Major Changes to the Real Life Choices Program

By: Herbert D. Hinkle, Esq. And Valerie A. Powers Smith, Esq.

Two major changes have occurred with the Real Life Choices Program since January 1, 2009. To refresh your recollection, RLC is a cash option in lieu of residential services offered by the New Jersey Division of Developmental Disabilities to clients on the priority waiting list for residential services.

First the good news: As reported in the last issue of The Law and Disability, the New Jersey Legislature expanded the rights of people receiving self-directed support services, of which RLC is one version.

Now the bad news, which is not completely bad: RLC is abolished in favor of offering a client a choice when his or her turn come up on the priority waiting list. Each client will be offered the choice of a placement with an organization or cash to set up a personal program. Click here to read the full article.

Accommodations on High Stakes Testing, College and Graduate School Admissions Tests

By: Hillary D. Freeman, Esq.

No Child Left Behind (NCLB), signed into law in 2001, requires states and districts to administer standardized assessments in certain grades to measure basic skills in reading, writing, and math.

Students with disabilities may not be excluded from these assessments. Instead, the district must provide appropriate accommodations as determined by the IEP team or §504 team. Some examples of accommodations may include, but are not limited to, extended time, isolated room, a reader and/or scribe, enlarged print, and/or a computer. Click here to read the full article.

Mental Health Advance Directives in Pennsylvania

By: Ira M. Fingles, Esq.

In 2004, legislation was enacted in Pennsylvania (Act 194 of 1994, 20 Pa.C.S.A. § 5831 et seq.) that allows individuals to execute a mental health advance directive. Such a document allows the individual with mental illness (known as the “principal”) to appoint an agent to make decisions regarding the mental health care provided to the principal during periods in which the principal is incapacitated; i.e., unable to make decisions for him or herself. Click here to read the full article.

Recent Legal Victories

EPSDT/PDN Services Restored

• As a result of the firm's intervention, a 7 year-old girl with multiple disabilities' Medicaid EPSDT/PDN hours were restored, and continued at the medically recommended amount of 16 hours per day.

In-home Medically-Necessary Services Maintained

• As a result of the firm's intervention, a 4 year-old boy with profound mental retardation and multiple physical disabilities' daily medically necessary 16 private duty nursing hours at home were maintained by his Medicaid Managed Care HMO.

Denial of Cancer Treatment Services Overturned

• Due to the firm's intervention, a 36 year-old man diagnosed with cancer who's private insurance plan was denying any and all services provided for the past year and a half relating to the cancer based on a pre-existing condition clause was ordered to reverse their decision by the New Jersey Department of Banking & Insurance's Office of Managed Care by virtue of a successful appeal at the third external level before the Independent Utilization Review Organization contacted by DOBI. As a result, the private insurance plan must pay for services totaling nearly 1/2 a million dollars.

Intensive Behavior Services Provided Under IEP at Developmental Center Placement

• The firm recently handled a case involving an 18 year-old man with autism that was placed at a Developmental Center due to his severe behaviors. Since he is a classified student, he is still entitled to an IEP that provides FAPE, however the IEP provided at the Developmental Center was not designed to address his severe behaviors. The firm filed a petition for Mediation and Due Process against the Office of Education seeking a 1:1 behaviorist to work with him at the Developmental Center to help him develop skills to enable him to move back into the community. By the end of the proceedings, the Office of Education agreed to provide a 1:1 behaviorist who is trained in implementing ABA methodologies to individuals with severe behaviors 20 hours per week.

TBI Injury Claim and Change of Case Manager

• The firm was successful in representing a 35 year-old male with traumatic brain injury, whose family was seeking coverage of his motor vehicle accident injuries from the state guarantee association and a more beneficial relationship with the case manager. As a result of the firm's intervention, all past claims have been fully paid and a new case manager has been assigned to the matter.

Hinkle, Fingles & Prior Supports Autism NJ and the Autism Community

Hinkle, Fingles & Prior recently pledged and donated $50,000 to Autism NJ, to support the agency's outreach, education and public policy work on behalf of people with autism and autism spectrum disorders and their families. Above, left to right, Herbert D. Hinkle, Esq., Amy E. Duff, Esq., and Autism NJ Executive Director, Linda Meyer, Ed.D., MPA, BCBA.

Five Things You Need to Know About Your Healthcare Coverage:

1. What type of insurance plan you have;
2. Other forms of insurance to which your child may be entitled;
3. How to coordinate various forms of health insurance;
4. What your insurance plan covers; and
5. How to appeal denials, reductions, or terminations of care.

Understanding your healthcare coverage can help you maximize services that you need and improve the quality of life of your loved one and family. Contact Hinkle, Fingles & Prior, Attorneys at Law for assistance if the healthcare services you need are denied or restricted.