Alabama Medicaid Agency v. Kerby ex rel. Montgomery

84 So. 3d 95, 2011 WL 5110208, 2011 Ala. Civ. App. LEXIS 290
CourtCourt of Civil Appeals of Alabama
DecidedOctober 28, 2011
Docket2100874
StatusPublished
Cited by2 cases

This text of 84 So. 3d 95 (Alabama Medicaid Agency v. Kerby ex rel. Montgomery) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alabama Medicaid Agency v. Kerby ex rel. Montgomery, 84 So. 3d 95, 2011 WL 5110208, 2011 Ala. Civ. App. LEXIS 290 (Ala. Ct. App. 2011).

Opinions

THOMAS, Judge.

In 2008, Brenda Montgomery, the cousin of Betty Jane Kerby, sought services for Kerby under the Alabama Mental Retardation Home and Community Based Waiver program (“waiver services”) from the Alabama Medicaid Agency (“the Agency”). The waiver services are administered by the Alabama Department of Mental Health (“the Department”) and are provided to persons suffering from an intellectual disability.1 The Department denied Mont[97]*97gomery’s request for waiver services for Kerby, and Montgomery sought review from the Associate Commissioner for the Division of Mental Retardation Services of the Department, who, at that time, was Patricia Martin. Martin upheld the denial of waiver services.

Montgomery then sought a fair hearing from the Agency, which was held before an administrative law judge (“ALJ”). Although the ALJ determined that Kerby qualified for waiver services and recommended that the denial of waiver services be overturned, the Agency’s Commissioner, Carol Steckel, disagreed and upheld the denial of Montgomery’s request for waiver services for Kerby. Montgomery sought judicial review of Commissioner Steckel’s denial of waiver services, and the circuit court overturned the Commissioner’s decision, concluding that it was not supported by the evidence provided to the Agency and the ALJ and that Commissioner Steckel’s decision to deny waiver services was arbitrary and capricious. The Agency appeals.

Under the Alabama Administrative Procedure Act (“AAPA”), Ala.Code 1975, § 40-22-1 et seq., review of the Agency’s administrative decision to deny waiver services to Kerby is limited. See Ala.Code 1975, § 41-22-20(k).

“Section 41-22-20(k) provides that in the circuit court ‘[t]he agency order shall be taken as prima facie just and reasonable and the court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact, except where otherwise authorized by statute.’ Under this limited standard of review, the circuit court must give the Agency’s determination of noneligibility a presumption of correctness. See Benton v. Alabama Board of Medical Examiners, 467 So.2d 234 (Ala.1985).
“In fact, under § 41-22-20(k) the circuit court may reverse or modify an agency’s decision only if it determines that the agency action is due to be set aside or modified under standards set forth in appeal or review statutes applicable to the agency (not applicable in this case) or ‘if substantial rights of the petitioner have been prejudiced because the agency action is:
“‘(1) In violation of constitutional or statutory provisions;
“ ‘(2) In excess of the statutory authority of the agency;
“ ‘(3) In violation of any pertinent agency rule;
“ ‘(4) Made upon unlawful procedure;
“ ‘(5) Affected by other error of law;
“ ‘(6) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or
“ ‘(7) Unreasonable, arbitrary or capricious or characterized by an abuse of discretion or a clearly unwarranted exercise of discretion.’
“This court has held that § 41-22-20(k) ‘recognizes the general rule that judicial review of administrative decisions is limited in scope to whether the order is supported by substantial evidence, whether the agency’s decision is reasonable and not arbitrary, and whether the agency acted within its power conferred upon it by law and the constitution.’ Ferlisi v. Alabama Medicaid Agency, 481 So.2d 400 (Ala.Civ.App.1985).”

Alabama Medicaid Agency v. Norred, 497 So.2d 176, 176-77 (Ala.Civ.App.1986). In [98]*98addition, “an agency’s interpretation of its own regulation must stand if it is reasonable, even though it may not appear as reasonable as some other interpretation.” Ferlisi v. Alabama Medicaid Agency, 481 So.2d 400, 403 (Ala.Civ.App.1985).

At issue in this case is the eligibility of Kerby for waiver services to be provided to intellectually disabled persons under the waiver-services program, as described in Ala. Admin. Code (Alabama Medicaid Agency), Rule 560-X-35-.01 et seq. The qualifications for waiver services are found in Ala. Admin. Code (Dep’t of Mental Health), Rule 580-5-30-.02(3)(a). That administrative rule reads:

“(3) State-Operated Developmental Center. Individuals with mental retardation who reside in the State of Alabama, and who meet the criteria for admission to a developmental center, will be admitted for evaluation for services (or as required by a Court Order), or may be admitted for short-term respite services or crisis stabilization services.
“(a) Admission Criteria: Individuals who meet the following specific criteria may be eligible for residence in the developmental center/intermediate Care Facility for Persons with Mental Retardation (ICF/MR) for the provision of identified services and supports:
“1. The individual has significantly sub-average general intellectual functioning (IQ lower than 70 on a standardized intelligence test), existing concurrently with deficits in adaptive behavior that manifested in the developmental period (before the age of 18 years, for mental retardation).
“2. Community-based services, both generic and specialized, can not afford the person adequate and appropriate services for habilitation.
“3. Residence in a state-operated developmental center is the least restrictive environment adequate for the person’s habilitation at the time.
“4. In order for an individual to be admitted to ICF/MR Active Treatment Services the individual must meet the criteria stated in # 1 through 3 above. Additionally, the individual will benefit from specialized or generic training, treatment, health and related services in three or more of the following areas of life activity: Self-care, Receptive and Expressive Language, Learning, Self Direction, Mobility, and Capacity for Independent Living. These services are directed towards:
“(i) the acquisition of behaviors necessary for the individual to function with as much self-determination and independence as capable; and/or
“(ii) the prevention of regression or loss of current optimal functional status.”

Commissioner Steckel determined that, despite the ALJ’s recommendation otherwise, Kerby did not qualify for waiver services under the requirements stated in Rule 580-5-30-.02(3)(a)(l).

The record contains both documentary and testimonial evidence establishing the following facts. Kerby was born prematurely in Arkansas in November 1946. Kerby moved to Alabama with her mother when Kerby was approximately 14 years old (around 1960). According to the testimony of Montgomery and another relative, Carolyn Turner, at the fair hearing before the ALJ, Kerby had never been “normal.” Kerby did not complete high school, she does not have a driver’s license, and she has never lived independently. Kerby’s [99]

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Bluebook (online)
84 So. 3d 95, 2011 WL 5110208, 2011 Ala. Civ. App. LEXIS 290, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alabama-medicaid-agency-v-kerby-ex-rel-montgomery-alacivapp-2011.