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RSA-227 for FY-2021: Submission #1176

Arkansas
09/30/2021
General Information
Designated Agency Identification
Disability Rights Arkansas, Inc.
400 West Capitol Avenue
Suite 1200
Little Rock
AR
72201
501-296-1775
800-482-1774
800-482-1174
Operating Agency (if different from Designated Agency)
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Additional Information
Thomas Nichols
Susan Pierce
501-492-5760
spierce@disabilityrightsar.org
Part I. Non-case Services
A. Information and Referral Services (I&R)
10
0
0
4
0
6
20
B. Training Activities
4
140
UAMS Jones Eye Institute Training- DRA's CAP advocate gave a grand rounds lecture to University of Arkansas Medical School (UAMS) Jones Eye Institute ophthalmology and optometry faculty and students. The lecture informed these health care professionals of the importance of public and private resources in building a resource and support network for patients upon diagnosis of a visual impairment, as proper knowledge of available resources can assist blind and low-vision individuals in living and working independently. Over twenty-five participants attended the live virtual session, and the recording is available as part of UAMS’s continuing education program. The cost of this training was split between three grants; CAP covered 33% of the cost.
In April 2021, DRA held a virtual conference in which transition services were a prominent topic. CAP and PABSS staff conducted a 90-minute web presentation on transition services for youth with disabilities, with a focus on the importance of developing a comprehensive transition plan to support educational and post-secondary vocational outcomes, and how the utilization of appropriate educational and vocational rehabilitation services at the earliest possible stage is crucial to removing barriers to employment for individuals with disabilities. Participants were informed about DRA's CAP and PABSS programs and how they can help individuals who need assistance when working with Arkansas Rehabilitation Services (ARS), or who need transition services, including the importance of ARS participation in the transition process. Twenty-five percent of the cost of the conference was allocated to CAP.
Intersection between Special Education and the Justice System- DRA's Director of Legal and Advocacy Services was invited by a judge to educate him and other judicial staff regarding the rights of juveniles eligible for special education and related services who have had contact with law enforcement and/or the judicial system. Focus was placed on warning the participants about the effects of residential placement orders and the overuse of Family in Need of Services (FINS) petitions. Attendees were also informed about appropriate transition services and bringing rehabilitation services into the process early, which also provided the opportunity to talk about the CAP program. Funding for this training was accorded to several grants; 10% of the cost was allocated to the CAP grant.
A CAP attorney was invited to speak to an anatomy class at a Central Arkansas high school about spinal cord injury and living with a disability. She shared her firsthand experiences with ARS and the part they played in helping her return to work. She also explained her role as a CAP attorney in ensuring that people receive the services they need to successfully remain in, or reenter, the workforce. She spoke about attending law school as a person with a disability and the type of accommodations needed to be successful in that endeavor. She informed the students about disability resource centers that should be on campus at each post-secondary school and about transition services for high school students so that any students with disabilities in the audience would know that they should already be receiving these important services. The CAP attorney concluded her presentation by showing the students her accessible vehicle to demonstrate the types of modifications that are possible to allow someone with a significant spinal cord injury to drive.
C. Agency Outreach
DRA staff working primarily in the CAP and PABSS grants spoke about their lived experiences with disability to a class of physician assistant students at a community college; one as an individual whose disability occurred gradually because of a degenerative condition and the other as an individual whose disability resulted suddenly from a trauma. They spoke about how the medical and supportive services systems (including rehabilitation services) in retrospect both succeeded and failed in serving them and informed the students about DRA services and the agency’s mission to assist people with disabilities to live full, independent lives, including employment in integrated, competitive jobs. They were informed about Arkansas Rehabilitation Services (ARS) and how ARS can assist individuals who want to work, and about how the CAP can assist with issues once someone has applied to ARS for services. While this outreach was targeted to professionals (physician assistant students), these students will fan out across the state to work once they graduate, and DRA is hopeful that the information shared at this event will reach unserved/underserved communities. Forty-five percent of the cost of this training was allocated to the CAP grant.
DRA's Director of Legal and Advocacy Services was a panelist at a Department of Human Services (DHS) conference intended to provide attendees, who were mostly parents of children with disabilities, with resources. Information about rehabilitation services and the CAP were provided to parents, along with other information about DRA and its services. While DRA cannot be sure how many of the parents participating in this conference were from unserved or underserved communities, it is hoped that DHS will share the information provided with its staff in DHS field offices across the state. The CAP covered 20% of the cost of this training.
D. Information Disseminated To The Public By Your Agency
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1
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0
6268
DRA has 5,082 followers on Facebook and 1,186 followers on Twitter. These are not website hits, but social media followers.

E. Information Disseminated About Your Agency By External Media Coverage
The CAP and rehabilitation services were the featured topic of the month in October 2020 at KABF, a community radio station in Little Rock, Arkansas. KABF bills itself as the "The Voice of the People" which refers to its populist mission of serving middle- and lower-income Arkansans. CAP staff, along with ARS and Division of Services for the Blind (DSB) representatives, discussed pre-employment transition services, supported employment services, and post-secondary education support services as vital components of successful post-secondary vocational outcomes. CAP staff particularly focused on the role that the CAP plays in supporting students with disabilities to receive these services.
Part II. Individual Case Services
A. Individuals served
5
8
13
0
5
B. Problem areas
0
8
5
0
0
0
0
0
C. Intervention Strategies for closed cases
2
0
5
0
1
0
8
D. Reasons for closing individuals' case files
7
1
0
0
0
0
0
0
0
0
0
0
N/A
E. Results achieved for individuals
0
0
0
0
5
2
1
0
0
0
N/A
Part III. Program Data
A. Age
0
2
4
6
1
13
B. Gender
10
3
13
C. Race/ethnicity of Individuals Served
0
0
0
6
0
7
0
0
D. Primary disabling condition of individuals served
0
0
0
0
0
0
1
1
2
1
0
0
0
0
0
0
0
0
0
1
2
0
0
1
0
3
0
0
0
1
0
0
0
0
13
E. Types of Individuals Served
2
0
10
1
0
0
Part IV. Systemic Activities and Litigation
A. Non-Litigation Systemic Activities
0
In a follow up to last year's report about the proposed merger of Arkansas Rehabilitation Services (ARS) and the Division of Services for the Blind (DSB), when ARS was pressuring the Arkansas Rehabilitation Council (ARC) to support the merger, FY2020 ended with the ARC trying to obtain information from ARS and the Governor's office regarding the impact the merger would have on client services and what cost savings were anticipated. DRA's Executive Director, as the CAP representative on the ARC, particularly expressed concerns about how the merger would impact client services and insisted the ARC be provided data about the anticipated impact of the merger. Ultimately, ARS did not produce the requested data and did not proceed with the merger due to concerns raised by the CAP representative and other ARC members.

While working with a client, the CAP identified an issue regarding a lack of consistency across ARS when using Form RS-16. In this client’s case, the application of Current Procedural Terminology (CPT) codes for allowable agency expenses resulted in fees to the client that were sufficiently high enough to effectively be considered a denial of services. This concern was brought to the attention of the Rehabilitation Services Administration (RSA) during a meeting between RSA and DRA prior to RSA’s 2021 audit of ARS. Meanwhile, as the client’s case progressed, ARS proposed changes to their policy on these codes to only utilize codes from Medicare and the Arkansas Worker’s Compensation Commission instead of also utilizing codes from the Blue Cross/Blue Shield insurance company. DRA’s Director of Legal and Advocacy Services communicated concerns regarding this change directly to ARS’s attorney and the Arkansas State Rehabilitation Council (SRC) board. As the policy is currently in effect and ARS staff have been trained on the application of the new policy, DRA intends to request all training materials and videos to review the application of the new policy and will monitor to determine whether the implementation of this policy is resulting in a reduction of services for consumers. This effort will be ongoing in FY22.
B. Litigation
0
0
0
DRA did not engage in systemic litigation/class action activities during FY2021.
Part V. Agency Information
A. Designated Agency
External-Protection and Advocacy agency
Disability Rights Arkansas, Inc.
No
N/A
B. Staff Employed
A total of 18 DRA staff are charged to the CAP.

Attorneys and advocates: 11
Administrative: 6
Clerical: 2

17 staff are full time. 1 staff is part-time.
Percentage of staff hours allocated to the CAP:
Professional (program and administrative staff): 91%
Clerical: 9%
Staff hours allocated to the CAP as a percentage of all staff hours worked across all grants: 5.80%
Part VI. Case Examples
Case Examples
While the CAP successfully assisted ARS clients, as evidenced in the case examples below, it should be noted that because of the ongoing pandemic, ARS was unable to transition as many clients to employment as might be expected otherwise. The pandemic and the resulting decrease in ARS clients also negatively impacted the number of ARS clients who contacted the CAP for assistance. We would expect our CAP case numbers to increase once ARS is able to resume normal operations.

A recipient of rehabilitation services contacted the CAP when she was denied certain services through Arkansas Rehabilitation Services (ARS). She had requested ARS pay her mortgage and other bills following a tornado that caused damage to her home, and she also requested new tires and oil changes for her car, citing her work commute. Her counselor never gave her a firm denial but rather refused to answer her questions or otherwise proceed with her case. DRA’s CAP attorney consulted with the client about the services available to her as outlined in the ARS policy manual, and about reasonable expectations for services. The attorney called the client’s ARS counselor regarding the lack of response to the client’s requests and not otherwise progressing with the client’s case. The CAP attorney also participated in conference calls with the client and her counselor regarding the requested services subsequently being denied; however, it was determined that mental health counseling and a weight loss program would benefit this client and would be covered by ARS. The client expressed appreciation for the CAP attorney reviewing ARS policy with her to help her understand the types of services she could reasonably expect and assisting her in obtaining services that would be both beneficial and accessible through ARS.

An individual with a disability resulting from facial trauma that caused migraines, tinnitus, and an inability to eat solid foods or to speak for more than brief periods of time experienced significant barriers to employment. The client contacted DRA after she was certified eligible for vocational rehabilitation services through ARS but was unable to progress to individualized plan for employment (IPE) development in a timely manner. A multi-phase treatment plan, deemed medically necessary by the client’s physician, was presented to ARS for inclusion in the client’s IPE. Although a time frame was not specifically defined, completion of all phases of treatment was expected within a six-month time frame. The client’s counselor would not commit to including all phases of the treatment plan in the calculation of consumer financial participation, a necessary step prior to IPE development. Additionally, the time for which the financial contribution was calculated did not reflect the duration of treatment or the number of services needed. DRA’s CAP advocate requested an administrative review to address these issues. The administrative review did not resolve the client’s issues, so mediation was requested. DRA’s CAP attorney assisted with preparations for mediation while negotiations began between ARS, the client, and the CAP advocate. ARS subsequently agreed to include all phases of treatment in one IPE plan-year and to calculate the amount of consumer financial participation based on the five treatment phases rather than by the previous twelve-month calculation. Costs supported by ARS were determined by applying all available ARS treatment codes, with the remaining costs paid by the client. Of approximately $75,000 in treatment costs, the client was responsible for $20,000, an outcome considered positive by the client, so the request for mediation was withdrawn.

A client with low vision contacted the CAP to seek assistance with receiving vocational rehabilitation services through the DSB. The client reported difficulty communicating with her vocational rehabilitation counselor about establishing para-transit approval and requesting job search assistance. The CAP advocate contacted the DSB area manager, who immediately assigned a new counselor to the client’s case. The new counselor assisted the client with applying for para-transit services, which were approved. This approval made it possible for the client to participate in assistive technology training at the DSB technology lab. Meanwhile, the CAP advocate learned the client was unable to pay for prescriptions that treated a mental illness. As this was a significant barrier to the client participating in vocational rehabilitation, DSB included the cost of prescription medications in the client’s IPE. The client’s new counselor also assisted her with job applications and job searches, traveled with the client for job interviews, and helped her purchase work clothing. The client was ultimately successful in obtaining employment in a restaurant utilizing magnifiers provided by DSB.

An individual contacted the CAP regarding a dispute with ARS over the provision of a computer needed to complete coursework for medical billing certification. This lack of technology would present a barrier to program participation and ultimately a failed attempt at vocational rehabilitation. DRA’s CAP advocate contacted the client’s counselor to determine the rationale for excluding this technology from the client’s IPE and requested an assistive technology evaluation be performed by ARS to provide more information about how assistive technology could assist the client in program participation. ARS agreed to refer the client for an assistive technology evaluation which, upon completion, revealed the client would benefit from a computer to effectively participate in coursework. The assistive technology component was added to the client’s IPE, and she is set to begin online training for medical billing at a local state university.

An individual receiving services from ARS and majoring in early childhood education contacted the CAP after her counselor did not approve payment of tuition in her IPE if the client took less than a full-time course load, despite the client’s disability preventing her from successfully managing that many classes. The client also sought a change of counselors and district offices owing to conflicts arising at this field office due to a family member of the client being employed there. The CAP advocate contacted a field services manager, who approved these changes, and the IPE was subsequently rewritten to include continued provision of tuition without the full-time course load requirement.

An ARS client contacted the CAP seeking assistance with facilitating communication with her counselor regarding the inclusion of mental health counseling services and medications to treat her ADHD in her IPE. The client’s vocational goal was self-employment, and she was developing a small business plan for ARS to review and approve; however, her ability to develop this plan was difficult without proper treatment of her ADHD. DRA’s CAP advocate contacted the client’s vocational rehabilitation (VR) counselor and the area district manager to effectively communicate the steps to include these services in the client’s IPE. Upon the approval of specific vendors to provide the client’s counseling and medications, these services were integrated into the client’s IPE and provided to the client.

A former ARS client contacted the CAP to request assistance with the reopening of her case with the DSB. The client’s case had been closed successfully following DSB’s assistance with funding cataract surgery that had allowed the client to maintain employment in the public school system; however, the client needed an additional procedure to resolve cloudiness issues with her implanted lenses. DRA’s CAP advocate contacted the DSB area manager and the client’s case was reopened to provide post-employment services. The necessary procedure was included in the client’s IPE and the client’s medical issue was successfully treated, thereby allowing her to continue in her job with the school district.
Certification
Approved
Susan Pierce
Grants Manager
2021-12-27
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