Opinion ID: 204141
Heading Depth: 5
Heading Rank: 1

Heading: Finality of the List

Text: The Groton parents urge us to accept their interpretation of the agreement: that the List is final and the state will conduct no further individualized review of class members. The district court reached, and the record supports, two conclusions that undermine the Groton parents' reading of the agreement. First, the List reflects a preliminary but not final determination that certain class members may be appropriate for community placement and transition planning is warranted. Id. at 183. DMR will conduct individualized evaluations during transition planning and consider the wishes of class members' families. Id. at 180, 183-84. It will only recommend community placement if it determines that all of a class member's needs, including medical needs, can be met in an appropriately designed and staffed community setting. Id. at 180. 19 We review the evidence presented during fairness hearings when determining whether a district court abused its discretion by approving a settlement. See, e.g., Dikeman v. Progressive Exp. Ins. Co., 312 F. App'x 168, 171 (11th Cir. 2008) (affirming the district court in part on the testimony and evidence presented at the fairness hearing); United Auto., Aerospace, and Agric. Workers of Am. v. General Motors Corp., 497 F.3d 615, 636 (7th Cir. 2007) (reviewing live testimony from a fairness hearing); Walker v. City of Mesquite, 858 F.3d 1071, 1072-73 (5th Cir. 1988) (noting the district court considered oral testimony and documentary exhibits). -21- The settlement limits when DMR may transfer List members. DMR must determine[], through the PASARR process, that a class member [on the List] can be safely served in the community, and that appropriate community services and supports are, or will soon be, available. During PASARRs, the state assesses, in consultation with class members and their families, 42 C.F.R. § 483.128(c)(3), whether a nursing home, community setting, or another placement is best for each individual. Id. § 483.132. It must decide by reviewing an individual's physical and mental health and ability to perform daily tasks. Id. § 483.132(c). If the state concludes a community placement is the best setting, as the DMR commissioner and the state's counsel explained, it will then determine whether an appropriate placement is available during transition planning. Under the Joint Plan, the state must review class members' personal and medical needs and plan, in careful detail, transition to a safe and appropriate community setting, as the settlement requires. Coordinators must review this plan with RISP team members, including family members and clinical professionals. The district court could accept, as the DMR coordinator and the state's counsel requested, that the state needs time to work with families during this process before -22- making a final decision about community placement for List members.20 Second, the district court found residents had appeal rights from a decision by the state contrary to the wishes of a parent or guardian, which the agreement did not limit. Rolland XI, 562 F. Supp. 2d at 184. The settlement reserves any other legal rights class members have; the parties agree this clause preserves class members' appellate rights.21 As the parties agree, the NHRA allows anyone adversely affected by a PASARR determination to appeal through a state process. 42 U.S.C. § 1396r(e)(7)(F); 42 C.F.R. § 431.220(a)(4); id. § 483.204(a)(2). State regulations also let Medicaid beneficiaries appeal decisions by the state Medicaid agency regarding the scope and amount of assistance (including, but not limited to, level-of-care determinations), 130 Mass. Code. Regs. 610.032(A)(5), and imposing any condition . . . for assistance or receipt of assistance that is not authorized by federal or state law or regulations, id. 610.032(A)(7). 20 During transition planning the state will also consider what enhanced specialized services List members should receive and incorporate that plan into their RISPs. Though focused on services and not placement, the RISP process is another time the state will review class members' needs with them and their families. 21 The settlement also expressly creates some appellate rights not relevant to the Groton parents' concerns. -23- Class members may appeal PASARR and Medicaid determinations in the state's administrative fair hearing process. 130 Mass. Code Regs. 456.412(B); id. 610.032(A). The fair hearing involves an evidentiary hearing before an impartial agency officer who issues a final, written decision. See id. 610.012-.086. Some cases may receive a rehearing. Id. 610.091. Parties may seek judicial review in Massachusetts state court. Id. 610.092. b. Whether the Settlement Creates a Required Quota for Placement The Groton parents contend the agreement could force the state to improperly transfer class members who belong in nursing homes because it creates a quota for placing 640 individuals in the community. This argument overlooks how the settlement protects class members from inappropriate transfers and the size of the pool of class members eligible for transfer. Under the agreement, the state will transfer class members incrementally over four years. As we explained above, the state will carefully review whether a safe, appropriate placement is available for individuals before moving anyone, and class members may appeal adverse decisions. The state may also, per the agreement, keep class members off the List who should not be transferred because of medical needs or personal circumstances. Indeed, roughly half of the residents of Seven Hills had been deemed inappropriate for community placement, including the -24- children of two of the four parents who testified at the fairness hearing, for this reason. Rolland XI, 562 F. Supp. 2d at 183. The settling parties expect far more class members will be eligible for transfer than the state can accommodate in community placements. The state has initially determined 666 class members could benefit from community placement. DMR can add up to 160 new nursing home admissions and substitute even more admissions for class members who die or are removed from the List. If too few class members could be safely transferred, the parties have represented to this court that they will renegotiate the agreement. c. Right to Refuse Community Placement Finally, the Groton parents argue that the agreement is unfair because it does not give them an absolute right to refuse community placement for their children. They say Olmstead and, especially, a grandfather provision in the NHRA, 42 U.S.C. § 1396r(e)(7)(C)(i), give them this right and the agreement is unfair if it does not expressly protect it. We do not need to interpret § 1396r(e)(7)(C)(i) definitively and believe it is unwise to do so in the abstract. The settlement is nonetheless fair because it allows individual class members to raise this objection in other settings, where they can assert any rights they may have. The grandfather provision, § 1396r(e)(7)(C)(i), allows some long-term residents of nursing homes to choose to remain in their current nursing facility. At a minimum eligible residents -25- must have been determined to need specialized services but not nursing home care during a PASARR and must have lived in a nursing home for at least 30 months before the date of the determination. Id. The parties dispute when that PASARR determination needed to occur; we need not resolve this issue.22 It is indisputable that whether an individual is a longterm resident under the statute is a fact-based inquiry. It depends on the timing and results of the person's PASARRs and where the person has lived. This issue is best resolved in the individualized review process we have described above: during class members' PASARRs, during the transition process, and on appeal. In light of these facts, it was not an abuse of discretion for the district court to refuse to strike down the settlement to more expressly protect any rights a few class members may ultimately prove they individually have. The court could choose to approve a settlement that benefits the vast majority of the class, including those whom the state does not want to move from Seven Hills, since it adequately protects objectors' rights. 22 The parties disagree whether the grandfather provision applies only to residents who lived in nursing homes and received their first PASARR before April 1, 1990, or to residents who lived in a nursing home for thirty months before a PASARR finding that they no longer need nursing home care. Nothing in the district court's decision or this decision prejudices class members' right to argue they are long-term residents under either interpretation to the state and on appeal. The district court's conclusion that class members had no legal right to remain in nursing homes, see Rolland XI, 562 F. Supp. 2d at 185, is not precedent on this issue. -26- Olmsted, on which the Groton parents alternatively rely, adds nothing to their claim. Olmstead interpreted the scope of state authority to retain individuals in institutions under the integration mandate of Title II of the ADA. 527 U.S. at 592-93, 602. But Title II is not the basis for the state's authority to transfer class members to the community in the settlement agreement; the NHRA is.23