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Without providing adequate notice to his family, the state reduced and then ended Therapeutic Behavioral Services (TBS) for “Abdul,” a 13-year-old boy with cerebral palsy, autism, stereotypic movement disorder, and intellectual disability. DRM advocated for Abdul to be reinstated into his previous level of TBS pending his appeal. While the state ultimately authorized these hours pending the hearing, but before Abdul could receive them, he was hospitalized in a psychiatric facility for several weeks, which according to his neurologist, was due in part to the lack of in-home TBS services. DRM provided extensive support, including answers to legal questions and strategic advice, to a pro bono attorney who represented Abdul in appealing the reductions and termination of TBS hours. The administrative law judge found that the reductions below 40 hours/week of TBS, and the subsequent termination of his hours altogether, were improper. We will follow up to ensure that Abdul connects with an agency able to provide the ongoing 40 hours/week TBS services.

DRM represented “Yesenia,” who despite her severe physical disability, had maintained her job as an inclusion school teacher for the past 15 years with the assistance of 90 weekly hours of attendant care under Medicaid, first under a waiver program and then under Medicaid Community First Choice (CFC). Yesenia had also been able to purchase her own home. When DHMH terminated the self-directed option under CFC and transferred her services to an agency, the state reduced her hours to 77 per week but failed to send her written notice with appeal rights in accordance with the law. Yesenia’s ability to continue working, paying her mortgage and living in the community rather than a nursing facility was at risk, as she could not afford to pay for the additional care she needed and thus intended to quit her job unless she received the full 90 hours of care. She came to DRM when appealing a later request to restore her from 77 to 90 weekly hours. We represented her to get the Department of Health and Mental Hygiene (DHMH) to restore her to 90 hours pending the appeal hearing and advocate on the merits for the restoration of her approval for 90 hours. While DHMH did restore her to 90 hours until the hearing, they refused to reverse their decision on the merits. We referred the case to a pro bono attorney with limited experience and provided many hours of technical assistance to her on handling the case over several months. After negotiations, the week before the scheduled hearing, DHMH rescinded its decision to cut Yesenia’s hours and restored her to 90 hours/week.

DRM received a complaint from the father of “August,” a male resident at a state psychiatric hospital who was receiving inpatient treatment for Bipolar Disorder. Throughout August’s stay at the hospital, his father attended all of his treatment planning meetings as his advocate. However, when he was transferred to a different ward, August’s new treatment team denied him the right to have an advocate attend his individual treatment planning meetings. DRM investigated by reviewing August’s records and interviewing hospital staff members. We discovered that denying residents the right to have an advocate attend treatment planning meetings was an ongoing ward practice designed to promote “patient independence” by cutting off family involvement in their mental health treatment. DRM determined that this practice was in clear violation of Maryland law. August and his family also reported that the other residents on the ward were afraid to contact DRM about the practice because they feared retaliation from the treatment team. DRM wrote a complaint to the hospital CEO and Office of the Attorney General (OAG) demanding that the practice be discontinued. During DRM’s investigation, the OAG re-educated all hospital employees on patients’ rights. DRM later conducted a monitoring visit on the ward and determined that the practice had been discontinued. We also conducted a rights presentation to all residents on the ward. A few days after the monitoring visit and rights presentation, DRM received numerous calls from ward residents to inform us about other rights violations that they had experienced on the ward.