Opinion ID: 4375110
Heading Depth: 1
Heading Rank: 1

Heading: analysis

Text: At the outset, DHHS and its officers note on appeal that there is a distinction between eligibility for Medicaid and eligibility for receipt of AABD Medicaid waiver services. They assert generally that this distinction was overlooked by the district court, leading it to exceed the proper scope of its order of remand. On appeal, they contend specifically that because additional criteria must be satisfied before Paige is eligible for or could receive AABD Medicaid waiver services, they cannot comply with the district court’s directions on remand as a matter of law. We agree. Relevant Regulations. AABD services are administered by DHHS and consist of money payments to, medical care in behalf of, or any type of remedial care in behalf of needy individuals. See § 68-1001. In - 85 - Nebraska Supreme Court A dvance Sheets 302 Nebraska R eports LEON V. v. NEBRASKA DEPT. OF HEALTH & HUMAN SERVS. Cite as 302 Neb. 81 a recent case, we have described Medicaid waiver services as intended for clients who are at a nursing-home level of care but choose to receive home and community-based services. Merie B. on behalf of Brayden O. v. State, 290 Neb. 919, 863 N.W.2d 171 (2015). [5,6] DHHS promulgates rules and regulations providing for services to AABD clients. § 68-1001.01. Properly adopted and filed agency regulations have the effect of statutory law. Merie B. on behalf of Brayden O. v. State, supra. When an appeal calls for statutory or regulatory interpretation or presents questions of law, an appellate court must reach an independent, correct conclusion irrespective of the determination made by the court below. See id. Statutory language is to be given its plain and ordinary meaning, and we will not resort to interpretation to ascertain the meaning of statutory words which are plain, direct, and unambiguous. Merie B. on behalf of Brayden O. v. State, supra. The provisions of 480 Neb. Admin. Code, ch. 5 (1998), are applicable to this case. Under the regulations, Medicaid waiver services are provided statewide to eligible clients for whom a slot is available. 480 Neb. Admin. Code, ch. 5, § 002. Under § 002, to be eligible for waiver services, clients must 1. Be eligible for the Nebraska Medical Assistance Program (NMAP); 2. Have participated in an assessment with a services coordinator; 3. Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); 4. Have care needs which could be met through waiver services at a cost that does not exceed the cap; and 5. Have received an explanation of NF services and waiver services and elected to receive waiver services. The regulations contained in 480 Neb. Admin. Code, ch. 5, § 003.B, and other regulations anticipate that a sequence of various events occur prior to becoming eligible for Medicaid waiver services. For example, § 003.B4(c) provides that a - 86 - Nebraska Supreme Court A dvance Sheets 302 Nebraska R eports LEON V. v. NEBRASKA DEPT. OF HEALTH & HUMAN SERVS. Cite as 302 Neb. 81 “child’s waiver eligibility period may begin no earlier that the date of the guardian’s signature on the consent form” and the “waiver consent form is not valid . . . until the child’s eligibility for Medicaid has been determined.” Thus, to the extent that Leon and Cristy contend that the regulations require simultaneous eligibility determinations, we do not agree, and in any event, the parties agree that not all criteria in 480 Neb. Admin. Code, ch. 5, § 002 et seq., have been achieved. However, to the extent that Leon and Cristy assert that an ultimate award of waiver services may be retroactive, the appellate briefing of DHHS and its officers appears to agree. DHHS Cannot Provide Medicaid Waiver Services Based Solely on Determination of Eligibility for Medicaid. The district court conducted a limited review of the DHHS determination that Paige was not disabled for purposes of eligibility for Medicaid. Based on the evidence and the law, the district court found that Paige satisfied the first requirement of 480 Neb. Admin. Code, ch. 5, § 002, i.e., that she was eligible for Medicaid. We find no error in this district court finding. Due to the issue raised in the appeal, however, the district court’s review was limited in scope; it did not make a determination as to the satisfaction of the remaining criteria contained in § 002. The only issue on review from DHHS was whether Paige had a qualifying disability. Nevertheless, in its order, the district court remanded the matter to DHHS with directions to award Leon and Cristy full AABD Medicaid waiver services. We agree with DHHS and its officers that under § 002, Medicaid “waiver” services is a term of art, defined at 480 Neb. Admin. Code, ch. 5, § 001.E, and that eligibility for Medicaid does not equate to eligibility for Medicaid waiver services. With respect to the criteria in § 002 et seq., there is no evidence in the record of a services coordinator assessment, a plan of services, a signed consent form, or evidence - 87 - Nebraska Supreme Court A dvance Sheets 302 Nebraska R eports LEON V. v. NEBRASKA DEPT. OF HEALTH & HUMAN SERVS. Cite as 302 Neb. 81 that a waiver slot was available for Paige which would have enabled DHHS to provide Paige with appropriate and individualized waiver services. The district court’s instruction on remand appears to assume that Paige and the facts met the additional criteria in § 002 et seq., with neither proceedings nor evidence to this effect. Because the district court’s order on remand exceeded the record and the scope of its review, we reverse the portion of the order directing payment of Medicaid waiver services.