Heard: March 12, 2014.
Appeal From The Administrative Law Court, Carolyn C. Matthews, Administrative Law Judge.
Patricia Logan Harrison, of Columbia, for Appellant.
Richard G. Hepfer, of South Carolina Department of Health and Human Services, of Columbia, for Respondent.
Anna Maria Darwin and Sarah Garland St. Onge, of Columbia, for Amicus Curiae, Protection and Advocacy for People With Disabilities, Inc.
Amy Landers May, of Columbia, for Amicus Curiae, the South Carolina Chapter of the National Academy of Elder Law Attorneys.
Kirby Mitchell, of Greenville, for Amicus Curiae, South Carolina Legal Services, of Greenville.
Stephen Suggs, of Columbia, for Amicus Curiae, the South Carolina Appleseed Legal Justice Center.
KONDUROS, J. WILLIAMS and LOCKEMY, JJ., concur.
[410 S.C. 275] KONDUROS, J.:
Richard Stogsdill appeals the Administrative Law Court's (ALC's) order affirming the South Carolina Department of Health and Human Services' (DHHS's) decision approving the reduction in services to him. We affirm in part, reverse in part, and remand.
Stogsdill is a Medicaid-eligible man receiving services under the South Carolina Intellectual Disabilities/Related Disabilities (ID/RD) Waiver (Waiver). His mental capacity is normal, but because of premature birth, he suffers from significant physical disabilities that require aid in nearly every activity of daily living. Under the Waiver, the South Carolina Department of Disabilities and Special Needs (DDSN) beneficiaries can be provided a mix of services. Waivers permit eligible recipients to receive these services without the requirement of institutionalization. On January 1, 2010, the five-year renewal of the Waiver went into effect. The renewed Waiver included a cap or limit on some services and excluded others. DHHS administers the state Medicaid program and is responsible for the overall administration of the Waiver. DDSN is responsible for the day-today operation of the Waiver.
Prior to the Waiver changes, Stogsdill was receiving a combined sixty-nine hours of Personal Care Aide (PCA) and Companion Care services per week and approximately thirty-six hours of Respite Care per week. PCA services consist of hands-on personal care that the person needs to accomplish his or her activities of daily living such as bathing, toileting, dressing, and eating. Companion Care services are similar to PCA services but include an aspect of community integration. Respite Care can be a range of services, including personal care but is designed to provide services when the normal caregiver is absent or needs relief.
[410 S.C. 276] The Waiver capped any combination of PCA and Companion Care services at twenty-eight hours per week. The normal cap for Respite Services is sixty-eight hours per month, approximately sixteen hours per week, but exceptions can be granted for up to 240 hours per month, approximately fifty-six hours per week. Under these new limits, Stogsdill's services were reduced to twenty-eight hours per week of all PCA services, including Companion Care services, and sixty-eight monthly hours of Respite Care. After an application by his Service Coordinator, Stogsdill's Respite Care hours were increased to 172 hours per month. His occupational therapy and speech therapy were discontinued. Stogsdill appealed the reduction in services through the administrative process finally ending with the ALC affirming the reduction in services. This appeal followed.
STANDARD OF REVIEW
" The Administrative Procedures Act (APA) establishes the standard of review for appeals from the ALC." Greeneagle, Inc. v. S.C. Dep't of Health & Envtl. Control, 399 S.C. 91, 95, 730 S.E.2d 869, 871 (Ct. App. 2012), cert. pending.
The court of appeals may affirm the decision or remand the case for further proceedings; or, it may reverse or modify the decision if the substantive rights of the petitioner have been prejudiced because the finding, conclusion, or decision is:
(a) in violation of constitutional or statutory provisions;
(b) in excess of the statutory authority of the agency;
(c) made upon unlawful procedure;
(d) affected by other error ...