Opinion ID: 2052163
Heading Depth: 2
Heading Rank: 5

Heading: Evidence Related to Suzman's ADA Claim

Text: [¶ 19] Suzman claimed at the administrative level that the reduction of his PCA services and the 90% rule violated his rights under the ADA. The hearing officer stated that the merits of Suzman's ADA claim could not be addressed at the administrative level, and that while the ADA issue may be one that can be raised in state or federal courts, an administrative decision must be based on the applicable agency regulations. Although the Commissioner's decision does not mention the ADA claim, the Commissioner's decision states that the hearing officer's recommendation is adopted. [¶ 20] DHHS did not present any evidence at the hearing relevant to the ADA claim. Suzman offered a packet of documents that was marked Suzman # 6. One of the documents in Suzman # 6 purports to be a waiver renewal application, dated June 21, 2000. [9] This application states: the average per capita expenditures under the waiver will not exceed 100 90% percent of the average per capita expenditures for the level(s) of care in item 2 of this request under the State plan that would have been made in that fiscal year had the waiver not been granted. Item 2 refers to a provision in the application that states that the waiver is requested to provide home and community-based services to individuals who, but for the provision of such services, would require [nursing facility] level(s) of care, the cost of which could be reimbursed under the approved Medicaid State plan. Also contained in Suzman # 6 is a letter from the Commissioner to CMS, which mentions, among many other items, the 90% cap and states: We do not anticipate that this change will have an adverse effect on consumers because, based on higher projected nursing home rates, the new cap at 90% will be higher than the previous cap. There was no testimonial or other explanation of Suzman # 6. [10] The hearing officer made no factual findings concerning Suzman # 6. [¶ 21] In spite of the fact that the hearing officer and the Commissioner declined to decide the ADA claim, the parties submitted written arguments to the Superior Court on the ADA claim. DHHS argued that the 90% rule was required to meet the federal fiscal parity requirements and any change to the waiver program could result in a termination of the waiver program by the federal authorities, thereby resulting in a fundamental alteration. Suzman argued that DHHS had failed to meet its burden of proving fundamental alteration. [¶ 22] The Superior Court decided the ADA claim after reviewing the administrative record and making factual findings. The proceeding before the court was one for judicial review of administrative action pursuant to M.R. Civ. P. 80C and 5 M.R.S.A. §§ 11001-11007 (2002). The court had not been requested to take additional evidence, see M.R. Civ. P. 80C(e), nor was the judicial review action joined with an independent action, see M.R. Civ. P. 80C(i). [11]