Providence County Superior Court
Nicholas Trott Long, Esq. For Plaintiff:
Jennifer S. Sternick, Esq. For Defendant:
Katherine Ambrosini (Appellant), on behalf of her son, Theo Brown (Theo), appeals a decision (the Decision) of the Rhode Island Department of Human Services (DHS) finding that Theo is no longer eligible for Medical Assistance (MA) benefits under the Katie Beckett Program (the Program). The Appellant argues that the Decision is clearly erroneous, arbitrary and capricious because the hearing officer adopted a new set of standards and failed to consider all of the evidence. Jurisdiction is pursuant to G.L. 1956 § 42-35-15. For the reasons set forth in this Decision, this Court remands this case to DHS for further proceedings consistent with this Decision.
Facts and Travel
Theo was born on XX/XX/1998. At age two he was diagnosed with autism, a motor speech disorder (apraxia of speech), and lead poisoning. (Hr'g Tr. at 23, Dec. 11, 2012.) As a result, Theo was non-verbal and his behavior was erratic. Id. at 23-24. Consequently, Theo began speech therapy, occupational therapy, physical therapy, and treatments for lead poisoning. Id. By age three, he had fled from his home on three separate occasions. Id. at 24. Thereafter, Theo attended school year round and began receiving services at home. Id.
In 2002, Theo began receiving Katie Beckett services. (Ex. 1, CEDARR Clinical Narrative, Jan. 25, 2012.) In recent years, he has received twenty (20) hours per week of home care to improve communication, behavioral, and psychosocial skills; twenty (20) hours per week of Personal Assistance Services and Supports (PASS), where a social worker helps Theo participate in social situations; and Respite Services, to help provide care for Theo. (Hr'g Tr. at 39-40.) As a result of his diagnosis, Theo continues to suffer from a variety of impairments, including a tendency to elope when stressed; difficulty sustaining attention; impulsivity; low frustration tolerance; irritability; social skills deficits; and aggressive behavior. Id. at 25-27. Theo also continues to struggle with speech and language skills. (Ex. 10, Neuropsychological Evaluation of Dr. Nicole Shay at 2, Aug. 15, 2012.)
After review for recertification of Theo's Katie Beckett services, DHS rendered a decision on September 14, 2012, determining that Theo was no longer qualified to receive services. (DHS Decision at 9-10, May 3, 2013.) The agency held that Theo was not disabled or in need of the level of care requiring special interventions and intensive services typically provided in an institution. Id. at 11. Appellant appealed DHS's denial and requested an Administrative Hearing (Hearing) on September 15, 2012.
The Hearing was held on December 11, 2012 before Hearing Officer Michael J. Gorman (Hearing Officer). (Hr'g Tr. at 1.) At the Hearing, Appellant was represented by Attorney Nicholas Long (Attorney Long), and the agency presented Michelle Bouchard, RN (Nurse Bouchard), Katie Beckett Unit, Dr. Julie Meyers (Dr. Meyers), Pediatrician, Katie Beckett Unit, and Frank Canino (Dr. Canino), Psychologist. (Hr'g Tr. at 1-2.)
Nurse Bouchard explained Theo's recertification process. Id. at 4. She testified that DHS had to do a new evaluation because the agency never received the financial redetermination paperwork from Appellant. Id. Nurse Bouchard stated that a clinical evaluation was conducted and that two reviewers analyzed the information. Id. at 6.
Subsequently, Dr. Meyers testified regarding her review of Theo's records for his recertification application on September 25, 2012. Id. at 10. Dr. Meyers noted that she reviewed a physician form completed on July 19, 2012 by Dr. Arena,  Theo's primary care doctor. Id. She also reviewed a parent questionnaire completed July 6, 2012; Theo's IEP from May 5, 2011; Theo's PASS plan from December 2011; a report from Bradley Hospital from January 2012; a Comprehensive Evaluation Diagnosis Assessment Referral and Reevaluation (CEDARR) care plan from January 25, 2012; Theo's academic records from Barrington Public Schools; and a psychological evaluation from Dr. Shay. Id. at 10-12. After reviewing the materials, Dr. Meyers testified that she did not feel that the child was severe enough in any of the individual diagnoses to qualify as disabled for SSI eligibility. Id. at 14. When a child's diagnoses do not meet the disability requirements, Dr. Meyers testified, the child's disability eligibility is reviewed over six functional domain areas. Id. In order to meet disability by this method, a child needs to have marked impairments in two out of the six domains. Id. Dr. Meyers testified that she determined Theo to have a marked score in the domain of interacting and relating to others. Id. at 15. However, she did not find Theo to have a marked score in any other domain, including the domains of acquiring and using information; attending and completing tasks; moving about and manipulating objects; and caring for himself. Id. Thus, she found that Theo only had one marked score and did not meet the disability criteria required for Program services. Id. at 16.
Additionally, Dr. Meyers opined that Theo did not meet the level of care required to receive services because she did not find Theo to have two substantial functional limitations. Id. Dr. Meyers acknowledged that Theo needs extra help with self-care and has learning issues, but she testified that neither is severe enough to meet the level of care criteria. Id. Dr. Meyers determined that Theo's impairments do not cause significant disruption in functioning and he is not a serious risk to himself or others. Id. Thus, Dr. Meyers determined that in her opinion, Theo does not meet a psychiatric hospital level of care. Id.
Subsequently, Dr. Canino testified on behalf of DHS. Id. He reviewed Theo's records from August 2012, and explained that the information did not include certain elements about Theo's neuropsychological condition. Id. Dr. Canino also testified that he reviewed Theo's CEDARR report, the Bradley Hospital report, Theo's academic records, and Theo's neuropsychological evaluation. Id. at 16-17. Dr. Canino attested that the recommendations from the evaluations indicate that Theo's behavior is consistent with ADHD and Asperger's, but, in his opinion, the reports do not provide enough information about all areas of Theo's life. Id. at 19. Dr. Canino testified that the neuropsychological assessment recommends considering a placement at Bradley Hospital. Id. However, ...