In the Appeal of: I J on Behalf of K
J
For: Mental Retardation/Related
Conditions (MR/RC) Waiver
Consumer Directed Community Supports
Agency: Minnesota
Department of Human Services
Docket: 83043
On
January 31, 2005, Appeals Referee Inta M. Sellars held an evidentiary hearing
under the authority granted by Minnesota Statutes, section 256.045, subdivision
3.
The
following persons participated in the hearing:
I J, Appellant
William Fisch, Appeals Specialist, Ramsey County Community Human
Services Department
Sandra Foy, MR/RC Waiver Coordinator, Ramsey County Community
Human Services
Department
Jennifer Stockwell, Legal Analyst, Minnesota Department of Human
Services (by telephone)
The
referee, based on the evidence in the record and considering the arguments of
the parties, recommends the following findings of fact, conclusions of law and
order.
Whether the state agency properly decreased the
appellants daughters Consumer-Directed Community Support services budget
allotment effective January 1, 2006.
FINDINGS
OF FACT
1.
In October 2004, the county agency sent the appellant of a notice of her
daughters daily budget allotment effective January 1, 2006, for Consumer-Directed
Community Support (CDCS) services funded through the federal waiver for persons
with mental retardation and related conditions (MR-RC). The appellant
requested an appeal on January 7, 2005. She did not send in the appeal
earlier because she thought she had already filed an appeal. [1] A hearing was held at the county
agency offices on January 31, 2005. The referee received three exhibits
and closed the record at the conclusion of the hearing.
2.
K J is a recipient of MR/RC Waiver Services through the CDCS option. The
primary services she receives each year are personal care assistance services
and day-training and habilitation services. The appellant, I J, is K’s mother
and they live together.
3.
As of January 2006, K’s annual allotment of CDCS funding will be reduced to
$131.63 per day, which does not include the cost of her day training and
habilitation services. Her daily rate had been $114.58 per day, not
including the costs of her day training and habilitation services. The
appellant believes that the new allotment will not be enough to cover all of K’s
costs of care. The day training program costs more than $104 per day. Ms. J
needs to work and when she is at work, she cannot be at home with her daughter
to assist her. In addition, when K does not attend her day training and
habilitation services, Ms. J needs to have someone with K. K has behavioral
issues and, for example, will scream. Ms. J is afraid she could lose their
housing because of K’s behavior. The appellant expressed interest in having the
county agency find a group home to place K.
4.
The allocation effective January 1, 2006, was calculated by the state agency,
the Minnesota Department of Human Services, to reflect a 2004 amendment to the
agreement between the federal agency and the state agency that establishes the
MR-RC waiver funding mechanism. The calculation is based an individuals
county screening documents. The state assesses a recipients needs based on 28
characteristics that are related to costs of services. The state uses a formula
that is weighted and reflects the relationship between an individuals
characteristics and the cost of care. The Centers for Medicare and Medicaid
Services, the federal agency overseeing the agreement, approved the formula.
The Department of Human Services has no discretion in applying the formula. Testimony
of Jennifer Stockwell.
5. Ms. J argues that people with mental
illness and disabilities cannot be categorized. Each person is different.
6. K
is due to be rescreened by the county agency. This reassessment may lead to
changes in the screening document that the state agency used to determine her
budget for 2006.
CONCLUSIONS
OF LAW
1.
This appeal is timely. While the appellant did not file the appeal within 30
days of the October notice of action, she did file it within 90 days as
required by law. Minn. Stat. 256.045, subd. 3. She had good cause for
doing so because she though she had already filed an appeal on the issue.
2. The Commissioner of Human Services has
jurisdiction over its subject matter. Minn. Stat. 256.045, subd. 3.
3.
The MR-RC waiver document
permits the state to use Medical Assistance Program funding to pay for certain
non-medical services that arise from medical conditions but which the Medical
Assistance Program would not cover. It is an agreement between the state
and the federal agency and governs coverage of specific services. CDCS is a
service option within the MR-RC waiver.
4.
As to the CDCS daily
allotment, the waiver document effective January 2004 directs the state agency
to set a maximum spending amount for the future that shall not exceed 70% of
the statewide cost of non-CDCS recipients with comparable conditions and
service needs. The required calculation is based on a formula.
Outside the formula, there is no provision to increase the CDCS daily allotment
to ensure that selected services can actually be covered. The state
agency’s calculation of K’s budget must be upheld.
5.
This decision will not prevent appellant from receiving the benefit of any
future system-wide changes that may be instituted by the county or state agency
or the legislature. Also, it will not prevent appellant from obtaining
services through general MR-RC waiver provisions rather than through the CDCS
mechanism.
THE REFEREE RECOMMENDS THAT,
according to the findings of fact and conclusions of law herein, the state
agency be AFFIRMED in its calculation of the daily allotment for the CDCS
service option available effective January 2006 through MR/RC waiver
funding.
________________________________
_____________________________
Inta
M. Sellars Date
Appeals
Referee
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
An
appellant or 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.
cc:
I J, Appellant
William
Fisch, Ramsey County
Jennifer Stockwell, DHS 3857
[1]
Referee Steven Moon handled the appeal. He sent Ms. Medin a letter
stating that the matter would be resolved and if Ms. Medin wanted to go forward
with the appeal, she needed to contact Referee Moon. The appellant did not do
so because she did not receive Referee Moons letter. I have referred the matter
to Referee Moon for further action because the county was not prepared to
address actions occurring in 2003 and 2004 at the hearing on January 31, 2005.