senior Ombudsman Director had to cancel due to unexpected needed surgery. DRI’s PAIR Coordinator and the Senior Ombudsman are both members of the Community Care Advisory Council (CCAC) often collaborating on issues to help improve the quality of care for PAIR clients residing in CFH and RALFS and each agency refers to each other when appropriate. During FY 2018, collaboration occurred on behalf of an elderly women with DD who needed her Durable Power of Attorney (POA) for Health Care nullified after her POA denied access to needed medical care. DRI and a Senior Ombudsman also collaborated on behalf of a PAIMI client who needed air conditioning in the RALF she resided experiencing heat exhaustion.

Certification

Signed?Yes
Signed ByJames R. Baugh
TitleExecutive Director
Signed Date12/23/2018