Tuesday, October 23, 2007
I, Wendi Damerval, Mother of Shaefer Damerval do request an administrative hearing on behalf of my disabled son, Shaefer Damerval, in response to the four Individual Planned Action Notice/Service Decisions Dated 10-10-07, with an effective date of October 27, 2007, and October 1, 2007 and one Planned Action Notice State Only Funded Services, dated July 10, 2007 with an effective date July 10, 2007, all together delivered to client address via USPS on October 12, 2007.
History: We waited for more than 5 years on the DDD waiting list for Shaefer to qualify for what we were told was CAP Waiver. I went to speak to Governor Christine Gregoire personally when she came to speak in Pasco of the Tri-Cities. I wrote many letters asking members of Congress to do more to help working families with disabled children of average income. Specifically I asked repeatedly for Representatives to work to include those children who’s families are technically poor bearing all the expense of the child’s disability because they cannot access DDD services, or Medicare, and are not on any form of public assistance. I argued that it is unfair for these departments to consider the family income without considering that the child client does not have an income and further to disregard the easily provable exorbitant client expenses born by the families vs. family income ratio. We were very excited when we got a letter in 2006 saying our son was qualified for a pilot program the Governor had just funded. Too bad the local DDD office did not get the same letter and consistently denied any pilot program existed.
Objections:
Issue One: Wrongful denial of FSP service payments agreed to by DDD and the client in a written service plan and or contracted with the parent for reimbursement of goods or services purchased by the parent The Division of Developmental Disabilities contracted for but failed to provide the services to a person eligible under this title when funds are available. There is an individual service plan, as per RCW 71A.18.020 and thus the secretary shall consider the need for services as provided in that plan.
Issue Two: WAC 388-823-0090 DDD received sufficient documentation to determine you eligible, DDD has thirty days from receipt of the final piece of documentation to make the determination of eligibility and yet DDD has asked for this information in July of 2006 in order to complete this eligibility and was provided such at that time and still has not by phone, and not in writing provided us with a determination.
Argument Issue One:
The Division of Developmental Disabilities should proffer a one-time payment to the parents on behalf of the client Shaefer Damerval immediately and without further excuse in the amount of the remaining balance of his Family Support Pilot Budget Award or other funds available for which he should have qualified under a timely and correct decision based on his ISP.
It is at issue that the client, Shaefer Damerval, was not correctly considered for all programs for which he may have qualified and continue to qualify including all CAP waiver programs, or other waiver programs in effect in 2006 and 2007, and that DDD did not provided services with reasonable promptness, delaying their first notice of any decision until July of 2007, even though notice of eligibility was mailed to Shaefer Damerval from the Olympia Division of Developmental Disabilities in August of 2006.
The August 2006 Notice stated the Governor, Christine Gregoire, had made available funding to move him off the waiting list to access funds under a Medicaid Waiver Program. Terri Buck at the Kennewick office was Shaefer’s caseworker at the time the notice was mailed to us from Olympia. He asked and I complied to fax him our notice from Olympia after I described it to him over the phone and he said he didn’t know anything about it.
After persistent inquiries about the notice the Kennewick office by phone stated he could not be qualified for the Pilot Program until he reached the age ten. They continued to refuse to take action to qualify him for any program and he was forced to wait he went without services until August of 2007.
Parents continued to protest that he had just turned nine, was not ten, and therefore qualifying him for the pilot program was being wrongfully delayed. We called to check on his case every couple weeks, we found a new case worker at least three times that repeated the age 10 requalification needed to be completed by a Sue Cox.
After nearly a year of this mom called to inform DDD that our son had attempted suicide and we were in a state of crisis in managing his care. Only then did Mary Jo Buyer, the Kennewick supervisor call us to say she was going to waive the age ten determination and get him qualified for his eligibility under the pilot program at his current age of 9. Mary Jo went over all the receipts I was asked to provide, she then made a determination on the ISP and told us she would be sending us a check for more than $2200 with $700 to go to respite care. This did not happen. Instead a process of turning the case over to different workers continued on lasting for nine months. July of 2007, a phone call came to us and both Mary Jo Buyer and Ms. Koci told me they had decided to deny most of the previously written ISP and approve respite care only. Our family has met the requirements of WAC 388-825-236 for serious need funds, we have indicated the type of services our family needs, explained why they can only be obtained through the use of serious need funds and outlined the changes we anticipate in our family situation if the requested services are not received and estimated the length of time our family will need the requested services.
We called after receipt of one notice that said Shaefer had been qualified for services, but everything we asked for was verbally denied. The only service that was allowed was respite care and only through a licensed DDD contracted provider. We have had caregivers sent to us with criminal backgrounds easily discovered by going to Washington Courts Government Search, showed up obviously on drugs, called in sick, no showed repeatedly and were too young with no experience and without having received any training. Perspective ages of contracted caregivers have been18, 22, and 20.
We had been told that by my completing the contract through DDD with a named employee, Gloria at Kennewick DDD, we would then be able to place an ad for caregiver employment and screen and make our own decision on who we hired to provide care to our son. After the letter of qualification under the Pilot Program was received in July of 2007 we asked Kennewick DDD if we could access his funds and pay for our choice of caregiver. We were told we had to use one of their contracted service providers in the area. I never understood why they had me come in and fill out a contract telling me I would be able to do this but later refused to follow through. If the department of DDD does not require or monitor the contracted caregivers to be qualified under the standards of the appropriate WAC’s they are as gatekeepers to the program effectively denying qualified care and in violation of the law.bg
On October 1, 2007, with medical, behavior therapy and psychiatric bills pilling up, I wrote a letter to request funds to meet his service needs. This was not however the first request. This is in addition to the ISP. This letter is attached, please see exhibit A. DDD waiver laws changed between the time he got notice that he was being taken off the waiting list and could now qualified for the program in August of 2006 to May of 2007. Those waivers in the law should be applied that were in effect in August of 2006, not those that enacted after he first received notice of eligibility in May of 2007. DDD should not be permitted to use administrative delays and excuses of changing case workers, fired, sick or untrained, or temporary part time case managers who’s work is re-assigned, and re-re-assigned, to determine eligibility under WAC’s that were not effective during the year in which he rightfully qualified for services. In the miss-management of his case the Division of Disabilities wrongfully used much more than what funds he did finally become eligible for, to pay administrative salaries, thus intercepting and depleting funds from the intended client, and defeating the purpose of the program, His assessed needs documented in his individual service plan were not provided for as promised and we did not receive a timely written response to all requests for services. Shaefer has been hurt as a result of the way DDD handled our request for services
Argument Issue Two:
More than one year to determine continued eligibility when he reaches age ten in November of 2007 is by far in excess of what the law allows. DDD has copies of all Shaefer’s records, we have called to ask if more is needed and each time any document was requested it has been produced by us. DDD has a copy of the recent July 2007 speech test reports from Kadlec that shows a more than two standard deviations below the mean in Communication, and the RSD psychologist testing from December of 2006 that shows more than a two standard deviation below the mean in social/interpersonal skills.
We request that as per WAC 388-823-0420 a Department staff or designee contracted with DDD must administer the ICAP so that a determination can be expedited before he has reached age 10. Since the bulk of documents of Shaefer’s disability we previously provided have failed to elicit a determination from the department we expect this test will prevent further unnecessary delay or lapse or denial of DDD services. We request DDD arrange for the administration of the ICAP if VABS or SIB-R as these results are not submitted as specific named tests have not been given by any other service provider or the school district. We request that a decision as to continued eligibility be made within 30 days of the date of this documents filing.
Sincerely,
Wendi Damerval