In re Ryan

2008 VT 93, 958 A.2d 678, 184 Vt. 597, 2008 Vt. LEXIS 138
CourtSupreme Court of Vermont
DecidedJune 26, 2008
DocketNo. 07-167
StatusPublished
Cited by4 cases

This text of 2008 VT 93 (In re Ryan) is published on Counsel Stack Legal Research, covering Supreme Court of Vermont primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Ryan, 2008 VT 93, 958 A.2d 678, 184 Vt. 597, 2008 Vt. LEXIS 138 (Vt. 2008).

Opinion

¶ 1. Petitioner Marcella Ryan’s appeal stems from a Department of Aging and Independent Living decision to reduce the number of hours of in-home personal-care services that she receives pursuant to Choices for Care, a state-administered Medicaid waiver program. Petitioner argues that her need for personal-care services has remained the same, and therefore her previous award of 102 hours biweekly should not have been reduced. The Human Services Board concluded that there was insufficient evidence to support the Department’s determination and found for petitioner; however, the Secretary of the Agency of Human Services reversed and reinstated the Department’s decision authorizing fewer hours. We reverse the Secretary and reinstate the Board’s decision.

¶ 2. Petitioner is a fifty-two-year-old disabled woman who suffers from muscular dystrophy, cerebral palsy, visual impairment, gastric problems, neurogenic bladder, chronic urinary tract infections, arthritis, chronic pain, and colonization by antibiotic-resistant bacteria. She has no use of her legs, limited use of her arms and hands, and is wheelchair bound. Since 2001, petitioner has received personal-care services through Department-administered Medicaid waiver programs to assist her with the activities of daily living, allowing her to remain in her home despite her health and functional limitations.

¶ 3. From December 2004 to December 2005, the Department provided petitioner with 102 hours of in-home personal-care services every two weeks based on an Independent Living Assessment completed by her case manager pursuant to Vermont’s Home and Community Based Services (HCBS) Medicaid waiver program. In October 2005, the Department initiated a new Medicaid waiver program called Choices for Care (CFC) to replace HCBS. As an HCBS recipient, petitioner was automatically enrolled in the CFC program at the conclusion of the 2005 service year. Like HCBS, the CFC program provides the nonmedical services necessary for nursing-home-level Medicaid recipients to remain in the community and avoid institutionalization.

¶ 4. In November 2005, petitioner’s case manager, Helen Turcotte, submitted an annual reassessment of petitioner’s need for personal-care service hours. Using the Department’s form to complete the assessment, Turcotte determined that petitioner’s needs were essentially the same as they had been the prior year, and requested 102 hours of care every two weeks. Included in the calculation of 102 hours, petitioner requested a variance for certain activities of daily living, to allow her more personal-care services than the maximum time allotted by the program for those activities. On December 12, 2005, the Department notified petitioner that it was approving her for only 75 service hours biweekly for the period beginning December 16, 2005 and ending December 15, 2006. Petitioner filed a timely appeal, requesting a fair hearing.

¶ 5. On March 8, 2006, the hearing officer held a status conference at which the parties were asked to consider the reason for the reduction in service hours [598]*598and determine whether they could agree on the number of service hours needed by petitioner. In October 2006, petitioner’s case manager again conducted an annual reassessment under the CFC program, and submitted a request for 97 hours of personal-care services every two weeks which also included a variance request for certain activities. Upon review of the assessment, the Department approved petitioner for 79.5 hours of personal-care services for the program year beginning in December 2006. Petitioner appealed the decision, again requesting a fair hearing.

¶ 6. The Board held a hearing on the appeals on January 8, 2007. At the hearing, the Department called a single witness, nurse Toni Morgan, the Long Term Care Clinical Coordinator who reviewed petitioner’s reassessments on the Department’s behalf and ultimately recommended reducing petitioner’s personal-care service hours. Petitioner presented the testimony of her case manager and her longtime primary-care physician, and testified on her own behalf. In addition, she submitted a letter of support from the nurse who had assisted her case manager in completing the reassessments at issue. The Board determined that the Department had the burden of proof “to show a factual basis supporting a reduction of service hours,” and that it failed to meet that burden in light of the evidence supporting petitioner’s position that she maintained the same need for personal-care services as in past years. Thus, on March 23, 2007, the Board ordered the Department to provide petitioner with the service hours requested in the assessments prepared by petitioner’s case manager.

¶ 7. On April 5, the Secretary of the Agency of Human Services reversed the Board’s decision and reinstated the Department’s service plan with the reduced hours. The Secretary reasoned that the Board’s decision was unsupported by the evidence, and that the Board had misapplied the agency rule on notice of variance decisions. On April 13, 2007, petitioner appealed the Secretary’s order to this Court.

¶ 8. On appeal, petitioner argues that the Secretary lacked any factual or legal basis on which to reverse the Board’s findings and conclusions. Furthermore, she contends that the Secretary erred in determining that the Department’s notice of reduction of benefits was adequate despite the fact that she was not provided separate notice of the denial of her variance requests.

¶ 9. To begin, the State of Vermont voluntarily participates in the federal Medicaid program. Medicaid was created, in part, to provide medical assistance to disabled individuals who lack the resources to meet their need for medical services, and rehabilitation and other services to help those individuals “attain or retain capability for independence or self-care.” 42 U.S.C. § 1396. Pursuant to the Medicaid program, a participating state is permitted to apply for a waiver of certain requirements of the program to allow it to best meet the medical needs of its residents. CFC is a federally approved Medicaid waiver program developed by the Department to assist disabled Vermonters — who would otherwise “require the level of care provided in a hospital or a nursing facility” — to remain in their homes. Id. § 1396n(e)(l). The program provides in-home nonmedical services to nursing-home-level Medicaid recipients, including personal-care services such as dressing, bathing, and eating assistance based on an individual assessment of need. See Choices for Care 1115 Long-term Care Medicaid Waiver Regulations (VTI)(2)(B)(5) (October 7, 2005).

¶ 10. Under HCBS, the predecessor to CFC, the Department determined that petitioner required nursing-home-level care and was eligible for in-home personal-care services. When it transitioned [599]*599to CFC, the Department automatically enrolled petitioner in the program. Consequently, petitioner’s entitlement to personal-care services under the Medicaid waiver program is not at issue here. Rather, the question at the fair hearing was whether the reduction of petitioner’s service hours from 102 hours biweekly to 75 hours biweekly and 79.5 hours biweekly, respectively for the 2006 and 2007 service years, was appropriate to protect petitioner’s health and welfare as mandated by the program. See Choices for Care 1115 Long-term Care Medicaid Waiver Regulations (II)(A).

¶ 11.

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Bluebook (online)
2008 VT 93, 958 A.2d 678, 184 Vt. 597, 2008 Vt. LEXIS 138, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-ryan-vt-2008.