Krauskopf v. Perales

139 A.D.2d 147, 530 N.Y.S.2d 667, 1988 N.Y. App. Div. LEXIS 7425
CourtAppellate Division of the Supreme Court of the State of New York
DecidedJuly 7, 1988
StatusPublished
Cited by20 cases

This text of 139 A.D.2d 147 (Krauskopf v. Perales) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Krauskopf v. Perales, 139 A.D.2d 147, 530 N.Y.S.2d 667, 1988 N.Y. App. Div. LEXIS 7425 (N.Y. Ct. App. 1988).

Opinion

OPINION OF THE COURT

Mikoll, J.

Petitioners are challenging the promulgation by respondent Commissioner of Social Services of an internal ruling of the Department of Social Services (hereinafter DSS) setting forth the standards for determining which individuals are mentally disabled for Medicaid reimbursement purposes; local governmental entities are entitled to 100% reimbursement from respondent State of New York for the care of mentally disabled individuals pursuant to Social Services Law § 368-a (as amended by L 1983, ch 816, § 1). Petitioners sought a declaration that the definition of mentally disabled individuals was not adopted pursuant to procedures set forth in the Social Services Law, was promulgated in violation of the procedures set forth in the State Administrative Procedure Act, is inconsistent with the Social Services Law in that it excludes numerous persons who are mentally disabled, specifically those mentally disabled individuals who receive only State Medicaid benefits, and that it is otherwise arbitrary and capricious. Petitioners also sought injunctive relief forestalling the continued application of DSS’ ruling. Supreme Court converted the matter to a CPLR article 78 proceeding challenging the definition developed by DSS for reimbursement eligibility pursuant to Social Services Law § 368-a.

As a result of skyrocketing costs which are attributable to the policy inaugurated by the State in deinstitutionalizing mentally ill patients, the State enacted Social Services Law § 368-a (1) (h) (hereinafter referred to as the Takeover Statute). This measure requires the State to reimburse localities for 100% of the localities’ share of the cost incurred for Medicaid services rendered to "those individuals who are eligible pursuant to section three hundred sixty-six of this article as a result of a mental disability as determined by the commissioner in consultation with the commissioner of the office of mental health and the commissioner of the office of mental retardation and developmental disability and with the approval of the director of the budget after first deducting therefrom any federal funds properly received or to be re[150]*150ceived on account thereof’ (Social Services Law § 368-a [1] [h]). The Takeover Statute carries no cap on expenditures.

Petitioners’ challenge stems from a notification to the New York City Human Resources Administration (hereinafter the HRA), dated January 13, 1984, from DSS stating its intention to use the same standard of mental disability utilized in State Finance Law § 54-i (commonly known as, and hereinafter referred to as, the Overburden Law) for implementation of the Takeover Statute. The standard excludes numerous individuals unless they are eligible for Federal nonparticipating Medicaid benefits as a result of mental disability. Also excluded from reimbursement are mentally ill persons who are currently inpatients in voluntary (private), county or municipal psychiatric hospitals, persons with significant histories of prior hospitalizations in the same institutions and all chronic clients of community-based facilities who have not had at least 45 days of continuing treatment visits in any calendar quarter. Supreme Court dismissed the petition, finding as follows: "the documents show a rational and lawful decision has been made by the respondents to develop the Overburden Law definition and then to carry it forward for use under the Takeover Statute, and this Court will not substitute its opinion for that of respondents where the respondents have not been arbitrary or capricious.” Petitioners have appealed.

Addressing petitioners’ challenges ad seriatum, we first consider whether the Commissioner’s failure to formally promulgate the definition of a mentally disabled individual as a rule or regulation violated the State Administrative Procedure Act, which generally provides the public with the right to have notice of and comment upon rules and regulations promulgated by administrative agencies (see, State Administrative Procedure Act § 202). The type of rule required to be promulgated in this manner has been defined by the Court of Appeals as follows: "a fixed, general principle to be applied by an administrative agency without regard to other facts and circumstances relevant to the regulatory scheme of the statute it administers” (Matter of Roman Catholic Diocese v New York State Dept. of Health, 66 NY2d 948, 951). State Administrative Procedure Act § 102 (2) (b) (i) excludes "rules concerning the internal management of the agency which do not directly and significantly affect the rights of or procedures or practices available to the public” from the requirement of notice to affected parties.

We conclude that even though DSS’ definition of a [151]*151mentally disabled individual has a profound impact upon the total amount of Medicaid reimbursement the localities will receive from the State for mentally disabled persons, the. definition does not directly affect "that segment of the 'general public’ over which [the administrative agency] exercises direct authority” (Matter of Connell v Regan, 114 AD2d 273, 276; see, Matter of Jones v Smith, 64 NY2d 1003, 1005; People v Cull, 10 NY2d 123, 129; cf., Matter of Stuyvesant Polyclinic v Axelrod, 117 AD2d 99, 100, 102). The definition of a mentally disabled individual is a rule concerning the internal management of DSS and, as such, is not required to be promulgated pursuant to the notice and hearing mandates of the State Administrative Procedure Act.

Petitioners’ next contention is that DSS violated Social Services Law § 368-a (1) (h) in that it failed to consult with the Commissioner of Mental Health and the Commissioner of Mental Retardation and Developmental Disabilities concerning the establishment of the definition of mentally disabled individuals. We find that a review of the record reveals sufficient interagency consultations in conjunction with DSS’ adoption of the definition for use with the Takeover Statute to evidence compliance with Social Services Law § 368-a (1) (h).

Petitioners also contend that DSS’ definition of mentally disabled individuals for the purpose of determining State reimbursement for local Medicaid expenditures was arbitrary and capricious in that it excludes large numbers of persons who admittedly may be medically disabled under clinical definitions. Petitioners contend that DSS established a narrow, underinclusive fiscal definition which is not in accordance with the Takeover Statute. The Takeover Statute provides that the State shall reimburse localities for the following: "Beginning January first, nineteen hundred eighty-four, one hundred per centum of the amount expended for medical assistance for those individuals who are eligible pursuant to section three hundred sixty-six of this article as a result of a mental disability as determined by the commissioner in consultation with the commissioner of the office of mental health and the commissioner of the office of mental retardation and developmental disability and with the approval of the director of the budget after first deducting therefrom any federal funds properly received or to be received on account thereof’ (Social Services Law § 368-a [1] [h]). Petitioners urge that the language of the Takeover Statute requires State reimbursement for 100% of the cost of medical assistance expended for the [152]*152mentally disabled, which includes more than those fitting DSS’ definition. While the statute speaks to 100% reimbursement, it refers to those who are eligible as determined by

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Bluebook (online)
139 A.D.2d 147, 530 N.Y.S.2d 667, 1988 N.Y. App. Div. LEXIS 7425, Counsel Stack Legal Research, https://law.counselstack.com/opinion/krauskopf-v-perales-nyappdiv-1988.