News from Self-Advocacy Groups

1 comment

1. 

   TRENA

   November 13, 2011 at 7:08 pm (UTC -8)

   Reply

   THIS IS INFORMATION ABOUT PARTICIPATING IN A LAW SUIT REGARDING IN HOME SUPPORT SERVICES CUTS.

   Hello fellow advocates,

   The attorneys who are trying to stop the state from going forward with the 20% cut need your immediate help to identify possible plaintiffs.

   Two forms are attached: one is a screening tool to help identify possible plaintiffs (along with instructions on how to return the form); the other is a release of information.

   If you qualify as a plaintiff fill out the attached forms and mail them AS SOON AS POSSBILE.

   I encourage each of you to get more people to participate in this action. Unifying our efforts makes us stronger!!

   In Solidarity,

   Raquel Vega

   Raquel Vega

   Community Organizer

   Access to Independence

   8885 Rio San Diego Drive #131

   San Diego, CA 92108

   Phone: (619) 293-3500 ext. 236

   Toll-Free: (800) 300-4326

   Fax: (619) 704-2054

   TDD: (619) 293-7757

   http://www.accesstoindependence.orgScreening to Identify Possible Plaintiffs/Declarants

   INSTRUCTIONS: If you are an IHSS client or know an IHSS client who fits the description below and is willing to talk to our lawyers about participating in a lawsuit to fight IHSS cuts, do the following:

   1.Have the IHSS client fill out the “Information for Follow-Up” below and the attached release ASAP.
   2.Send the information below and the release (if you have it) to Natalya DeRobertis-Theye, either by fax (415-362-8064) or by email (nderobertistheye@altber.com).
   3.Include the client’s NOA (Notice of Action) if available.

   Information for Follow-Up
   Name of IHSS Recipient: ______________________________________
   County: _______________________ Phone number: ________________
   Best day and time to reach: ____________________________________
   E-mail address (if any): ________________________________________

   STEP 1
   Do you believe that a 20% cut will harm you, because you risk institutionalization or will not be safe or healthy in your home?

   Yes/No
   If YES, go to STEP 2; If NO, Stop
   STEP 2

   Answer
   These
   Questions

   
   1) Are you a person who gets IHSS for fewer than 3 PERSONAL CARE TASKS (PERSONAL CARE = BATHING, EATING, DRESSING, MOBILITY INSIDE, BOWEL/BLADDER, TRANSFER, RESPIRATION)?

   2) Are you a person with depression, OCD, or mild cognitive disabilities BUT that does not prevent you from being left alone?

   3) Are you (or is the client) a child or youth under age 21, especially if the parents will not consider out-of-home placement?

   If you answered YES to ANY of these questions, go to STEP 3.
   If you answered NO to ALL of the them, STOP
   STEP 3
   Answer
   These
   Questions
   

   4) Do you get Medi-Cal waiver services through state In-Home operations (also known as IHO) or do you get regional center services?

   5) Do you get hours for protective supervision?

   If you answered NO to both questions 4 and 5,
   we would like you to talk to our lawyers to find out
   whether you fit the profile for challenging the IHSS cuts.
   Authorization For Disclosure of
   Health and Other Information

   NOTE: Your protected health information can be disclosed only if this authorization form is completely filled out and is dated and signed. See, Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations, 45 C.F.R. § 164.508(b)(2)(ii), 164.501; Cal. Civil Code § 56.11, 56.05(f)

   I, __________________________________________________, authorize:
   ___________________________________________________________
   to release my health information (as described below) to Altshuler Berzon LLP, 177 Post Street, Ste 300, San Francisco CA 94108.
   Description of the health and other information to be disclosed (See, 45 C.F.R. §§ 164.508(c)(1)(i)):
   my most recent IHSS notice of action, my SOC 293 form, all medical certification forms from January 1, 2010 to the present.
   Description of each purpose for which my health information is to be disclosed or used See, 42 C.F.R. § 164.508(c)(1)(iv), 164.501: legal representation and at my request.
   I understand that if my protected health information is further disclosed by the recipient of the information, it might no longer be protected under federal health information privacy regulations or California medical information privacy laws, unless it is disclosed to a health care provider or health plan. See, 45 C.F.R. §§ 164.508(a)(1), 164.508(c)(2)(iii), Cal. Civil Code § 56.13. However, other confidentiality requirements may protect my health information from disclosure.
   I have had the opportunity to read and consider this authorization. This authorization is voluntary on my part and has been approved by me.
   I understand that I may revoke this authorization at any time by writing to the provider(s) of the health information named above, except that I cannot revoke this authorization to the extent that any health care provider or health plan named above has taken action in reliance on this authorization. (If I am a nursing home resident, any revocation must be signed in the presence of a representative of Disability Rights California in order for the revocation to be valid.)
   I understand that I have a right to receive a copy of this authorization.
   A photocopy or facsimile of this authorization may be used in place of the original.
   This authorization expires on November 1, 2012.
   Signed: _______________________________ Date: _____________
   Printed Name: ____________________________________
   Relationship or authority of person signing (if signed by personal representative, e.g. parent, guardian, conservator, health care agent). See, 45 C.F.R. §§ 164.508(c)(1)(vi), 164.502(g):___________________________________
   Date of Birth of Patient/Client
   (optional, but important for identification): ___________________________