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

North Dakota (PROTECTION and ADVOCACY PROJECT) - H240A180035 - FY2018

General Information

Designated Agency Identification

NameNorth Dakota Protection and Advocacy Project
Address400 East Broadway
Address Line 2Suite 409
CityBismarck
StateNorth Dakota
Zip Code58501
E-mail Addresspanda@nd.gov
Website Addresshttp://www.ndpanda.org
Phone701-328-2950
TTY 711
Toll-free Phone800-472-2670
Toll-free TTY
Fax701-328-3934
Name of P&A Executive DirectorTeresa Larsen
Name of PAIR Director/CoordinatorTeresa Larsen
Person to contact regarding reportPamela Mack
Contact Person phone701-328-2950
Ext.

Part I. Non-Case Services

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

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas122
2. Individuals receiving I&R outside PAIR priority areas206
3. Total individuals receiving I&R (lines A1 + A2)328

B. Training Activities

1. Number of trainings presented by PAIR staff37
2. Number of individuals who attended training (approximate)243

Summary of Training Provided

1. 10/4/2017 -- Prairie St. John’s - Monthly throughout the fiscal year, P&A staff provides training on abuse, neglect and exploitation and mandatory reporting to the newly hired staff at Prairie St. John’s (PSJ). PSJ is a private facility within the eastern part of the state who provides mental health and chemical dependency inpatient and outpatient treatment. These efforts ensure that all staff within the facility are aware of their responsibilities to prevent ANE from occurring and to mandatorily report suspected ANE as part of their professional positions within the facility. 12 trainings were held and 144 new employees participated in the training.

2. 10/13/2017 - Rehab Services, Inc. - Training on Abuse, Neglect & Exploitation, Mandatory Reporting and Risk Management was provided throughout the fiscal year. 7 trainings were held with 37 people participating in the training.

3. 10/18/2017 -- ND State Hospital New Staff Training - Each month P&A staff provides training to new staff who have been hired to work at the ND State Hospital. Staff work in both the acute mental health portion of the facility and the addiction and recovery programs. Training content focuses on abuse, neglect and exploitation, mandatory reporting, risk management and conducting investigations. 12 trainings were held and 88 new employees participated in the training.

4. 10/27/2017 - South Central Human Service Center - P&A provided training on guardianship and rights of wards to staff in the mental health and addiction departments of the human service center. 23 people participated in the trainings.

5. 2/6/2018 - Medicaid Waivers 101 - In conjunction with Designer Genes of ND, The Arc of Bismarck, and Family Voices of ND, P&A sponsored a statewide topic call training on Medicaid waivers in the state of North Dakota. Participants were provided with information regarding the waivers, eligibility for the waivers, and services provided. 40 people participated in the educational call.

6. 2/28/2018 - Northland PACE & ND Developmental Disabilities Division. P&A provided training regarding advocacy and protective services to new personnel from Northland PACE and the state DD Division.

7. 5/3/2018 - Minot Interagency - In collaboration with Anne Carlsen Center, Pathfinder Parent Center, Family Voices of ND and ND parent to parent, collaboration and knowledge of community services is achieved. P&A conducted a presentation on P&A services and also a training on Abuse, Neglect & Exploitation, ND laws regarding ANE and Mandatory Reporting. 8 people participated in the training.

8. 5/10/2018 - Dakota Center for Independent Living Wellness Group - P&A provided information regarding advocacy and protective services work conducted by the agency. Information regarding mandatory reporting and ND state laws regarding abuse, neglect & exploitation was also included in the training. 3 people participated in the training.

9. ND Association for the Blind 2018 Annual Conference - P&A provided training to the attendees of the 2018 Association for the Blind Annual Conference. Information regarding advocacy and protective services was provided, along with ways to request services from P&A. 28 people participated in the training.

10.ND Transition Planning Workshop - P&A provided information regarding P&A services to Special Education Case Managers and Transition teachers at the annual transition conference. 20 people participated in the training.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles4
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website24,089
5. Publications/booklets/brochures disseminated482
6. Other (specify separately)5

Narrative

Newspaper articles

Accessible transportation in Bismarck

In response to cuts in accessible transportation that serves people with disabilities, the Bismarck Tribune ran two articles on consecutive days addressing the impact on the availability of accessible public transportation. Budget cuts resulted in the BisMan Transit Board of Directors and the Bismarck City Commission to cut back on the frequency and availability of public transportation, which significantly negatively impacted people with disabilities. P&A’s network of individuals resulted in a large turnout at the city commission meetings, which were covered by the press. Following this meeting, P&A was instrumental in supporting people with disabilities in sharing their story regarding the negative impact. A two day series of articles were ran and also included excerpts from P&A staff in its content. This is an ongoing systemic issue that will continue to be addressed by P&A and people with disabilities. Daily circulation of the Bismarck Tribune is 25,584.

Special Education services in the Least Restrictive Environment in Fargo & West Fargo

P&A was involved in 3 newspaper articles, 4 TV interviews and 6 communications with the media regarding the issues of LRE, segregation, lack of appropriate services and supports for children with social/emotional/behavioral needs. It also made the public aware of the Agassiz project and what was happening to the 5 young boys in that program. What began as a Level D issue identified that services and supports were not sufficient in Levels C, B and A to address the needs of the children thus preventing the need for Level D services. The media activities also revealed the number of restraints and seclusions suffered by the 5 young boys placed in Level D at Agassiz Basement. By providing information to the media outlets the public became more aware of the needs and service requirements for the more than 1450 special education students in Fargo Public Schools. That was also true of the almost 1300 special education students in West Fargo. What we can measure is that between Fargo and West Fargo school districts there are approximately 3,000 students receiving special education services. Previous to this time period, the media focused on reporting when school personnel suffered injuries by students with social/emotional and behavioral needs. New media attention pointed out the need for more staff and better trained staff to prevent injuries to the staff. Additionally, it also became public of how children were being injured physical and emotionally by seclusion and restraints. Due to the media coverage and speaking out at Fargo and West Fargo School Board meetings by P&A, the Level D program at Agassiz was shut down and all 5 boys returned to a regular elementary school setting in the fall. A task force of school personnel, school administration, community members, community professionals and P&A was created to review the needs of students and whether or not a Level D setting should be developed. Another outcome of this media attention was the training and support of 25 parents, by P&A, so they could self advocate and represent parents at school board meetings. From March through June there were often times as many as 50 parents, advocates, community professionals speaking out at School Board meetings. The newspaper and TV media outlets serve the entire State of ND making it impossible to accurately reflect how many people received the information. Daily circulation of the Fargo Forum during the week is 37,500 and on Sundays, it is 47,100.

Other Dissemination Activities

10/3/2017 - Peaceful Pioneer Haven Health Fair - P&A sponsored a both at the event. Participants included tenants and community members. - 200 participants.

11/2/2017 - West Fargo High School Career Fair - P&A sponsored a booth at the event. Participants included school personnel, students and parents. - 150 participants.

4/20/2018 - Fort Totten Student & Parent Fair - P&A sponsored a both at the annual Student & Parent Fair on the Fort Totten Indian Reservation. School personnel, students, parents and other family members were in attendance. - 150 participants.

6/12/2018 - World Elder Abuse Awareness Day -- As part of the Vulnerable Adult Protective Services (VAPS) Coalition, P&A participated at the World Elder Abuse Awareness Day (WEAAD) event by putting up their display and brochures at the event. Evening food was served by the Lions Club and performers played music. Other coalition members participating included: Dakota Center for Independent Living, AARP, RSVP, AARC, ND Securities Department, Good Samaritan Society Home Care, ND Division of Aging Services, Dakota Home Care, Alzheimer's Association, Bismarck Public Health, Custer Health, and Northland Care Coordination. - 100 participants.

8/8/2018 - Stand Rock Community Fair - P&A sponsored a booth at this year’s Community Fair, which is an annual event held on the Standing Rock Indian Reservation. Students and parents, along with school personnel were in attendance. - 350 participants.

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)55
2. Additional individuals served during the year37
3. Total individuals served (lines A1 + A2)92
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 44

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment11
3. Program access0
4. Housing0
5. Government benefits/services1
6. Transportation0
7. Education59
8. Assistive technology0
9. Voting0
10. Health care9
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse0
16. Neglect1
17. Other13

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor33
2. Other representation found0
3. Individual withdrew complaint0
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.1
6. PAIR withdrew from case1
7. PAIR unable to take case because of lack of resources1
8. Individual case lacks legal merit1
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy2
2. Short-term assistance32
3. Investigation/monitoring0
4. Negotiation12
5. Mediation/alternative dispute resolution3
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 - 2260
3. 23 - 5923
4. 60 - 645
5. 65 and over3

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females39
2. Males53

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaskan Native15
3. Asian0
4. Black or African American0
5. Native Hawaiian or Other Pacific Islander1
6. White72
7. Two or more races3
8. Race/ethnicity unknown1

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent22
2. Parental or other family home63
3. Community residential home0
4. Foster care0
5. Nursing home2
6. Public institutional living arrangement4
7. Private institutional living arrangement1
8. Jail/prison/detention center0
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment1
2. Deaf/hard of hearing5
3. Deaf-blind0
4. Orthopedic impairment8
5. Mental illness10
6. Substance abuse1
7. Mental retardation1
8. Learning disability24
9. Neurological impairment13
10. Respiratory impairment4
11. Heart/other circulatory impairment4
12. Muscular/skeletal impairment4
13. Speech impairment3
14. AIDS/HIV0
15. Traumatic brain injury2
16. Other disability12

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities10

2. Number of individuals potentially impacted by policy changes14,580

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.

Supported Decision-making

P&A was involved in several meetings with the Directors of the ND Center for Persons with Disabilities (UCEDD) and the State Council on DD (SCDD) to discuss Supported Decision-making issues. In FY 2018, P&A received grant funding from SCDD to address Supported Decision-making in North Dakota.

This activity began with the establishment of a Steering Committee with membership from AARP, The Arc of North Dakota, ND Center for Persons with Disabilities, ND State Council on Developmental Disabilities, Youth MOVE BeyoND, ND Federation of Families for Children’s Mental Health, Mental Health America, ND Long Term Care Association, Family Voices of ND, and the Advocates Leading their Lives state-wide self-advocacy group. Seven steering committee meetings were held to guide the planning of the project and to move the concept forward in the state. In Feb. 2018, a state-wide community input meeting was held with eleven (11) interactive video networking (IVN) sites across the state, which included 41 participants. Two additional IVN meetings on SDM were held in May 2018, one in the afternoon with 10 IVN sites and 36 participants and an evening one with 12 IVN sites and 51 people in attendance. Additional trainings were provided to the state self-advocacy group (ALL), ND Consumer Family Network Annual Conference, State Independent Living Council, ND Association of Community Providers Annual Conference, Federation of Families for Children’s Mental Health, and Mountainbrooke Recovery Center. There were 205 participants in these trainings. A state-wide radio spot was also held regarding SDM with an audience of approximately 30,000 people. P&A also established a website for SDM which is the portal for all information regarding this project. It can be viewed at http://ndpanda.org/decide/. Legislation is being drafted at this time, with the introduction of it occurring in the 2019 legislative session.

Collaboration with ND courts regarding Guardianship Standards

P&A worked as a member of the Court’s Guardianship Work Group, and also as a member of a key subcommittee that involved creating, along with the National Center for State Courts, an online training program required of all guardians in ND. The Court adopted N.D. Supreme Court Administrative Rule 59, establishing new law on qualifications and training requirements for nonprofessional and professional guardians, which took effect March 1, 2018.

BisMan Transit Board & Bismarck City Commission Accessibility

Bis/Man Transit operates the bus services and para-transit services for the community & surrounding area. Over the past couple of years, changes have been made to the scope of service provided by BisMan Transit as a result of the company’s financial situation. As a result, the service area was decreased and times in which services were provided was decreased also. P&A has continued to attend the City Commission meetings and has ensured that people with disabilities and their needs are represented in discussions and decisions that are being made. If individuals are experiencing barriers, P&A is providing assistance to address them through the administration and if needed, the BisMan Transit Board of Directors. When critical issues are on the agenda, P&A ensures that people with disabilities and other interested parties are aware of meetings so that attendance and participation is supported by those who are affected by the changes. This activity resulted in 1 policy change and impacted 1,000 people.

Money Follows the Person Stakeholder’s Group

The ND Money Follows the Person program, funded by CMS, targets the movement of individuals with physical disabilities living in nursing facilities and individuals with developmental/intellectual disabilities in ICF’s/IDD, to community placements. Funds are also made available to patients moving from the State Hospital and private psychiatric placements to community settings to help with deposits on apartments, the purchase of home goods, etc. P&A staff has been active in the Stakeholders’ Committee. The Stakeholders provide significant input to the Money Follows the Person Coordinator through quarterly meetings. Calendar year 2018 transitions totaled 44 individuals, an increase of 7 from the previous year. This activity resulted in 1 policy change and impacted 44 people.

ND State Hospital Human Rights Committee

In an effort to ensure that patient’s rights are protected, P&A does maintain representation on NDSH’s Human Rights Committee. P&A had direct input into decisions relative to client rights issues at NDSH regarding ensuring direct treatment in IC areas for both APSA and SOTEP, access to feminine hygiene products in Tompkins program, client ability to call clients on other units, (prohibition of) use of cameras for observations/security in shower areas, and SOTEP resident use of free time during visits. P&A had direct input into the revision of NDSH policy to clarify the amount/types of items allowed within SOTEP personal property and to clarify procedure/timelines for the Consumer Concern process. This activity resulted in 2 policy changes and impacted 155 people.

Applied Behavior Analysis (ABA)

Through parents of children with diagnosis on the Autism Spectrum, it was learned that children who accessed Applied Behavior Analysis (ABA) therapy with Medicaid as a payor, were being denied the coverage. When addressed formally with the Department of Human Services, DHS has authorized individuals to receive ABA services and issued the "North Dakota Medicaid Policy and Procedures for the Autism Applied Behavior Analysis Service". In working with providers in the state, concerns with the initial policy were identified and two critical issues were addressed. These included the reimbursement rates initially identified and who the qualified professionals were to oversee and provide the service. These two issues were addressed satisfactorily, and service began during this fiscal year. These two policy outcomes impacted 250 children.

Fort Yates Public School Special Education Services

P&A received notification at the beginning of the school year that students who attended the public school in Fort Yates, North Dakota would not be receiving any special education services. Prior to the fall of 2018, students with disabilities who were receiving special education services were served through a cooperative agreement between the BIE grant school and the public school. In the spring of 2018, the grant school provided notification to the public school that they were terminating their cooperative agreement and taking all of the special education services and personnel to the grant school. This action meant that there were no services and personnel to address the special education needs of the students who were enrolled in the public school system. Action by the public school board was not taken, which resulted in the school year beginning with no special education services in place. P&A formally addressed this need in conjunction with the state education agency and worked to ensure that personnel and services were obtained in a manner that was timely once the school year began. A Director and the necessary services were put in place within a short period of time, or contracts for services were established to address student’s disability-related needs. These services will be in place until permanent solutions can be addressed by the school board. This activity resulted in 1 policy outcome and impacted 198 students with disabilities.

Ward County Special Education Services

P&A received notice that the Ward County Special Education District had adopted a practice of not initiating evaluation for special education services for any student if the request was initiated or the child find activities occurred after March 14th of the school year. This practice was adopted as the school system identified that their personnel would not have adequate time to conduct the necessary assessments and determine eligibility for services by the end of the public school year. This timeline violated the IDEA and resulted in significant delays in children being provided with the special education and related services to address their disability-related needs. P&A addressed this issue formally and ensured that the district would no longer implement this practice and that the law relative to this process would be followed. As a result, students with disabilities will have timely assessments and eligibility determinations regardless of timeframe in which the parent request or child find activities occur.

State IDEA Advisory Committee

P&A serves as a member at large representing consumer/advocate groups. The IDEA Advisory Committee, strengthened by its diverse membership, exists to identify and address unmet needs of all children in ND through policy advisement to the ND Department of Public Instruction and others to facilitate positive outcomes in all educational environments. P&A participated in committee meetings and provided recommendations and advice regarding the outcomes of the State Systemic Improvement Plan. Concerns and issues regarding seclusion & restraint, shortened days, school safety relative to ongoing school shootings and revision of parent survey based on parent input were raised in committee meetings with P&A advocating for prioritization of these matters for this committee.

The issue of shortened days continues to be addressed at the committee level with leadership and direction from and to the SPED Directors. This past year there was also much discussion on seclusion and restraint as well as many children suffering from PTSD due to seclusion and restraints.

This activity resulted in one policy change and impacted 13,277 students with disabilities.

State Systemic Improvement Plan

As a state agency, the Department of Public Instruction (DPI) is responsible to implement the State Systemic Improvement Plan, which addresses the principles of special education law and critical elements that effect special education program improvement. DPI has utilized the state IDEA Advisory Committee as a mechanism to monitor these activities. A key principal that the group looks at is the state’s effectiveness with instruction and provision of supports within special education. P&A’s representation on this Committee has allowed for an evaluation of current practices, along with the ability to monitor the current performance of schools. Currently, careful attention is being given to graduation rates of students with disabilities, especially those with behavioral needs, social and emotional needs, social communication needs and mental health needs. These efforts have resulted in school districts being required to collect data on graduation rates of students and more specifically, data regarding students with disabilities so that trending can be done.

More school districts are increasingly providing ongoing trauma care training to both general and special education teachers, administrators and other support staff. Two of the largest school districts in the State have implemented initial and ongoing training in best practices in the area of trauma-based care. Several other districts are planning to include such training in the school training plan and some are seeking special grants to fund training.

After a year into the Systemic Improvement Plan the Committee received the following report.

Seclusion & Restraint in Schools

Following the facilitation of a statewide task force, a bill focused on seclusion & restraint in the schools was defeated by the ND Legislature during the 2017 Legislation Session. There continues to be issues in many schools throughout the State. P&A has represented in cases on an individual student basis as well as with singular districts. While individual cases may get resolved, this is not an effective system process. P&A continues to work with parents and is contemplating looking for sponsors for a bill for the 2019 Session.

There are a multitude of issues in districts in the southeastern part of the State. A training for parents, and other partners who wish to attend (including schools), is planned for October 26, 2018 in Fargo. It will include IDEA as well as a focus on seclusion/restraint and least restrictive settings for placements.

ND Transition App

P&A fully implemented the ND Transition App during FY 2018 and promoted its use when doing outreach and educational activities. Updates to the app also took place to ensure that it continues to be maintained for use by students who are planning for and actively involved in transition activities. 52 students utilized the Transition app within the fiscal year.

Sanford Pediatric Rehabilitation Forum

In conjunction with outreach conducted by Dr. Kevin Murphy of Gillette Children's Hospital-St. Paul, MN, a group of Bismarck regional hospital therapists and Bismarck service providers have formed this group to assess and develop plans of action to address healthcare and systemic issues that people with disabilities face. Service providers involved include: P&A, Anne Carlsen Center, Great Plains Rehabilitation and Designer Genes of ND. Each month the group meets to discuss current issues and service barriers that are being encountered in the healthcare industry and with the provision of habilitative services. This group has been instrumental in the last three legislative sessions to address a gap in Medicaid coverage for children who have a developmental disability, but not an intellectual disability. This has resulted in the Department of Human Services requesting technical assistance from the Centers for Medicaid and Medicare Services to study current waivers within the state and to identify potential gaps in services. Efforts to address this gap will continue into the upcoming legislative session. Efforts by the group also addressed caps on therapy services for children as part of the EPSDT component of Medicaid. This activity resulted in 2 policy changes and impacted 120 children with disabilities.

Governor’s Children’s Behavioral Health Task Force

During the legislative session in 2017, the Governor created the Children’s Behavioral Health Task Force to address the gaps in services for children with behavioral health needs in the state. During FY 2018, the task force met a number of times and established eleven areas of focus and recommendation to the Governor’s office. These include: Adoption of School Seclusion and Restraint Policy and Practices Guidelines; Formation of a State-Level Children's Services Committee; Suicide Prevention; Bullying Prevention and Intervention; Brain Development; Sufficient, Sustainable Funding; Expanded Emergency Care Resources; Juvenile Court Rules for Maltreatment; State and Tribal Service Collaboration; Early Intervention; IDEA Part C; and Substance Exposed Newborn Services. These formal recommendations have now been submitted to the Governor’s office for potential action and systemic activities.

B. Litigation/Class Actions

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

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

Not Apllicable

Part V. PAIR'S Priorities and Objectives

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

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

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

Priority 1

1. A statement of the priority.

ABUSE, NEGLECT & EXPLOITATION

Individuals with disabilities will be free from abuse, neglect, and exploitation.

2. The need, issue or barriers addressed.

The combination of the personal effects of a disability and associated factors, such as support of multiple caregivers, creates high levels of vulnerability. Therefore, the provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities who reside within institutions and facilities. The ND Department of Human Services has authority to address abuse, neglect, and exploitation under state statute through its Long-Term Care Ombudsman program and through funding to regional human service centers for Vulnerable Adult Protective Services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include investigations of reports of abuse, neglect and exploitation, and systemic and collaborative activities in conjunction with the Long-Term Care Ombudsman and Vulnerable Adult Protective Services.

4. Objectives & Progress

Objective 1: P&A will investigate suspected abuse, neglect, and exploitation of individuals with disabilities where the reported incident or situation is not being address through VAPS or the LTC Ombudsman Program.

P&A provided information & referral services to thirty-seven (37) people who contacted the agency regarding abuse, neglect and exploitation. P&A received nine (9) reports of suspected abuse, neglect and exploitation regarding PAIR eligible clients. Seven of these reports were completed during the fiscal year and all had favorable outcomes as a result of the investigation activities. Two of these reports were pending at the end of the fiscal year and will remain open and carried over into FY 2019.

5. Collaboration with other entities

North Dakota Long Term Care Ombudsman

P&A continues to partner with the Long Term Care Ombudsman to support the efforts of people with disabilities who live in both basic care and skilled care facilities. P&A continues to refer reports and receive reports of suspected ANE between these two entities.

Aging Services and Vulnerable Adult Protective Services

ND state law requires mandatory reporting to the Department of Human Services, Aging Services Division, the Vulnerable Adult Protective Services (VAPS) when abuse or neglect of eligible individuals is suspected. This creates overlapping authority with P&A for individuals with disabilities who may be vulnerable and abused or neglected. Through collaborative efforts, it was decided that VAPS has primary responsibility to respond to allegations involving people with mental illness living in the community who do not receive services. P&A’s focus is on individuals with developmental disabilities and individuals with mental illness and other disabilities living in facilities or receiving other publicly-funded services.

Throughout FY 2018, P&A and VAPS staff have continued to work collaboratively to refer reports of suspected abuse, neglect and exploitation to one another, in accordance with the agreed upon protocols. When needed, clarification or discussion takes place to ensure consistent implementation and understanding regarding who is going to be doing the formal follow-up regarding reports receives. This has been very effective in ensuring that all reports are received and responded to by the appropriate entity in a timely manner.

P&A and VAPS will continue to collaborate at the state and regional level to refer reports to one another, collaborate on investigations and work together to address training needs relative to mandatory reporting and investigations. These efforts will continue throughout FY 2019 and P&A will continue to pursue administrative meetings with the Aging Services Division and VAPS program.

6. Case Summaries that demonstrate the impact of the priority

Case One: The client is a 24 year-old Native American female inmate of the ND Department of Corrections & Rehabilitation (DOCR). At the time that the report was received, she was receiving inpatient treatment within the Tompkins Rehabilitation Program at the ND State Hospital (NDSH) in the state. The client has diagnosis which include Stimulant Use Disorder, Amphetamine Type, severe; Alcohol Use Disorder, severe; Opioid Use Disorder, mild; and Specific Learning Disability, impairment of reading comprehension. She is her own legal decision maker. P&A received a report that a teacher within the Hospital was yelling at her during training courses for her GED. This incident was witnessed by another staff member who identified that the teacher did speak to the client in a manner that was demeaning. P&A conducted an investigation regarding this report and did find that the teacher’s interaction was of concern and violated the facilities policies and procedures regarding respectful conduct. P&A did identify recommendations for training of personnel and recommended increased supervision of the staff member involved to ensure demonstration of appropriate conduct and professionalism. During the investigation, P&A also identified a potential systemic concern relative to cooperative agreements between the DOCR and NDSH. P&A did address this, which resulted in the establishment of a defined process for GED participation and assessment. This was implemented by both entities during the fiscal year.

Case Two: The client is a 60 year-old male who has experienced neurological impairments as a result of a brain injury and poly-substance use. P&A received a report that the client’s corporate guardian posted fliers within establishments around the community in which the client lived with information regarding the client’s disability to ensure that people did not provide him with alcohol or give him money. P&A conducted an investigation regarding this report and did find that witnesses had identified seeing such fliers; however, it was identified that they were taken down shortly after they had been placed within the business establishments. P&A did substantiate the allegation as exploitation and neglect and took steps to formally address the conduct with the corporate guardian. With the guardianship being corporate in nature, P&A also notified the court to ensure that they were maintaining appropriate oversight of the guardianship and duties of the guardian per state law.

Case Three: The client is a 73 year-old Native American female who has diagnosis which include Dementia, Alzheimer’s type and physical limitations. Her eldest daughter was appointed as the woman’s guardian through tribal court. The woman also resides with her daughter, who is the guardian. P&A received a report that the woman’s brother is exploiting the client. The report identified that while the client was her own legal decision maker, her brother took her to the land office and had her sign over 140 acres of her land to him and his minor daughter. This transaction was done 4 days prior to the hearing for the guardianship. P&A conducted an investigation regarding this report of suspected exploitation. It was found that all family members were notified formally in written form regarding the guardianship hearing. The investigation did reveal that the transaction had taken place and that the client’s brother was now renting the land for cash income. P&A took steps to notify the BIA and the necessary parties as to the transaction. As a result of these efforts, the woman’s assets were protected, and the guardian given the necessary authority to ensure that she is no longer at risk of potential financial exploitation by family members or others.

Priority 2

1. A statement of the priority.

EDUCATION

Students with disabilities will receive a free appropriate public education including needed accommodations.

2. The need, issue or barriers addressed.

Educational Services for children are not provided consistent with requirements of the Individuals with Disabilities Education Act or Section 504 of the Vocational Rehabilitation Act. One barrier is a lack of understanding of the process by both the parents and professionals in the educational system. A second barrier occurs because there is sometimes a conflict between the needs of individuals which are to be addressed by each IEP team and the collective needs of all students. These issues are exacerbated by a divided system of education that views students as two separate populations: students with disabilities and students without disabilities. There is a need for education and understanding of the intent of the law by all parties involved in the identification, evaluation, child-find activities, behavioral supports, implementation of IEPs, and transition of students with disabilities. There is also a need for individual support and representation for students whose rights are being violated.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include individual casework completed by P&A advocates and attorneys, education and training activities, and public information and outreach activities.

4. Objectives & Progress

Objective 1: Students with disabilities inappropriately denied their rights to education through behavioral supports, transition, shortened school days, seclusion & restraint and 504 disability-related accommodations will have a favorable outcome.

Twenty-seven people (27) were provided with information and referral within the area of student’s rights to education. Forty-seven (47) people were provided with advocacy services to address their disability-related educational rights violations. Twenty-two of these cases were closed during the fiscal year with all of them being closed with favorable resolutions for the student. Twenty-five (25) cases will be carried over into FY 2019.

5. Collaboration with other entities

Special Education Unit Directors Meetings

P&A staff collaborate across the state with Special Education Directors. Ongoing discussions regarding policies, procedures, disability-related issues, and student’s needs take place. These pro-active efforts allow P&A staff and Special Education Directors to address needs that students with disabilities are facing. Targeted efforts are currently being done in the following areas of the state: Cities of Mandan, Fort Yates, Minot, Fargo, West Fargo and Grand Forks, Morton and Sioux Counties and the Upper Valley Special Education Consortium.

Services to Native American reservations

P&A currently provides advocacy and legal services to all four Native American reservations within the state of North Dakota. One reservation, which is the most populated in the state, does have a full-time advocate who serves the reservation and surrounding counties. The other three reservations are served by regional P&A Disabilities Advocates through routine scheduled outreach activities. P&A staff has built a strong network of contacts to include Indian Health Services, Sacred Child Project Coordinators, Job Service offices, colleges, Employment & Training Programs, Mental Health providers, juvenile and adult court systems and school staff. P&A staff has been available for parent information fairs and other community events in an effort to increase exposure to students, parents and others who reside or work on the reservation. These efforts have resulted in an increased number of referrals to P&A for people that have disabilities and live on the reservation.

In collaboration with the Behavioral Health Division of the ND Department of Human Services, ongoing efforts to identify unmet needs on the Native American reservations is continuing.

6. Case Summaries that demonstrate the impact of the priority

Case One: The client is a 19 year-old female who lives in an urban community with her parents. She has been diagnosed with severe optic migraines, which are difficult to treat and are quite debilitating. The client is her own legal decision maker. P&A received a referral regarding this student because she is 19 years old and only is considered a freshman credit wise in the school system. It was found that the school was failing to provide accommodations for absences when the student was missing school related to her medical condition and was unwilling to allow her to make work up or to turn it in past identified deadlines. Prior to P&A’s involvement, the parents had requested a 504 plan; however, the school denied the request and continued to identify her failure to complete the work and obtain the necessary credits. P&A provided representation level advocacy. With the assistance of P&A the school developed a comprehensive 504 plan to meet the student’s needs. Accommodations were made to allow for the student to demonstrate the needed skills to obtain her credits, while allowing her to establish a pace of learning that accommodated her medical needs and her migraines. P&A ensured that an effective plan was in place and that the student was progressing through credit advancement so that she could be successful in the school setting.

Case Two: The client is a 13 year-old 8th grader in a rural school in North Dakota. He has diagnosis which include Reading Disorder, Math Disorder, Written Expression Disorder, ADHD and Dysgraphia. At the time of referral to P&A, he was not receiving any accommodations or modifications within the educational environment. P&A provided representation level advocacy services to him to address his eligibility for special education and his right to a free and appropriate public education. He was found eligible for special education and a comprehensive IEP was developed with input from his community-based therapists. Negotiation also occurred with the school relative to disability-related behavior needs that the student had, which were not being properly addressed by the school. If the student was struggling, he was sent home, or was sent to in-school detention, where no learning occurred. P&A educated the school personnel on the manifestation of the student’s disability and ensured that he was receiving his education in the least restrictive setting. Lastly, P&A addressed the assistive technology needs that the student had to enhance his learning and ensured that they were available to him within the educational setting. As a result of these efforts, a comprehensive plan was addressed, and he demonstrated improved participation and success in the school setting.

Case Three: The student is a 6 year-old attending a rural school in North Dakota. He has diagnosis which include non-categorical delays in Speech and OT and significant sensory needs. More formal diagnosis has not yet occurred; however, the concerns in these areas are significant and he was found eligible for special education. The students regular school programming was successful; however, when the IEP began to address his Extended School Year (ESY) needs, things did not go as well. The IEP team agreed that he needed these services, but a denial of ESY services was issued to the parent by school administration with an indication that they do not have personnel to address the child’s needs in the summer program. The child’s parents were encouraged to seek private services and therapies throughout the summer to address their child’s needs. P&A provided advocacy services to the child and his parents to address this denial in a formal manner through the IEP team process. The District was educated on their responsibilities to ensure that all students who are entitled to ESY services must be provided with them. The student was provided with educational services throughout the summer as recommended by the IEP team and he was very successful in the program.

Priority 3

1. A statement of the priority.

INCLUSION

Individuals with disabilities will reside in the least restrictive environment of their choice with necessary services and supports.

2. The need, issue or barriers addressed.

ND continues to spend a disproportionate amount of funding on institutional placements and this often is the default choice for individuals needing a higher level of care or assistance. Sufficient flexibility in the use of funds has not been established within our current system of services. This has negatively impacted communities’ abilities to provide appropriate services that enable people with disabilities to remain or return to their communities of choice. In addition, people with disabilities in the state of North Dakota do not have sufficient services to ensure full participation in the community or adequate supports to ensure that they can live in the least restrictive environment. Communities often have not devoted resources to ensure that public sites and services are fully accessible and that barriers to inclusion and participation are eliminated.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include advocacy and legal services along with systemic and collaborative activities which will be carried out by P&A staff throughout the agency.

4. Objectives & Progress

Objective 1: Individuals with disabilities who are at risk of institutionalization will receive the disability-related supports necessary to remain in the community.

P&A provided information and referral to eleven (11) people regarding P&A’s inclusion priority during FY 2018. In addition, advocacy services were provided to eleven (11) people who were at risk of institutionalization. Five of these cases were closed during the fiscal year and all five were closed in the client’s favor. Six (6) of the cases were pending at the end of the fiscal year and will be carried over to FY 2019.

Objective 2: Individuals with disabilities who are in an institution and able to live in the community will receive the disability-related supports necessary to meet their needs in lesser restrictive settings.

During FY 2018 P&A provided information & referral to five (5) people who contacted P&A regarding situations where people with disabilities were unnecessarily remaining institutionalized. In these five situations, P&A conducted supervised referrals to entities that could provide the needed advocacy to address their needs. These five situations were handled as I&Rs.

P&A did receive one request for advocacy services during FY 2018. It was identified that a woman was being denied the opportunity to return to her previous living environment after a swing bed stay post-surgery. P&A provided case representation to the woman to establish a plan to support her ability to return to her home. At the end of the fiscal year activities were taking place, but placement had not yet occurred. The client’s case will carry-over to FY 2019.

5. Collaboration with other entities

ND State Capitol Groups Committee

P&A partnered with the Dakota Center for Independent Living to ensure that the ND Capitol Grounds Committee has adequate information regarding accessibility needs as they make decisions regarding the physical and aesthetic features of the interior and exterior of all buildings on the Capitol grounds. As a result of these efforts project members conducted a walk-through of the Capitol, the grounds and other buildings located on the Capitol grounds. Areas that pose barriers to accessibility were identified. The areas identified include accessible parking spaces near the main entrance and State Library, the cross slope of the main entrance, lift in the Brynhild Haugland room, and bathroom accessibility in the main floor Capitol bathroom and in the State Library bathroom. Project members plan to meet with the State Capitol facility manager to inform him of the barriers identified. These will be addressed formally in the coming fiscal year.

Interagency Project for Assistive Technology (IPAT) Consumer Advisory Council

P&A staff serves on the ND Assistive (formerly IPAT) Consumer Advisory Committee, attending two face-to-face meetings a year. This committee is made up of people with disabilities, parents and representatives from the education field, employment services, independent living, commerce and aging services. The Committee reviews the programs and services provided through ND Assistive, whose focus is on adaptive technology and its use to enable continued independence and the enrichment of lives. The input provided by consumers and agency stakeholders insures better and more effective service delivery to people with disabilities in ND who can benefit from assistive technology.

ND Olmstead Commission

The planning subcommittee for the Olmstead Commission presented recommendations to the full Commission for changing its structure. This was received well by the Commission and the ball is rolling to implement the changes to make the Commission more independent and effective. The order moves the Commission out of the ND Dept. of Human Services. It expands the Commission’s advisory and oversight role, “focused on moving the State forward toward services and supports, health care, housing, employment, education and transportation. North Dakota must be a place where people with disabilities can live, learn, work, travel and enjoy life in the most integrated setting possible.” The order changes up membership (P&A is still a member) and provides for an attorney from the Governor’s Office and a member chosen by the public to be the Co-Chairs. The executive order may be found at: https://www.governor.nd.gov/sites/governor/files/documents/Executive%20Order%202018-05.pdf

P&A worked closely with the Governor’s Office legal counsel on the development of the executive order. P&A has also be selected to “staff” the Commission and is working, with the Governor’s support, to hire an attorney to fulfill this role as well as conduct training on Olmstead (and the ADA) and respond to inquiries about Olmstead issues.

Community Elder Service Network (CESN)

In collaboration with 40 other entities that serve the Bismarck and Mandan communities, P&A staff continue to work towards achieving a cohesive plan to address aging and disability service needs within these communities. Meetings are held monthly and P&A participates on a regular basis. A monthly program is held to inform participants of ongoing services within the Bismarck and Mandan communities. In addition, monthly reports are completed by each entity to ensure that updates are shared amongst all participants. The CESN has been instrumental in developing programmatic and educational information for people who are aging and who have disabilities throughout the two communities that are represented. Of significance this past year is the development of a list of service gaps that affect people who are aging and those who have disabilities. This information will be used by the various entities to educate policymakers regarding service needs of this population.

Interagency Groups

P&A staff participate in a number of interagency work groups to address the needs of people with disabilities who are living in rural communities. Currently, P&A staff participate with groups in the cities of Minot, Devils Lake, Williston, New Town, and also within County programs of McLean, Renville, Burleigh, Morton and Nelson Counties. P&A also participates in a group that serves the Turtle Mountain Indian reservation.

Human Service Advisory Committee

Through a partnership with the Division of Mental Health and Substance Abuse, Human Service Advisory Committees have been formed in each region of the state to address the treatment needs of people with disabilities both from a behavioral health perspective and also with addiction and chemical dependency. Aging Services staff and Vulnerable Adult Protective Services staff have also been included to identify proactive supports that can be put in place to support community living and supported employment for people with disabilities. Ongoing information regarding gaps in services and community needs is provided to the advisory committee so they can continue to plan for appropriate supports and services.

Community Coordinating Councils

P&A staff attends community coordinating meetings in ND’s larger communities. These are meetings of community/regional providers that focus on strengthening and building local infrastructure to better support people with mental health issues. These meetings are primarily held to discuss local issues, barriers, strengths, and challenges. In some instances, discussion may be used to prevent placement and movement to the ND State Hospital or more restrictive settings. Informational topics are also discussed on an ongoing basis, which strengthens the knowledge of the people involved.

ND Self-Advocacy Network/Advocates Leading their Lives

In an effort to strengthen the voice of self-advocates across the state, P&A has partnered with the ND Center for Persons with Disabilities (NDCPD-ND’s UCEDD) and the State Council on Developmental Disabilities to develop a statewide self-advocacy network. Self-advocacy groups from across the state have also been brought into the process to ensure that all self-advocacy groups are represented.

The group adopted the name “Advocates Leading their Lives” and have continued to meet on a regular basis throughout the year. Self-advocates are very engaged in this process and are excited to be the ones to make the decisions regarding membership, structure, group name, logo, etc.

The group has determined that they will be including people with all types of disabilities in the membership as they want to ensure that the group is as strong as it can be. The officers have continued to move this group forward throughout their quarterly meetings. Membership has now grown to approximately 120 people.

The ALL group also continues to be very active with community self-advocacy groups and has partnered to plan and coordinate a statewide self-advocacy conference. The group will continue to meet into FY 2019 and will continue to strengthen as the process unfolds. What is of significant importance in this group is that self-advocates are leading all aspects of the process and are being empowered to do so by the various advocacy organizations that are involved.

North Dakota Disabilities Advocacy Consortium

P&A is an active member of the North Dakota Disabilities Advocacy Consortium (NDDAC), a non-profit organization representing about twenty disability-related entities from across the state. P&A’s Executive Director is an officer of the Consortium. The NDDAC does not have staff. The work is done by the membership. Information about the organization and its activities can be found at http://www.nddac.org/. NDDAC meetings are an effective vehicle for organizations to share information, resources, and ideas that may positively impact individuals with disabilities & their families.

The NDDAC’s overarching purpose is to positively impact public policy work that may have a significant impact on individuals with disabilities and their families. Examples of issues addressed in FY 2018 included Medicaid and insurance coverage for those diagnosed with autism.

This was also a planning year for the NDDAC in preparation for two major events:

1) Disability Awareness Day - NDDAC is sponsoring Disability Awareness Day at the Capitol on January 31, 2019. This event fills the Great Memorial Hall at the ND capitol with vendor exhibits, hundreds of people with disabilities and their families, and lunch with ND Legislators. It provides for a memorable day of interaction between policy-makers and people with disabilities.

2) Legislative Training Institute (LTI) - Sponsored by the NDDAC, this will be the third of these events. It is scheduled for Nov. 7-9, 2018, two months prior to the start of the ND Legislative Session which meets every two years. Prior LTI’s were held in 2014 and 2016. The LTI is an educational event where participants are “legislators” and go through three days of bill-writing, committee work, and mock House and Senate floor sessions.

6. Case Summaries that demonstrate the impact of the priority

Case One: The client is a 35 year-old female who lives in an urban community with her mother and daughter. She has two sons who spend time living with their father and at times with the client. The client has a diagnosis of Huntington’s Disease with an associated seizure disorder. She does have a limited guardian, who is the public administrator. P&A received a referral for advocacy services with the request that the client be supported to remain living in the community. It was identified that the guardian was pursuing placement for the client in a long-term care facility. P&A provided representation level advocacy services to ensure that the client was able to remain living in the community with support services through the HCBS waiver coming into her home. P&A also ensured that the client was aware of the funding mechanisms that could be used to fund her services, thus allowing her special needs trust money to be used for additional items that her Medicaid did not cover.

Case Two: The client is a 32 year-old female with diagnosis of Multiple Sclerosis and depression, which is well controlled with medication support. The client is her own decision maker. Advocacy services were requested by the client to address what she felt was a lack of appropriate support with discharge planning and being at risk for placement in a setting that was more restrictive than what she wanted. At the time of referral, the client had been hospitalized due to pneumonia and a bacterial infection that was not responding to oral antibiotics. It was learned after the hospital admission that the home that the client was living in had been condemned and did not have running water or electricity and was in terrible disarray. The client reportedly lived there with her brother, who had been involved with the law frequently as a result of drug possession and drug running. When this was discovered, the hospital personnel determined that the woman would be best supported in a skilled nursing facility and intended this to be the discharge plan. P&A ensured that the client was educated regarding her rights and various service options that she felt would be the least restrictive. As a result of these efforts the client was able to choose her discharge plan that she felt would meet her needs and was based upon her expressed wishes.

Case Three: The client is a 60 year-old female with a neurological impairment who was living in a rural community in North Dakota. At the time of referral, the client had received notice that she was being dis-enrolled from PACE (Program of All-Inclusive Services for the Elderly). Through this program she was receiving in-home care; however, it was the recommendation of the doctor who oversees the PACE program that the client enter a skilled nursing facility. When the client expressed dissatisfaction with this, the program dis-enrolled her and indicated that she was not following the advice of their physician. P&A provided advocacy representation to the client to address her service needs and assisted her with establishing home and community based waivered services to meet her disability-related care needs. These services were put in place and the client was able to remain living in her home.

Priority 4

1. A statement of the priority.

HEALTHCARE

Individuals with disabilities will have the necessary healthcare coverage to meet their disability-related healthcare needs.

2. The need, issue or barriers addressed.

As federal dollars diminish for health care, there is a push within the state to limit and cut Medicaid services, when the opposite needs to occur. There is a need for greater and better health care services for Medicaid eligible individuals. Individuals with disabilities are often denied benefits without understanding the basis for the denial or the complex procedures required to effectively appeal those denials or obtain needed services. There is also a need for individuals with disabilities to access support in the initial application process to ensure that the application contains relevant information to support the right to the specific benefit.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include advocacy and legal services along with systemic and collaborative activities which will be carried out by P&A staff throughout the agency.

4. Objectives & Progress

Objective 1: People with disabilities improperly denied coverage for their disability-related healthcare by Medicaid, Medicare, the Veteran’s Administration, or private insurance will have a favorable outcome as a result of P&A involvement.

P&A provided information and referral to fifteen (15) people regarding P&A’s healthcare priority during FY 2018. In addition, advocacy services were provided to nine (9) people who had disability-related healthcare needs. Five of these cases were closed during the fiscal year and all five were closed in the client’s favor. One of them was closed with a determination that the actions by the Department of Human Services was appropriate and that an appeal would not be successful. Four cases were pending at the end of the fiscal year and will be carried over to FY 2019.

5. Collaboration with other entities

State Medicaid Advisory Committee

The State Medicaid Advisory Committee meets on a quarterly basis throughout the year and reviews data, information and proposed changes on a broad range of Medicaid issues that affect people with disabilities. During FY 2018, these topics included: Substance Use Disorder and Rehabilitative Services Coverage; IEP Medicaid Services Billed by Schools; DME Fee Schedule; proposed revisions to the state Medicaid plan; pending and recent changes to the Administrative Rules; Electronic Visit Verification System; Overview of Behavioral Health Needs Assessment, Services Rendered via Telemedicine; Medication Therapy Management; Overview of Hepatitis C Coverage; Fraud, Waste and Abuse referrals; Medicaid Managed Care Study (topic of legislative interim committee study); Developmental Disabilities Division Updates; 2019-2021 Budget Review; Tribal 638/IHS services; and updates on quality control (“program integrity”). Efforts will continue during FY 2019.

ND CARES

ND CARES is a group that addresses the needs of Veterans, Service Members, their Families and Survivors. The ND National Guard identified a need to bring disability-based partners together to address primarily the needs of Veterans and Service Members who have experienced brain injuries and mental health issues as a result of their service. The group became a collaborative effort between the National Guard, Department of Human Services, the Governor’s office, P&A, Department of Corrections & Rehabilitation, and Center for Rural Health and veterans and family members. The group continues to identify potential needs for veterans and service members, but also identified the need for supports and services for family members and survivors. Significant efforts are taking place to create awareness of service-related needs for both veterans and their family members and to strengthen the services around this issue.

6. Case Summaries that demonstrate the impact of the priority

Case One: The client is a 61 year-old woman who resides in a rural community in North Dakota. She was employed with a coal company in the community and has medical insurance through her employer. The client sustained an ankle injury several years ago for which medical attention was not sought. Throughout the years, the client had continued problems with swelling and pain in her ankle. When formal medical care was sought, a physician initially identified that she had developed arthritis and medication was prescribed. Further consult was recommended with an orthopedic specialist and she was diagnosed with end stage arthritis in her ankle, osteoarthritis of the knee, ankle and foot. Treatment options were discussed with the client and a recommendation for fusion and total ankle replacement occurred. The surgery was completed by the orthopedic surgeon and after the surgery it was discovered that the clinic staff did not seek pre-authorization of the surgical procedure. The client’s insurance company determined that it was not medically necessary and that non-surgical options were not explored prior to the procedure being done. P&A provided legal representation to the client to appeal the denial by her private insurance company. An external review of the denial was conducted and through the negotiation process within this review, the hospital agreed to accept the payment the client had submitted at that time and agreed to write off the remaining $68,000 of the surgical and hospitalization costs.

Case Two: The client is a 9 year-old female who resides with her parents in an urban community in North Dakota. She was born with a very rare heart condition that affects the functioning of her heart valves. The client’s parents requested advocacy services from P&A to address a recent determination that she was no longer eligible for Medicaid and the in-home caregiver services through the Developmental Disabilities waiver. When P&A examined the case, it was found that the parents were not offered services through a different waiver that could have supported their need for Medicaid and respite care when she was determined to no longer be eligible for the DD waiver. P&A provided information and advocacy support to the family to apply for services under the Children’s with Special Healthcare Needs waiver, which would then allow for them to receive Medicaid coverage and respite care services with a special trained caregiver. As a result of these efforts, the needed services were put back in place for the child and ensured that she also had the healthcare coverage needed for her heart condition.

Case Three: The client is a 35 year-old Native American male who is a tribal member of a tribe in North Dakota. He does have a significant physical disability that resulted from being hit by a car many years ago. The client requested advocacy services from P&A to address a denial of healthcare coverage from tribal Indian Health Services. At the time of referral, the client had been doctoring due to an infection that had taken over his injured leg for which an amputation was being recommended. The infection was continuing to spread up the man’s leg and the infection disease specialist identified that no further steps could be taken to control the infection and that amputation was recommended. P&A provided advocacy support to the client to obtain the necessary medical records and referrals needed to access the surgery that was being recommended, with payment by Indian Health Services. These efforts were sucessful and surgery was performed per physician’s recommendations.

B. Priorities and Objectives for the Current Fiscal Year

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

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

Priority 1

1. A statement of the priority.

ABUSE, NEGLECT & EXPLOITATION

Individuals with disabilities will be free from abuse, neglect, and exploitation.

2. The need addressed.

The combination of the personal effects of a disability and associated factors, such as support of multiple caregivers, creates high levels of vulnerability. Therefore, the provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities. The ND Department of Human Services has authority to address abuse, neglect, and exploitation under state statute through its Long Term Care Ombudsman program and through funding to regional Human Service Centers for Vulnerable Adult Protective Services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals.

3. A description of the activities to be carried out.

Objective 1: P&A will investigate, or cause to be investigated, suspected abuse, neglect, and exploitation of individuals with disabilities.

Priority 2

1. A statement of the priority.

EDUCATION

Students with disabilities will receive a free appropriate public education.

2. The need addressed.

Educational services for children with disabilities are often not provided consistent with requirements of the Individuals with Disabilities Education Act or Section 504 of the Vocational Rehabilitation Act. One barrier is a lack of understanding of the process by both the parents and professionals in the educational system. A second barrier occurs because there is sometimes a conflict between the needs of individuals which are to be addressed by each IEP/504 team and the collective needs of all students. These issues are exacerbated by a divided system of education that views students as two separate populations: students with disabilities and students without disabilities.

There is a need for education and understanding of the intent of the law by all parties involved in the identification, evaluation, child-find activities, behavioral supports, implementation of IEPs, and transition of students with disabilities. There is also a need for individual support and representation for students whose rights are being violated.

3. A description of the activities to be carried out.

Objective 1: Students with disabilities inappropriately denied their rights to education through behavioral supports, transition, shortened school days, seclusion & restraint and 504 disability-related accommodations will have a favorable outcome.

Priority 3

1. A Statement of the Priority

INCLUSION

Individuals with disabilities will reside in the least restrictive environment of their choice with necessary services and supports.

2. The need addressed.

People with disabilities in the state of North Dakota do not have sufficient services to ensure full participation in the community or adequate supports to ensure that they can live in the least restrictive environment. Communities often have not devoted resources to ensure that public sites and services are fully accessible and that barriers to inclusion and participation are eliminated.

3. A description of the activities to be carried out.

Objective 1: Individuals with disabilities who are at risk of institutionalization will receive the disability-related supports necessary to remain in the community.

Objective 2: Individuals with disabilities who are in an institution and able to live in the community will receive the disability-related supports necessary to meet their needs in less restrictive settings.

Priority 4

1. A statement of the priority.

HEALTHCARE

People with disabilities will have the health care necessary to meet their disability-related needs.

2. The need addressed.

People with disabilities need appropriate health care and treatment to correct or ameliorate their disability-related health conditions. Public comment/forums, client contact, mailed surveys, and extensive staff experience have helped us determine that people with disabilities are often denied needed health care services.

3. A description of the activities to be carried out.

Objective 1: People with disabilities improperly denied coverage for their disability-related healthcare by Medicaid, Medicare, the Veteran’s Administration, or private insurance will have a favorable outcome as a result of P&A involvement.

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

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.

Sources of funds received and expended

Budget for the fiscal year covered by this report

Description of PAIR staff (duties and person-years)

Involvement with advisory boards (if any)

Grievances filed under the grievance procedure

Coordination with the Client Assistance Program (CAP) and the State long-term care program,

if these programs are not part of the P&A agency

A. SOURCES OF FUNDS RECEIVED AND EXPENDED:

2018 PAIR federal grant $101,312 (includes $1,231.20 in attorney’s fees)

2017 PAIR federal grant $72,640

TOTAL: $173,952

B. BUDGET FOR THE FISCAL YEAR COVERED BY THIS REPORT:

Salaries -- 108,028.95

Temp Salaries -- 275.00

Benefits -- 47,024.95

Travel -- 2,482.93

Professional supplies -- 634.25

Postage -- 178.06

Printing -- 124.58

Insurance -- 57.08

Office leases -- 6,276.18

Repairs -- 176.38

IT data processing -- 3,513.78

IT communications -- 538.84

Professional development -- 1,131.94

Fees-professional services -- 3,508.93

TOTAL: $173,951.85

C. DESCRIPTION OF PAIR STAFF: P&A has ten offices in the State. Each site has from one to three Disability Advocates (14 in total) and all 14 have time allocated to the PAIR Program). Additional staff allocated PAIR Program time include the two Directors of Program Services, Director of Legal Services, one attorney, a 1/2 time Support Staff position (who also drives the Disability Advocate as she has a visual impairment), the Director of Policy & Operations, and the Executive Director. Of the total 27.5 FTE’s (28 staff), 21 have some PAIR time.

POSITIONS PAIR % FILLED TOTAL

Disability Advocate - Williston 10% 100% .10

Disability Advocate - Minot 10% 100% .10

Disability Advocate - Devils Lake 10% 100% .10

Disability Advocate - Belcourt 10% 100% .10

Disability Advocate - Grafton 10% 100% .10

Disability Advocate - Grand Forks 5% 100% .05

Disability Advocate - Fargo 10% 80% .08

Disability Advocate - Fargo 10% 80% .08

Disability Advocate - Fargo 10% 100% .10

Disability Advocate - Jamestown 10% 100% .10

Disability Advocate - Jamestown 5% 100% .05

Disability Advocate - Bismarck 20% 80% .16

Disability Advocate - Bismarck 10% 100% .10

Disability Advocate - Dickinson 10% 100% .10

Support Staff (.5 FTE) - Williston 10% 100% .05

Attorney - Bismarck 10% 100% .10

Dir. of Program Services 15% 100% .15

Dir. of Program Services 10% 100% .10

Dir. of Legal Services 5% 100% .05

Executive Director 10% 100% .10

Director of Policy & Operations 10% 100% .10

TOTAL: 1.97

D. INVOLVEMENT WITH ADVISORY BOARDS (IF ANY):

P&A is an independent State agency with its own seven-member governing board. It does not have a separate advisory council.

E. GRIEVANCES FILED UNDER THE GRIEVANCE PROCEDURE:

No grievances were received relative to the PAIR program during FY 2018.

F. COORDINATION WITH THE CAP AND THE STATE LONG-TERM CARE PROGRAM (IF NOT PART OF THE P&A):

P&A is now administering the Client Assistance Program (CAP) under a contract with the Department of Human Services/Vocational Rehabilitation Division. P&A administrative staff has been meeting frequently with staff from the Long Term Care Ombudsman Program in order to better define roles and responsibilities. Referrals are shared between P&A and the Long Term Care Ombudsman Program on an ongoing basis. P&A also established a formal Memorandum of Agreement with the ND Long Term Care Ombudsman program effective October 2016.

Certification

Signed?Yes
Signed ByTeresa Larsen
TitleExecutive Director
Signed Date12/19/2018