Court Opinion

ID: 9386639
Source: CourtListenerOpinion
Date Created: 2023-04-13 14:04:58.425444+00
Date Added: 2024-06-11T17:18:07.492164
License: Public Domain

FILED
                                                                   IN THE OFFICE OF THE
                                                                CLERK OF SUPREME COURT
                                                                       APRIL 13, 2023
                                                                 STATE OF NORTH DAKOTA

                  IN THE SUPREME COURT
                  STATE OF NORTH DAKOTA

                                 2023 ND 71

Joseph Jahner,                                                    Appellee
      v.
North Dakota Department of Health
and Human Services,                                              Appellant

                                No. 20220313

Appeal from the District Court of Burleigh County, South Central Judicial
District, the Honorable Bruce A. Romanick, Judge.

REVERSED.

Opinion of the Court by Crothers, Justice.

Justin J. Vinje (argued) and Tiffany J. Vinje (on brief), Bismarck, ND, for
appellee.

Jane G. Sportiello, Bismarck, ND, for appellant.
                                  Jahner v. NDDHS
                                    No. 20220313

Crothers, Justice.

[¶1] The North Dakota Department of Health and Human Services1 appeals
from a district court judgment reversing the Department’s order affirming the
denial of Joseph Jahner’s application to enroll as a Medicaid provider. We
reverse the district court’s judgment and reinstate the Department’s order.

                                             I

[¶2] Jahner is employed by West Central Human Service Center as a peer
support specialist. A peer support specialist uses his or her lived experience of
recovery from addiction plus skills learned in formal training to deliver
services to promote recovery. N.D. Admin. Code § 75-03-43-01(5). In December
2020, Jahner applied with the Department to be an enrolled provider with
North Dakota Medicaid as a peer support specialist. In June 2021, the
Department denied Jahner’s application. The Department stated its Medicare
Provider Enrollment Screening Policy (“1915(i) Policy”) prohibited Jahner
“from enrolling as a provider with ND Medicaid” because of his criminal
history. Between 2002 and 2017, Jahner was convicted of 13 crimes, including
negligent homicide, reckless endangerment, aggravated assault, assault, and
menacing.

[¶3] Jahner requested a hearing before an administrative law judge (ALJ).
After the hearing, the ALJ recommended reversing the Department’s decision,
concluding the Department should have done a thorough review of Jahner’s
criminal history to determine if any offenses had a direct bearing on the
position of peer support specialist.

[¶4] The Department did not adopt the ALJ’s recommended decision, and
affirmed its decision denying Jahner’s application. The Department concluded
peer support specialists serve a vulnerable population, Jahner’s criminal

1 The Department of Human Services merged with the Department of Health to become the
Department of Health and Human Services on September 1, 2022, via House Bill 1247 of the 67th
Legislative Assembly.
                                             1
offenses have a direct bearing on the position of peer support specialist, and he
was not sufficiently rehabilitated. The Department’s decision prevented
Jahner from becoming a Medicaid provider but did not affect his ability to work
as a peer support specialist.

[¶5] Jahner appealed the Department’s decision to the district court. In
August 2022, the court reversed the Department’s decision, concluding the
Department failed to sufficiently identify a criminal offense directly bearing on
the position of peer support specialist. The court also concluded the
Department did not properly consider whether Jahner was sufficiently
rehabilitated. The court held the Department’s decision was not in accordance
with the law.

                                       II

[¶6] Courts exercise limited review in appeals from administrative agency
decisions. Johnson v. North Dakota Workforce Safety & Ins., 2010 ND 198,
¶ 10, 789 N.W.2d 565. On appeal from the district court, we review the
administrative agency’s decision in the same manner that the district court
reviewed the agency’s decision. N.D.C.C. § 28-32-49. Under N.D.C.C. § 28-32-
46, a district court must affirm an administrative agency order unless:

      “1. The order is not in accordance with the law.

      2. The order is in violation of the constitutional rights of the
      appellant.

      3. The provisions of this chapter have not been complied with in
      the proceedings before the agency.

      4. The rules or procedure of the agency have not afforded the
      appellant a fair hearing.

      5. The findings of fact made by the agency are not supported by a
      preponderance of the evidence.

      6. The conclusions of law and order of the agency are not supported
      by its findings of fact.

                                       2
      7. The findings of fact made by the agency do not sufficiently
      address the evidence presented to the agency by the appellant.

      8. The conclusions of law and order of the agency do not sufficiently
      explain the agency’s rationale for not adopting any contrary
      recommendations by a hearing officer or an administrative law
      judge.”

[¶7] In reviewing the agency’s findings of fact, this Court does not make
independent findings or substitute our judgment for the agency’s judgment.
Sloan v. N.D. Workforce Safety & Ins., 2011 ND 194, ¶ 5, 804 N.W.2d 184.
“Rather, we decide whether a reasoning mind reasonably could have
determined the findings were proven by the weight of the evidence from the
entire record.” Id. The application and interpretation of a statute is a question
of law. Rodenbiker v. Workforce Safety & Ins., 2007 ND 169, ¶ 15, 740 N.W.2d
831. Questions of law are fully reviewable in an administrative appeal. Sloan,
at ¶ 5.

[¶8] The Department is responsible for implementing the state’s Medicaid
program. Gross v. N.D. Dep’t of Hum. Servs., 2004 ND 24, ¶ 2, 673 N.W.2d 910.
Chapter 50-24.1, N.D.C.C., governs the Medicaid program. Under N.D.C.C. §
50-24.1-04, the Department “may adopt rules and regulations as necessary to
qualify for any federal funds available under this chapter.”

                                      III

[¶9] The Department argues the district court erred in concluding the
Department’s order affirming its denial of Jahner’s application to enroll as a
Medicaid provider was not in accordance with the law under N.D.C.C. § 28-32-
46(1).

                                       A

[¶10] The Department’s 1915(i) Policy states it is regulated in part by N.D.C.C.
Title 12.1 and N.D. Admin. Code § 75-02-05. The orders issued by the
Department, the ALJ and the district court discussed N.D.C.C. § 12.1-33-02.1,
relating to a criminal conviction and the ability to engage in an occupation in

                                       3
which a license or permit is required by a state agency. Section 12.1-33-02.1(1),
N.D.C.C., provides:

      “A person may not be disqualified to practice, pursue, or engage in
      any occupation, trade, or profession for which a license, permit,
      certificate, or registration is required from any state agency, board,
      commission, or department solely because of prior conviction of an
      offense. However, a person may be denied a license, permit,
      certificate, or registration because of prior conviction of an offense
      if it is determined that such person has not been sufficiently
      rehabilitated, or that the offense has a direct bearing upon a
      person’s ability to serve the public in the specific occupation, trade,
      or profession.”

[¶11] The statute states a person with a prior conviction may not be prohibited
or disqualified from engaging in an occupation requiring registration or
licensure from a state agency. Here, Jahner applied with the Department to be
a Medicaid provider as a peer support specialist. The Department’s denial of
his Medicaid enrollment application did not disqualify him from engaging in
the occupation of a peer support specialist. Jahner was employed as a peer
support specialist when he applied with the Department. The Department’s
decision only concerned Jahner’s ability to bill Medicaid, not his ability to
engage in a specific occupation. Therefore, N.D.C.C. § 12.1-33-02.1 does not
apply.

                                        B

[¶12] The Department claims its 1915(i) Policy and the order affirming its
denial of Jahner’s application complies with N.D. Admin. Code § 75-02-05,
dealing with Medicaid and children’s health insurance program providers.

[¶13] Under N.D. Admin. Code § 75-02-05-04.1(9), the Department may deny
an application to become a Medicaid provider if:

      “The applicant has been convicted of an offense in section 75-02-
      05-11, which is determined by the department to have a direct
      bearing upon the applicant’s ability to be enrolled as a Medicaid or
      children’s health insurance program provider, or the department
      determines, following conviction of any other offense, the applicant
      is not sufficiently rehabilitated.”
                                          4
Section 75-02-05-11, N.D. Admin. Code, requires a criminal background check
for enrolled or newly enrolled providers. See also N.D.C.C. § 50-06-01.9(6)
(allowing the Department to require criminal history record checks for
Medicaid provider applicants). Under N.D. Admin. Code § 75-02-05-11(2):

      “The department shall evaluate criminal history against the
      reasons for revocation found in 42 C.F.R. 424.535(a)(3) and based
      on offenses described in North Dakota Century Code chapter 12.1-
      16, homicide; 12.1-17, assaults - threats - coercion - harassment;
      12.1-18, kidnapping; 12.1-27.2, sexual performances by children;
      or 12.1-41, Uniform Act on Prevention of and Remedies for Human
      Trafficking; in North Dakota Century Code section 12.1-20-03,
      gross sexual imposition; 12.1-20-03.1, continuous sexual abuse of
      a child; 12.1-20-04, sexual imposition; 12.1-20-05, corruption or
      solicitation of minors; 12.1-20-06, sexual abuse of wards; 12.1-20-
      06.1, sexual exploitation by therapist; 12.1-20-07, sexual assault;
      12.1-22-01, robbery; 12.1-22-02, burglary, if a class B felony under
      subdivision b of subsection 2 of that section; 12.1-29-01, promoting
      prostitution; 12.1-29-02, facilitating prostitution; 12.1-31-05, child
      procurement; 12.1-31-07, endangering a vulnerable adult; 12.1-31-
      07.1, exploitation of a vulnerable adult; subsection 1 of section
      26.1-02.1-02.1 of North Dakota Century Code, fraudulent
      insurance acts; or an offense under the laws of another jurisdiction
      which requires proof of substantially similar elements as required
      for conviction under any of the enumerated North Dakota
      statutes.”

Here, the Department’s order states “[a]ll offenses in [N.D. Admin. Code] § 75-
02-05-11 are considered direct bearing offenses.”

[¶14] The Department’s 1915(i) Policy states it will deny an application “if the
provider applicant has been convicted of any of the following felonies, class A
misdemeanors, or class B misdemeanors outlined in [N.D. Admin. Code] 75-
02-05-11(2) and have not been deemed ‘sufficiently rehabilitated’ by the
[Department].” The crimes listed in the policy are identical to those in N.D.
Admin. Code § 75-02-05-11(2).

[¶15] In determining whether an applicant has been sufficiently rehabilitated
following a conviction of an offense under N.D. Admin. Code § 75-02-05-11(2),
the Department’s 1915(i) Policy considers the time elapsed from the conviction.
                                        5
If an applicant has one conviction under N.D. Admin. Code § 75-02-05-11(2),
the applicant is sufficiently rehabilitated if one to three years has elapsed since
final discharge and release from any term or probation, parole or other form of
community corrections, or imprisonment without subsequent conviction. If an
applicant has two or more convictions, the applicant is sufficiently
rehabilitated if five years has elapsed since final discharge and release from
any term or probation, parole or other form of community corrections, or
imprisonment without subsequent conviction. If an applicant was convicted of
an offense under N.D. Admin. Code § 75-02-05-11(2) and a subsequent
conviction of any felony or class A or B misdemeanor occurs before the
applicant is deemed sufficiently rehabilitated under the policy, the “applicant
will forever be prohibited from enrolling as a provider with ND Medicaid.”

[¶16] The Department’s order discussed Jahner’s criminal history. In March
2002, Jahner was convicted of negligent homicide and reckless endangerment,
both class C felonies. Both crimes are direct bearing offenses under N.D.
Admin. Code § 75-02-05-11(2). In July 2002, Jahner was convicted of
aggravated assault, a class C felony and a direct bearing offense under N.D.
Admin. Code § 75-02-05-11(2). The Department’s order noted the aggravated
assault conviction occurred within five years of the March 2002 felony
convictions.

[¶17] In August 2011, Jahner was convicted of assault, a class A misdemeanor
and direct bearing offense under N.D. Admin. Code § 75-02-05-11(2). In
February 2014, Jahner was convicted of menacing, a class A misdemeanor and
direct bearing offense under N.D. Admin. Code § 75-02-05-11(2). Jahner was
convicted of four additional offenses in 2014 and 2015. The menacing and other
convictions occurred within the five-year rehabilitation period of the August
2011 assault conviction. In April 2017, Jahner was convicted of disorderly
conduct, a class B misdemeanor. The offense is not a direct bearing offense
under N.D. Admin. Code § 75-02-05-11(2); however, the offense occurred within
the five-year rehabilitation period of the February 2014 menacing conviction.

[¶18] The Department concluded Jahner was not sufficiently rehabilitated
because he “committed several direct bearing offenses and was convicted of
criminal offenses prior to the stated time period expiring from final discharge

                                        6
and release from any term of probation, parole, or other form of community
corrections, or imprisonment without subsequent conviction.” The Department
concluded:

      “Although his previous offenses may render him to be uniquely
      qualified to be a peer support specialist as the crimes he committed
      are closely related to the fact that he suffered from a chemical
      addiction, the fact remains that he committed too many direct
      bearing offenses and other offenses before final discharge or
      release from sentencing from previous offenses. The Department
      agrees that his experiences allow him to relate to those with
      similar experiences seeking help for an addiction and addiction is
      often the cause for criminal offenses. However, the fact remains
      that peer support specialists serve a vulnerable population . . . and
      the Department must be certain that those who serve in that
      capacity are truly sufficiently rehabilitated. Based on the number
      of offenses committed, the severity of the offenses committed, and
      the commitment of offenses while still on probation or parole, the
      Department may not deem Jahner sufficiently rehabilitated.”

[¶19] By adopting N.D. Admin. Code §§ 75-02-05-04.1(9) and 75-02-05-11, the
Department determined the offenses listed in N.D. Admin. Code § 75-02-05-
11(2) have a direct bearing on an applicant’s ability to be enrolled as a Medicaid
provider. In his brief, Jahner noted the regulations exclude offenses such as
theft, forgery, obscenity or interference with privacy, which also may impact an
applicant’s ability to be enrolled as a Medicaid provider. However, Jahner fails
to show the Department’s adoption of the regulations was arbitrary, capricious
or was not the product of a rational mental process. See Sloan, 2011 ND 194, ¶
12 (stating agency rules deserve deference “unless they produce an absurd
result, are arbitrary and capricious, or are inconsistent with statutes covering
the same subject matter”). The Department’s order states peer support
specialists deal with vulnerable people. Many of the direct bearing offenses in
N.D. Admin. Code § 75-02-05-11(2) involve violence. The regulation is not
arbitrary and capricious simply because it excludes some offenses that also
may have a direct bearing on an applicant’s ability to be enrolled as a Medicaid
provider.

[¶20] The Department denied Jahner’s application under its 1915(i) Policy
because he committed numerous direct bearing offenses under N.D. Admin.
                                  7
Code § 75-02-05-11(2) and was not sufficiently rehabilitated. The Department’s
1915(i) Policy complies with N.D. Admin. Code § 75-02-05. Its order affirming
the denial of Jahner’s application was in accordance with the law. The
Department’s findings of fact are supported by a preponderance of the
evidence, and its conclusions of law are supported by its findings of fact. We
reverse the district court’s judgment and reinstate the Department’s order.

                                     IV

[¶21] We have considered the parties’ remaining arguments and conclude they
are either without merit or not necessary to our opinion. The judgment is
reversed.

[¶22] Jon J. Jensen, C.J.
      Daniel J. Crothers
      Lisa Fair McEvers
      Jerod E. Tufte
      William A. Neumann, S.J.

[¶23] The Honorable William A. Neumann, S.J., sitting in place of Bahr, J.,
disqualified.

                                      8