In the Appeal of: T U
For: Medical
Assistance - Consumer Directed Community Supports
Agency: Minnesota
Department of Human Services
Docket No: 81460
On November 30, 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:
V U, father of
appellant
W U, mother of
appellant
X Y, caregiver
for appellant
Z Z, caregiver
for appellant
Jennifer
Stockwell, state agency legal analyst
Gerald Nord,
supervisor, state agency disabilities services division
Kathleen Kelly,
state agency supervisor
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, his parents signed an appeal request. The request was received by
the state agency on October 4, 2004. After one continuance, the hearing was
held on November 30, 2004. The record, which has 8 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). He has been diagnosed as having mental
retardation. He is appealing from the state agency's reduction of his 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 budget will decrease from $176.98 a day to $67.87
starting in April 2006. The appellant’s parents and caregivers contend that the
budget will not meet the appellant’s expenses. The appellant’s mother testified
that the county agency’s most recent screening is generally accurate but does
not completely 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 parents
contend that the most recent screening does not completely 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 he believes that the current one does not accurately reflect his 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:
V and W U, parents of appellant
DHS Jennifer
Stockwell - 3872
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.