Young v. Jesson

796 N.W.2d 158, 2011 Minn. App. LEXIS 34, 2011 WL 1364428
CourtCourt of Appeals of Minnesota
DecidedApril 12, 2011
DocketNo. A10-1303
StatusPublished
Cited by2 cases

This text of 796 N.W.2d 158 (Young v. Jesson) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Young v. Jesson, 796 N.W.2d 158, 2011 Minn. App. LEXIS 34, 2011 WL 1364428 (Mich. Ct. App. 2011).

Opinion

[161]*161OPINION

HUDSON, Judge.

Appellant, a recipient of home- and community-based services under Minnesota’s elderly-waiver medical-assistance program pursuant to section 1915(c) of the Social Security Act, challenges the decision of respondent Minnesota Commissioner of Human Services affirming a decision by respondent Steele County Board of Commissioners to refuse to contract with appellant’s chosen provider for those services. Because we conclude that the commissioner erred by determining that the county had authority to restrict appellant’s free choice of providers by declining to contract with a provider otherwise qualified to render services to appellant, we reverse and remand for further proceedings.

FACTS

In 2007, the Steele County Board of Commissioners (county) contracted with Valleyview of Owatonna, LLC, (Valley-view), an assisted-living and memory-care facility, to purchase customized-living services under the Minnesota elderly-waiver program. This program is a home- and community-based-services program operating under a waiver to Minnesota’s medical-assistance plan, as authorized by section 1915(c) of the Social Security Act. 42 U.S.C. § 1396n(c). The elderly-waiver program serves persons age 65 or older who would otherwise be eligible to receive Medicaid benefits in a traditional institution and allows them instead to obtain care in their homes or in community-based residences.

Minnesota operates approved medical-assistance waiver programs under both sections 1915(b) and 1915(c) of the Social Security Act. See 42 U.S.C. § 1396n(b)(l), (c)(1). Section 1915(b) relates to the provision of services for recipients who are enrolled in managed-care organizations. 42 U.S.C. § 1396n(b)(l). Section 1915(c) allows for home- and community-based alternatives to nursing-facility care for individuals who are not enrolled in managed-care organizations. See 42 U.S.C. § 1396n(c)(l).

Appellant Harold Young, who is 80 years old and has Alzheimer’s disease, was placed in the memory-care unit at Valley-view and began receiving customized-living services through the elderly-waiver program in June 2008. Less than two weeks after Young’s admission to Valleyview, however, Steele County Human Services informed Young’s daughter, who is now his guardian, that the county had voted to terminate its contract with Valleyview and would no longer permit the use of elderly-waiver funds to cover services at Valley-view after June 30.

Appellant sought a hearing with the Minnesota Department of Human Services (DHS) pursuant to Minn.Stat. § 256.045, subds. 3(1), 6 (2008), challenging the county’s action. In October 2008, before a hearing could be held, it was discovered that appellant was enrolled in a multi-county managed-care plan, which had a contract with DHS and the county to provide medical-assistance benefits, including elderly-waiver services, to enrolled participants. When it became apparent that this managed-care plan would pay for appellant’s elderly-waiver services at Valleyview retroactive to July 1, 2008, the human-services judge dismissed appellant’s appeal.

For reasons not in the record, appellant later became ineligible for the managed-care plan. As a result, in December 2008, the county issued another notice, stating that it would deny appellant elderly-waiver services effective January 1, 2009, because appellant was no longer receiving care [162]*162through a managed-care plan. Therefore, he would be receiving services on a fee-for-service basis, and because the county did not have a contract with Valleyview to provide elderly-waiver services for appellant, he would need to move to another facility. Appellant appealed the county’s decision to DHS, arguing that the county’s decision abridged his right to free choice among qualified medical-assistance providers in violation of 42 U.S.C. § 1396a(a)(23)(A) (2006).

At an evidentiary hearing before a human-services judge, appellant’s daughter testified that she wanted appellant to remain at Valleyview, which was providing appropriate care and was located close to her home and appellant’s physician. She testified that three of the five alternate facilities the county offered for appellant’s care were located outside of Steele County.

The Steele County social-services supervisor testified that, to her knowledge, Val-leyview was licensed by the Minnesota Department of Health (DOH) and appeared on the DHS website as a qualified provider of services for appellant. She testified that, although the DOH had notified the county about certain health and safety issues at Valleyview, she was not aware if those issues had adversely affected Valley-view’s license. She testified that one factor in the county’s decision to terminate Valleyview’s contract was the county’s financial liability in assuming case-management services for people from another county who would be using Valleyview’s services. She did not know about other possible reasons for the termination.

The Steele County human-services director testified that, prior to Valleyview’s opening, the county received a list of health-and-safety-related concerns, which had delayed the opening, but the county had nonetheless decided to contract with Valleyview for a period of time. He testified that DHS has delegated responsibility for oversight of the elderly-waiver program to the county; that even if a provider is a “qualified provider” as licensed by the department of health, the county had no duty to contract with that provider; that Valleyview no longer had a contract with the county; and that appellant’s free choice could be exercised by staying at a facility with which the county contracted.

The DHS aging-and-adult-serviees manager testified that Minnesota’s elderly-waiver application did not authorize the county to refuse to contract with a vendor who is otherwise qualified and meets the needs of a recipient. She agreed that appellant’s situation was a novel one and that it was ultimately the state’s responsibility to ensure that the elderly-waiver program was operated in compliance with federal law. She testified that DHS was not taking a position on whether appellant had free choice of providers.

The human-services judge issued findings of fact, conclusions of law, and an order, concluding that a qualified provider was a provider that had a contract with a lead agency, such as the county; that Val-leyview was not a qualified provider because it did not have a contract with the county; and that appellant has free choice of qualified providers because he could stay at any other facility with which the county did have a contract. The commissioner issued a decision adopting the findings, conclusion, and order. Appellant appealed to the district court, which affirmed the commissioner’s determination, and this appeal follows.1

[163]*163ISSUES

I. Does the commissioner have authority to review the county’s action of declining to contract with Valleyview?

II.

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Cite This Page — Counsel Stack

Bluebook (online)
796 N.W.2d 158, 2011 Minn. App. LEXIS 34, 2011 WL 1364428, Counsel Stack Legal Research, https://law.counselstack.com/opinion/young-v-jesson-minnctapp-2011.