A.A.A. v. Minnesota Department of Human Services

818 N.W.2d 552, 2012 WL 2505839, 2012 Minn. App. LEXIS 58
Court of Appeals of Minnesota·Decided July 2, 2012·No. No. A11-1831·Published·Cited by 4 cases

Opinion

OPINION

COLLINS, Judge*

Appellant Minnesota Department of Human Services (DHS) challenges the district court’s reversal of its determination to reduce respondent’s personal-care-assistance services in response to legislative changes to Minnesota’s medical-assistance program. DHS argues that the district court erred in interpreting the personal-care-assistance statute by concluding that respondent A.A.A. is dependent in mobility, a critical activity of daily living. Because we conclude that respondent is not dependent in mobility under the statute, we reverse.

FACTS

Respondent is a child with autism who receives personal-care assistance (PCA) under the state’s medical-assistance program. In 2009, the Minnesota Legislature changed the method used by DHS to calculate the amount of time a qualified individual is entitled to receive PCA. See 2009 Minnesota Laws, ch. 79, art. 8, §§ 85-86, at 935 (renumbering and repealing relevant statutes); 20-21, at 856-57; 28, at 875-78; 31, at 879-900 (enacting relevant current statutes).

The new method requires calculation of a “home care rating” and identifies three criteria to determine the home care rating: (1) the individual’s dependent activities of daily living (ADLs); (2) the individual’s complex health-related needs; and (3) the individual’s Level I behaviors (behaviors). Minn.Stat. § 256B.0652, subd. 6(b) (2010). An individual may be allotted PCA time in addition to the base allotment resulting from the calculated home care rating. Id., subd. 6(c) (2010).

Respondent was initially assessed by a public health nurse, who determined his home care rating was “U,” a rating that applies to individuals who have four to six ADL dependencies and one or more complex health-related needs. The base amount of PCA time for a “U” rating is 210 minutes.

The first criteria, dependent ADLs, are daily living activities for which “a person requires assistance to begin and complete” or the person needs “cuing and constant supervision to complete the task” or the person needs “hands-on assistance to complete the task.” Minn.Stat. § 256B.0659, subds.1(f), 4(b)(1)(i-ii) (2010). There are eight ADLs. Id., subd. 2(b)(1-8) (2010). Four of the eight ADLs, including “mobili[554] ty,” are classified as “critical.” Id., subd. 1(e) (2010). An individual is allotted an additional 30 minutes per day of PCA for every critical ADL in which they are dependent. Minn.Stat. § 256B.0652, subd. 6(c)(1).

The second criteria, complex health-related needs, are categories of interventions ordered by a physician. Minn.Stat. § 256B.0659, subd. 4(c)(l-8) (2010). There are eight categories of complex health-related needs, including a general-need category for “other congenital or acquired diseases creating a need for significantly increased direct hands-on assistance and interventions in six to eight [ADLs].” Id., subd. 4(c)(8) (emphasis added). An individual is allotted an additional 30 minutes per day of PCA for every identified complex health-related need. Minn.Stat. § 256B.0652, subd. 6(c)(2).

The third criteria, behaviors, are specific behaviors for which an individual requires assistance at least four times a week. MinmStat. § 256B.0659, subd. 4(d) (2010). There are three categories of behaviors. Id., subd. 4(d)(1-3). An individual is allotted an additional 30 minutes per day of PCA for every present behavior. Minn. Stat. § 256B.0652, subd. 6(c)(3).

Following the 2009 legislative changes, DHS developed guidelines for use by public health nurses conducting assessments. The public health nurse found that respondent was dependent in five ADLs, including two critical ADLs, but did not find respondent to be dependent in the critical ADL of “mobility.” For an individual older than two years of age, the guidelines define a dependency in mobility as an inability to ambulate without the assistance of a device. The public health nurse found that respondent had one complex health-related need due to a seizure disorder. The public health nurse found that respondent exhibited all three behaviors. Combining the base allotment with two identified critical ADLs, one complex health-related need, and the presence of three behaviors, the public health nurse recommended 390 minutes of PCA daily (210 + 60 + 30 + 90=390).

Respondent appealed to DHS and, following a hearing, an administrative law judge (ALJ) found that respondent was dependent in mobility, and thus, was entitled to an additional 30 minutes of PCA for the critical ADL. The ALJ also found that respondent had six ADLs and a “congenital disease that clearly creates a need for significantly increased hands-on assistance,” and thus, was entitled to an additional 30 minutes of PCA for the additional complex health-related need.

Regarding respondent’s mobility issues, the ALJ found:

[Respondent] is constantly active and makes frequent attempts [to] leave a room or wander away from his care providers when in public. Because [respondent] does not respond to verbal commands, when he is walking, direct physical contact must continuously be maintained to cue and constantly maintain supervision of [respondent]. Approximately one month prior to the fair hearing, the police had to be called when [respondent] managed to evade his school driver and somehow made his way to downtown Minneapolis; he was missing for two hours, but was fortunately not injured, although he was spotted by a neighbor about a mile from where he had fled in a street paying no heed to traffic. [Respondent] also frequently has to be physically restrained to keep him from engaging in dangerous or harmful actions, such as touching a hot stove.

Based on the finding that respondent had a dependency in mobility and an additional complex-health related need, the ALJ concluded that respondent was entitled to an [555] additional 60 minutes of PCA daily, for a total of 450 minutes, and recommended that DHS’s determination of 390 minutes be reversed.

A chief ALJ subsequently issued an amended order, rejecting the ALJ’s recommendation. The chief ALJ concluded that respondent was entitled to 390 minutes of PCA, based on the finding that respondent was not dependent in mobility and, thus, did not have six ADLs or an additional complex health-related need. Regarding respondent’s mobility issues, the chief ALJ found:

The [public health nurse] was correct in finding that [respondent] does not have a dependency in mobility because he is physically able to walk. The fact that he needs to be supervised so that he does not harm himself while out walking in public, for example, is properly accounted for by the daily PCA time allotted for his behaviors.

Respondent appealed to the district court. The district court reversed the determination of the chief ALJ, concluding that respondent is dependent in mobility, has an additional complex health-related need, and thus, is entitled to 450 minutes of PCA. Regarding respondent’s mobility issues, the district court found:

[Respondent] has to be physically moved away from dangerous situations, and will try to run away if someone is not holding his hand

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A.A.A. v. Minnesota Department of Human Services, 818 N.W.2d 552, 2012 WL 2505839, 2012 Minn. App. LEXIS 58 (Mich. Ct. App. 2012).

818 N.W.2d 552 (A.A.A. v. Minnesota Department of Human Services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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