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DRI comments lead to changes in Idaho’s Crisis Standards of Care Guidance

Click here to download the PDF version of this post.

On September 15, 2021, Idaho activated Crisis Standards of Care (“CSC”) statewide in response to the Covid-19 pandemic and overwhelming surge on Idaho’s healthcare system. Crisis standards of care are guidelines that help healthcare providers and systems prioritize and triage delivery of care during extraordinary circumstances of an overwhelming disaster or public health emergency. The very fact that these guidelines were implemented represents an unprecedented and unwanted point in our state’s history.

On behalf of all Idahoans with disabilities, DRI wrote to Governor Little on September 28, 2021 urging that he address and end the discriminatory policies in the Idaho Crisis Standards of Care. DRI collaborated with the Department of Health and Welfare (“IDHW”) on CSC guidance through correspondence, comments, and recommendations on how to align the triaging protocols with the ADA, Section 504, and the Age Act. As of today, November 10, 2021 the CSC guidance has been changed to better serve individuals with disabilities and adopted by IDHW. The following list reflects some of the changes to the guidance that were made through DRI’s advocacy and comments:

  • Exclusion of “life years”: Previously the guidance included the stated goal of saving “life years” in the triaging protocols and as a priority in the ethical framework. This provision risked importing quality of life criteria and unconscious bias into the process in a way that would discriminate against individuals with disabilities. The provision of this
    phrase has been removed from the new guidance and replaced with the language “The focus is on saving the most lives, within the context of ensuring meaningful access for all patients, ensuring individualized assessments, and diminishing the negative effects of
    social inequalities that lessen some patients’ long-term life expectancy.”
  • The triaging tool’s survivability consideration: The previous triaging tool allowed for points to be added to an individual’s score, deprioritizing them for treatment, if they had co-morbidities with substantial impact on near-term survival. The vagueness of the phrasing presented a risk that individuals with disabilities would be deprioritized for conditions that would affect their health beyond the acute hospital encounter. By providing further clarification on this point to IDHW, the triaging tool language was changed to only consider the survivability of the acute hospital encounter when adding
    points to an individual’s score.
  • Reasonable modifications to the SOFA score required: The previous guidance instructed that when using triaging tools to calculate an individual’s SOFA score, modifications “may be a necessary accommodation”. However, without the inclusion of language that modifications “must” be used when assessing individuals with disabilities, there was a risk that the use of these tools would lead to discrimination by providing inaccurate assessments based upon disability related characteristics. The updated guidance reflects this mandatory language change.
  • Removal of “lifecycles” in the tiebreaker language: The previous guidance contained a score tie resolution protocol that deprioritized patients based on lifecycle, prioritizing those patients who have lived through fewer lifecycles. This language conflicted with OCR guidance that medical care cannot be denied “on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age”. The use of this language has been removed from the tiebreaker and the score tie resolution is now based on clinical trajectory rather than age.

DRI thanks the State of Idaho Disaster Medical Advisory Committee on behalf of all Idahoans with disabilities for making the necessary changes to the CSC guidance. The revised guidance not only reflects a larger understanding of and consideration for the severe impact triaging protocols have on individuals with disabilities, but is also in compliance with guidance approved by the Office for Civil Rights thus far. DRI looks forward to continuing to collaborate with the department of Health and Welfare and continuing to advocate on behalf of all Idahoans with disabilities as we navigate the Covid-19 pandemic.

Click here to download the PDF version of this post.

El siguiente gran paso para la nueva herramienta de presupuesto está aquí: ¡Nuevas reglas de Medicaid!

(View this post in English.)

La nueva herramienta de presupuesto estará disponible en junio de 2022. Antes de eso, Medicaid de Idaho todavía tiene trabajo que hacer para prepararlo. El próximo gran paso está por venir. Medicaid de Idaho hará nuevas reglas para que pueda usar la nueva herramienta.

Para hacer esas reglas, Medicaid de Idaho tiene que recibir sus comentarios. Eso comienza el próximo mes, 2021 de noviembre. Medicaid llevará a cabo algo llamado “elaboración de reglas negociadas” para obtener sus comentarios.

Usted puede leer el borrador de reglas que Medicaid de Idaho quiere hacer aquí.

Puede compartir sus comentarios de dos maneras:

1. Usted puede compartirlo en una reunión especial de video el martes, 16 de noviembre de 2021, a las 2:00 PM MT / 1:00 PM PT.

Únase a la reunión en vídeo: https://bit.ly/Nov16rules

o llame al 1-415-655-0003 o al 1-720-650-7664

2. Puede escribir sus comentarios y enviarlos a Medicaid antes del viernes 26 de noviembre de 2021.

Envíelos por correo electrónico a: dhwrules@dhw.idaho.gov
O envíelos por correo a:

Reglas de DHW
PO Box 83720
Boise, ID 83720-0036

Antes de eso, hay tres oportunidades de obtener más información y estar preparado para compartir sus comentarios:

1. El Consejo de Discapacidades del Desarrollo de Idaho se unirá con los abogados de K.W. v. Armstrong para una reunión pública que le ayudará a prepararse para compartir sus comentarios. Puede asistir en directo o ver una grabación después.

Lunes, 8 de noviembre de 2021
6:00 PM MT a 8:00 PM MT / 7:00 PM PT a 9:00 PM PT

Cualquier persona puede unirse o ver esta reunión.

Para asistir en directo, regístrese aquí

Para ver la grabación después, vaya al canal de YouTube del DD Council.

2. Los abogados de K.W. v. Armstrong celebrarán una reunión privada sólo para las personas que reciben servicios de Medicaid DD en Idaho y su defensor principal. Esta reunión no será registrada.

Jueves, 11 de noviembre de 2021
1:30 PM MT a 3:30 PM MT / 12:30 PM PT a 2:30 PM PT

Debe registrarse con antelación para asistir. Regístrese aquí

3. Medicaid de Idaho planea publicar una grabación de video sobre las reglas. ¡Manténgase atento para obtener un enlace a la grabación una vez que se publique!

The next big step for the new budget tool is here: new Medicaid rules!

(View this message on the web in English.)

(Ver esta publicación en español.)

The new budget tool is coming in June 2022. Before then, Idaho Medicaid still has work to do to get it ready. The next big step is coming up. Idaho Medicaid will make new rules so it can use the new tool.

To make those rules, Idaho Medicaid has to get your feedback. That starts next month, November 2021. Medicaid will hold something called “negotiated rulemaking” to get your comments.

You can read the draft rules that Idaho Medicaid wants to make here.

 

You can share your feedback in two ways:

1.   You can share it at a special video meeting on Tuesday, November 16, 2021, at 2:00 PM MT / 1:00 PM PT.

Join the meeting by video: https://bit.ly/Nov16rules
Or call in:           1-415-655-0003 or 1-720-650-7664

Access code:        2467 615 8964
Password:           6KjTpTNMS35, or 65587866 from a phone

2.   You can write out your comments and send them to Medicaid by Friday, November 26, 2021.

Email them to: dhwrules@dhw.idaho.gov
Or mail them to:

DHW Rules
PO Box 83720
Boise, ID  83720-0036

Before then there are three chances to learn more and get ready to share your feedback:

1.   The Idaho Council on Developmental Disabilities will join with the K.W. v. Armstrong lawyers for a public meeting to help you get ready to share your feedback. You can attend live or watch a recording after.

Monday, November 8, 2021
6:00 PM MT to 8:00 PM MT / 7:00 PM PT to 9:00 PM PT

Anyone can join or watch this meeting.

To attend live, register here.
To watch the recording after, go to the DD Council’s YouTube channel.

2.   The K.W. v. Armstrong lawyers will hold a private meeting just for people who get Medicaid DD services in Idaho and their primary advocate. This meeting will not be recorded.

Thursday, November 11, 2021
1:30 PM MT to 3:30 PM MT / 12:30 PM PT to 2:30 PM PT

You must register in advance to attend. Register here.

3.   Idaho Medicaid is planning to post a video recording about the rules. Stay tuned for a link to the recording once it is posted!

Notice of Monitor at Grand Teton Residential Treatment Center

DRI is Idaho’s Protection and Advocacy System (P&A).  Each state’s P & A is part of a federally mandated system with the authority and obligation to protect and advocate for the human and legal rights of individuals with developmental disabilities, mental illness and/or other disabilities.  Developmental Disabilities Assistance and Bill of Rights Act (PADD), 42 U.S.C. § 15001, et seq.; Protection and Advocacy for Individuals with Mental Illness Act (PAIMI), 42 U.S.C. §10801; and, Protection and Advocacy for Individual Rights (PAIR), 20 U.S.C. §794e.  Since our establishment in 1977, we have visited facilities/service providers across the state to monitor the rights and safety of individuals with disabilities, as well as to provide information to individuals with disabilities about our organization.

 

Pursuant to the authority above, DRI staff will visiting Grand Teton Human Services the week of August 30, 2021. Our visit to the facility is for monitoring purposes, which simply means that we will be visiting the facility, speaking with residents and staff, and observing the general atmosphere and environment of the facility to monitor for compliance regarding safety and clients’ rights.

 

If you should have any questions or concerns about this, please feel free to contact us at 1-866-262-3462.

 

Please click here to download a PDF version of this notice.

Video

Confidentiality in Mental Health Sessions

DisAbility Rights Idaho and Idaho Federation of Families present: Minors’ Rights in Mental Health Treatment

Click here to download a PDF explaining confidentiality in youth mental health sessions

Idaho Federation of Families for Children’s Mental Health is conducting a survey of youth who view this video about Confidentiality in Mental Health Sessions.

Please click below link to provide feedback. Thank you!

https://lp.constantcontactpages.com/sv/4DzamU9