In the Appeal of: Z A
For: Medical
Assistance - Consumer Directed Community Supports
Agency: Minnesota
Department of Human Services
Docket No: 81606
On November 19, 2004 , a
hearing was held before Referee Lawrence D. Grewach to review a decision
of the Minnesota Department of Human Services, as provided by Minnesota
Statutes, section 256.045, subdivision 3. The following persons appeared at the
hearing:
B A, father of
appellant
Jennifer
Stockwell, state agency legal analyst
Gerald Nord,
supervisor, state agency disabilities services division
After reviewing the evidence and
considering the arguments of the parties, the referee recommends the following findings
of fact, conclusions of law and order.
The issue raised in this appeal
is:
Whether the Minnesota Department of Human Services correctly reduced the appellant’s budget under the Consumer Directed Community Supports program on the ground that it acted in accordance with federal requirements.
1. The Minnesota Department of
Human Services sent the appellant a written notice of action. On behalf of the
appellant, her parents signed an appeal request. The request was received by
the state agency on October 13, 2004. The hearing was held on November 19,
2004. The record, which has 6 exhibits, was closed on that date.
2. The appellant is a recipient of Medical Assistance (MA)
under the waiver for persons with mental retardation or related conditions
(MR/RC). She has been diagnosed as having cerebral palsy and mental
retardation. The appellant also is deaf. She is appealing from the state
agency's reduction of her budget for services under the Consumer Directed
Community Supports (CDCS) program of the MR/RC waiver. The state agency
maintains that it reduced the budget on the ground that it acted in accordance
with federal requirements.
3. CDCS is a program offered to MA recipients in the MR/RC
waiver. In 2002, the state agency obtained a waiver from the federal government
to operate the CDCS program. Under CDCS, recipients have a budget amount for
services. Prior to October 2004, the county agencies screened CDCS recipients
to determine their need for services and set individual budgets for services to
CDCS recipients.
4. In March 2004, the federal government approved an
amendment to the CDCS waiver plan. Under the amendment, the state agency began
setting the budget individual budgets for services to CDCS recipients, starting
in October 2004. The county agencies would continue to screen recipients to
determine their need for services. The waiver amendment also created a new standardized
statewide formula for determining the budgets for CDCS recipients. Under the
waiver amendment, a recipients budget is based by applying the new formula to
the most recent screening.
5. As a result of the waiver amendment, the appellant’s
yearly budget will decrease from $37,931 to $29,900. The appellant’s father
contends that the budget will not meet the appellant’s expenses and that the
county agency’s most recent screening does not accurately reflect the appellant’s
medical condition. In response, the state agency took the position that the
appellant should ask the county agency for a new screening.
6. The county agency declined to participate in the
hearing. The county agency took the position that the state agency was now
responsible for setting a budget amount.
1.
The appeal is timely pursuant to Minnesota Statutes, section 256.045,
subdivision 3.
2. The Commissioner of Human
Services has jurisdiction over this appeal under Minnesota Statutes, section
256.045, subdivision 3.
3. Under the Laws of Minnesota
1997, Chapter 203, Article 7, section 27, the state legislature authorized the
state agency to seek a waiver of federal laws and regulations regarding services
to persons with mental retardation or related conditions that would maximize
the number of persons served within the limits of appropriations and divert
persons from institutional placement. The state agency obtained the waiver for
CDCS from the federal government. Under the law in Minnesota Statutes, section
256B.092, subdivision 4(a), the state agency is required to make payments to
approved vendors participating in the medical assistance program to pay costs
of providing home and community-based services&to medical assistance
eligible persons with mental retardation or related conditions who have been
screened&and according to federal requirements.
4. Under the 2004 waiver
amendment, the federal government has given its approval to a new standardized
statewide formula for determining the budgets for CDCS recipients. Under the
waiver amendment, , a recipients budget is based by applying the new formula to
the most recent screening. Here, the state agency applied the new formula to
the most recent screening. Thus, the state agency’s budget for the appellant
meets federal requirements. As a result, the budget reduction should be
affirmed.
5. The appellant’s father
contends that the most recent screening does not accurately reflect the appellant’s
medical condition. Under subdivision 7 of section 256B.092, screening teams
evaluate the need for the [recipients] level of care. A screening team consists
of a case manager for the county agency, the recipient, the recipients parent,
legal guardian or conservator and a qualified mental retardation professional.
The state agency correctly notes that the appellant can ask for a new screening
if she believes that the current one does not accurately reflect her level of
care. The issue here, thus, is not the contents of the current screening.
Instead, the issue is whether the state agency acted in accordance with federal
requirements. Because of that, the appellant’s argument is not accepted.
RECOMMENDED
ORDER
THE REFEREE RECOMMENDS THAT,
according to the findings of fact and conclusions of law, the agency’s budget
reduction be affirmed.
________________________ ___________
Lawrence D. Grewach Date
Appeal Referee
ORDER
OF THE COMMISSIONER
IT IS THEREFORE ORDERED THAT
based upon all the evidence and proceedings, the Commissioner of Human Services
adopts the referees recommended findings of fact, conclusions of law, and order
as his final decision.
________________________ ___________
Kenneth M. Mentz Date
Chief Appeals Referee
Appeals and Regulations
Division
cc:
B A, parent of appellant
DHS Jennifer
Stockwell - 3872
Right of Appeal to District Court and/or
Reconsideration
An appellant or county agency who disagrees with this
decision may:
Start an appeal in the district
court. This is a separate legal proceeding, and you must start this within 30
days of the date of the appeal decision by serving a notice of appeal upon the
other party. The law that describes this process is Minnesota Statutes, section
256.045, subdivision 7.
or
Ask the appeals office to
reconsider this decision. You must put this request in writing, and state the
reason(s) you believe the decision is incorrect. Send the request within 30
days of the date of the decision to:
Appeals Office
Department of Human Services
444 Lafayette Road
St. Paul, MN 55155-3813
The
appeals office will deny or consider this request, at which point you can still
appeal to district court.