STATE OF NORTH CAROLINA IN THE OFFICE OF ADMINISTRATIVE HEARINGS

COUNTY OF WILSON 05 DHR 0117

)

KATHERINE LEWIS (guardian) in lieu of )

FRANCIS CURRAN LEWIS (son), )

Petitioner, )

) DECISION

v ) by SUMMARY JUDGMENT

)

WILSON-GREENE MENTAL HEALTH )

CENTER, CAP PROGRAM, )

Respondent. )

______

THIS DECISION is made in a contested case pursuant to N.C.G.S. 150B-34, by the undersigned Administrative Law Judge, based on the evidence and argument received at a hearing on August 30, 2005.

FINDINGS OF FACT

1. Petitioner, Francis Curran Lewis (hereinafter Curran), through his guardian and mother, Katherine Lewis, filed this case to appeal the denial of Medicaid payment for a camera and related equipment to benefit Curran.

2. Curran has qualified for the payment for services under the Community Alternatives Program for Persons with Mental Retardation and Other Developmental Disabilities (CAP-MR/DD), waiver program under the federal Medicaid program.

3. Petitioner offered evidence that the equipment would benefit Curran. Respondent did not contest this fact for the purpose of this hearing.

4. Respondent presented affidavits, unrebutted by the Petitioner, that equipment which is not specialized or adapted is not covered by the CAP-MR/DD program. Both affidavits stated that the requested camera and related equipment is not specialized or adapted. The Petitioner agreed that the equipment requested is the same as used by the general public and is not specialized or adapted for those with disabilities.

CONCLUSIONS OF LAW

1. Based on the foregoing, there is no disputed issue of fact in this matter.

2. Respondent is bound by the CAP-MR/DD waiver agreement with the Federal government. Arrowood v. N.C. Department of Health and Human Services, 140 N.C. App. 31, 43, 535 S.E. 2d 585, 593 (2000).

3. Appendix B, pages 28 and 29 of the waiver describe the requirements for coverage of equipment and supplies. Both parties agreed that if the camera and related equipment were to be covered that it would fall under “Category 4" described on page 29. This description specifically states that the equipment must be “specialized/adapted.” This is not further defined. There is no reason to question the interpretation given in the Respondent’s affidavits.

DECISION

Respondent’s Motion for Summary Judgment is granted. Respondent’s denial of Medicaid coverage for the camera and related equipment is upheld.

NOTICE

1. The agency making the final decision in this contested case is required to give each party an opportunity to file exceptions to this recommended decision and to present written arguments to those who will make the final decision. G.S. 150B-36(a).

2. The agency making the final decision is required to serve a copy of the final decision on all parties and to furnish a copy to each party’s attorney of record and serve a copy on the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714, in accordance with G.S. 150B-36(b).

3. The agency that will make the final decision in this contested case is the North Carolina Department of Health and Human Services, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.

This 5th day of October, 2005.

______

Beryl E. Wade

Administrative Law Judge

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