Hutchings Ex Rel. Hutchings v. Roling

193 S.W.3d 334, 2006 Mo. App. LEXIS 413, 2006 WL 851824
CourtMissouri Court of Appeals
DecidedApril 4, 2006
DocketED 85999, ED 86019
StatusPublished
Cited by23 cases

This text of 193 S.W.3d 334 (Hutchings Ex Rel. Hutchings v. Roling) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hutchings Ex Rel. Hutchings v. Roling, 193 S.W.3d 334, 2006 Mo. App. LEXIS 413, 2006 WL 851824 (Mo. Ct. App. 2006).

Opinion

KATHIANNE KNAUP CRANE, Presiding Judge.

In this consolidated appeal, both parties challenge the trial court’s award of attorney’s fees to plaintiff in the amount of $25,000 pursuant to section 536.087 RSMo (2000). Defendant, the director of a state agency, argues that the court should not have made any fee award because the underlying proceeding was not an “agency proceeding,” as defined in section 536.085(1) RSMo (2000), and his position was substantially justified under section 536.087. Defendant also maintains that no special factor justified a fee award in excess of $75.00 per hour under section 536.085(4). Plaintiff cross-appeals on the grounds that the trial court abused its discretion in making an award that was $17,000 less than that billed and requested, because the trial court’s findings did not support a conclusion that a lesser fee was reasonable. We reverse that part of the judgment that awarded a fee in the amount of $25,000 and remand with directions. In all other respects, the judgment is affirmed, including that part of the judgment that awards a fee in excess of $75.00 per hour.

FACTUAL AND PROCEDURAL BACKGROUND

This appeal involves the Medicaid program and actions by two state departments and various divisions within those departments. As an aid in understanding the factual chronology, we will first describe the Medicaid program and the state agencies involved in this case.

1. Medicaid Program

Medicaid is a joint federal-state program that seeks to provide medical assistance to low-income individuals who are unable to meet the costs of their medical care. See 42 U.S.C. section 1396 et seq. (commonly known as the Medicaid Act); Boulet v. Cellucci, 107 F.Supp.2d 61, 64 (D.Mass.2000). The federal government provides financial assistance through the Medicaid program to those states that elect to participate in the program in order to aid those states in providing health care to individuals in need. Boulet, 107 F.Supp.2d at 64. If a state chooses to participate in *341 the Medicaid program, the state must comply with all federal statutory and regulatory requirements. Id. One of those requirements is that the state must submit a state plan providing that “all individuals wishing to make application for medical assistance under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals.” 42 U.S.C. section 1396a(a)(8). Missouri has elected to participate in the Medicaid program. Maples v. Department of Social Services 11 S.W.3d 869, 872 n. 3 (Mo.App.2000).

The Medicaid Act allows states to provide home or community-based services in lieu of institutional care with Medicaid coverage through its waiver provision. 42 U.S.C. section 1396n(c)(l); Boulet, 107 F.Supp.2d at 64. Missouri has a Medicaid waiver plan.

2. The State Agencies

a. Department of Mental Health (DMH)

DMH was established as a state agency by section 630.003 RSMo (2000). The Division of Mental Retardation and Development Disabilities (MRDD) was a division within DMH. Through an interagency agreement, MRDD administered Missouri’s Medicaid Home and Community Based Services (Medicaid HCBS) Waiver program, which included determination of client eligibility.

b. Department of Social Services (DSS)

DSS was established as a state agency by section 660.010 RSMo (2000). Dana Katherine Martin served as Director of DSS at the beginning of the events chronicled in this case. Ms. Martin was succeeded by Steven Renne, who served as Acting Director, and then by defendant, Steven Roling, who served as Director.

The Division of Medical Services (DMS) was a division within DSS. DMS was established by section 208.201 RSMo (2000). Gregory A. Vadner served as Director of DMS. DMS was responsible for the development, administration, and enforcement of Missouri’s medical assistance programs, including the Medicaid program. Section 208.201.3. See 42 U.S.C. section 1396a(a)(5). However, as set out above, MRDD, a division of DMH, administered the Medicaid HCBS Waiver program. DMS also had a Quality Services Unit, which employed Dean Adkins, R.N. Nurse Adkins coordinated administrative hearings for DMS.

The Division of Legal Services (DLS) was another division within DSS. DLS had the Administrative Hearing Unit that conducted the administrative hearing that is the subject of this case.

2. Chronology

On May 10, 2002, plaintiff, Patrick J. Hutchings, applied to MRDD for the Medicaid HCBS Waiver program. On May 17, 2002, MRDD sent plaintiffs guardian, John R. Hutchings, a document entitled “Official Memorandum,” which advised guardian that although plaintiff was eligible for the waiver program, the state did not have sufficient funding to grant waiver slots to all eligible individuals. The memorandum further advised that plaintiffs name had been added to a waiting list and as funding became available, individuals on the waiting list would be served based on prioritized need, and not in the order in which the individual’s name was added to the list. The memorandum also advised guardian that he had appeal rights through both DMH and DSS.

After guardian expressed his desire to appeal MRDD’s action and requested a hearing, Nurse Adkins sent guardian a letter advising him that DMS had received *342 his request for a hearing and had determined the issue he raised could be appealed. The letter included a Missouri Medicaid Hearing Request Form for guardian to fill out and return to DMS, and advised guardian that when DMS received the completed form, DLS would set a hearing. Also enclosed with the letter was a document entitled “Important Information About Your Hearing” that described the hearing process and the decision-making process. The document explained that after the hearing, the hearing officer would send his or her recommendation to the Director of DMS, who would enter a decision and order based upon the evidence and testimony presented at the hearing and the recommendation of the hearing officer. The document also explained that if guardian was dissatisfied with the DMS director’s decision, he could appeal the decision and order to the circuit court.

Guardian thereafter requested a hearing on the Missouri Medicaid Hearing Request Form. On the lines for stating the reason for the hearing request, guardian wrote that DMH “refused to issue a Medicaid waiver slot to [plaintiff] after DMH determined that he is eligible and that unused waiver slots exist.”

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Bluebook (online)
193 S.W.3d 334, 2006 Mo. App. LEXIS 413, 2006 WL 851824, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hutchings-ex-rel-hutchings-v-roling-moctapp-2006.