Jay Hi/I Palm Street Little Rock 72205 501-686-9168 Printed: 12/22/2017 3:45 PM -Arkansas - 0MB No. 0930-0169 Approved: 07/17/2017 Expires: 07131/2020 Page 2 of 82 3 0 5 o u t
B. Demographics - Intervention on Behalf of Individuals Served PAIMI-Eligible Individuals served with PAIMI Program Funds Count individual once per fiscal year (FY). Multiple counts not permitted for lines 1-2. Enter Nllmber 1. Number of PAIMl-eligible individuals served with PAIMI Program funds, includes any program income resulting from legal actions supported by PAIMI Program funds as of October 1 2016.(only cases carried over from previous FY). 32 2, Number of new PAIMI-eligible individuals served during the FY 2017, 92 3. Total number of PAIMI-eligible individuals served during this FY 2017 (Add lines 1 and 2). 124 4, Total number of PAIMI-eligible individuals who requested program related advocacy services ,but were NOT served within 30 days of initial contact because of: a. insufficient PAIMI Program resources. 1 b. non prlority areas. 2 5, Individuals seived as of September 30, 2017 (Carry over to next FY; this should be less than or equal to the total in item #3). 33 Footnotes: Printed: 12/22/2017 3:45 PM -Arkansas - 0MB No. 0930-0169 Approved: 07/17/2017 Expires: 07/31/2020 Page 13 of 82
Independent (in the community & PAIMl-eligible) within 90 days post-discharge from a facility after 90 days of discharge 0 22 Parental or Other Family Home & PAIMl-eligible within 90 days post-discharge from a facility after 90 days of discharge 0 58 Unknown 0 Total -·· ·-·-···-··-···- -· · ' -·-···---·-·····----·.,_, .... -· ' - ' ,,, ··--- ··-·- ", .. as,_,_ ......... ,, _,..,........ - 124 ·---·--·-·--·'"·- Footnotes: - ' ' , .,
Complaints/Problems of PAIMI Eligible Individuals Interventions on Behalf of Groups of PAIMI-Eligible Individuals Multiple counts not permitted for lines 1 -3 and 6. .vf' ···..·..... .;'..:..I.··:··b····i··>·:·.;·;:··\··:·..·I. Ii....'\lk;r·;i·,·•·.·..:}·:..>:.:;,.;.t.i...}.:•< rIJt..1.:...'.'.·:.:.0·· ·::.f ..·.::······ Types of Interventions Potential # of Individuals Concluded Successfully Concluded Unsuccessfully On-going Impacted Group Advocacy non- litigation 0 0 0 0 Investigations (non-death related) 0 0 0 0 Facility Monitoring Services 2630 20 0 5 Court Ordered Monitoring 0 0 0 0 Class Litigation 0 0 0 0 Legislative & Regulatory Advocacy 14100 4 1 4
Grievance Procedures Grievance Procedures F Printed: 12/22/2017 3:45 PM -Arkansas - 0MB No. 0930-0169 Approved: 07/17/2017 Expires: 07/31/2020 Page 28 of 82
PAIMI Budget - Actual PAIMI Expenditures and Revenues PAIMI Expenditures 1. Does your P&A have an approved Federal indirect cost rate? If yes, what is the approved rate? C Yes No 0.00% 2. Total indirect costs 0 3, Total of all PAIMI program costs listed in I vm in the Budget 412184 Income sources and other resources (PAIMI program only) 1. PAIMI program carryover of grant funds identified by FY. Enter the last two digits of the Fiscal Year FY 16 147605 2. Interest on Lawyers Trust Accounts 0 3. Program income (PAIMI only) 0 4. State 0 5. County 0 6. Private 0 7. Other funding sources [identify each source] Printed: 12/22/2017 3:45 PM - Arkansas - 0MB No. 0930-0169 Approved: 07/17/2017 Expires: 07/31/2020 . Page 37 of 82
Target Population: PAIMI eligible individuals who need proper supports to transition to the community from an institutional setting, or who are already living in the community but are at risk of institutionalization because of inadequate community supports. Expected Target: 7 Printed: 12/22/2017 3:45 PM -Arkansas - 0MB No. 0930,0169 Approved: 07/17/2017 Expires: 07/31/2020 Page 39 ol 82
TABLE of CONTENTS SECTION TITLE PAGE A. GENERAL INFORMATION 3 B. PAIMI ADVISORY COUNCIL (PAC) MEMBERSHIP 4 c. PAC ETHNICITY/DIVERSITY 6 D. GENDER 6 E. GOVERNING BOARD INFORMATION 7 F. PAC ACTIVITIES 8 G. PAC ASSESSMENT OF PAIMI PROGRAM OPERATIONS 13 H. GRIEVANCE PROCEDURES 15 2 Printed: 12/22/2017 3:45 PM -Arkansas - 0MB No. 0930-0169 Approved: 07/17/2017 Expires: 07/31/2020 Page 48 of 82
H,2, The number of grievances filed by PAIMl-eligible clients, including representatives or family-members of such Individuals receiving services during this fiscal year. Total 0 H,3. The number of grievances filed by prospective PAIMI- eligible clients (those who were not served due to limited PAIMI Program resources or because of non-priority Issues), Total 1 H,4, Add H.2 & H.3 [42 CFR Section 51.25(a)(1),(2)] Total 1 11\ ''1"6 - ,ri f ri Vil11(?B -: pe dJb: :•-····-.•. ·. . .. :·· .. H.5. a. The Governing Board (the PAC Chair of a private, non- profit P&A system should have this information). Total 0 H.5.b, The Executive Director Total 1 H,5 c. The number of Grievances appealed [H,5.a. + H.5.B = H.5.c.], Total 0 H.6. The number of reports sent to the Governing Board AND the PAC (at least one annuall'll,) that describe the grievances received, processed, and resolved, Total 1 mrjffi,btJt ;;j\ tiiti,,!rliii I·; ji re"'!l1J ii:i ijt3,f§ 2t1 t_:§•t1 :§.1);:Jtji H.7. Please identify all individuals, by name & title, responsible for P&A system grievance reviews. DRAStaff: Debra Poulin, Legal Director Tom Masseau, Executive Director DRA Board of Directors: Cherokee Bradley, ORA Board President Fred Reinheardt, DRA Board Vice-President Kimberly Marshall, ORA Board Treasurer Teresa Dodson, ORA Board Secretary
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