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Medicaid-ineligible spouse must be included to determine income limit for Medicare Savings Programs.

Topic: Health Law, Decided by Judge Miller 
Docket Number: ***** , Decision Date: 2016-07-27 
Attachment: Click here to download the decision. 

Pursuant to its policy manual, the Division of Family and Children Services determined the income limit for Q-track Medicaid programs according to the federal poverty level for an individual where the applicant had a Medicaid-ineligible spouse.  This policy contradicted the plain language of the Medicaid [..] Read More..

Acceptance of partial payment insufficient to show alteration of Admission Agreement.

Topic: Health Law, Decided by Judge Miller 
Docket Number: ***** , Decision Date: 2016-06-06 
Attachment: Click here to download the decision. 

The fact that the owner of a personal care home accepted partial payments from a resident did not alter the terms of the Admission Agreement where the resident assured the owner he would make up for the difference in payment at a later date.  Therefore, [..] Read More..

Civil penalty amount unsupported where no residents were in facility’s care.

Topic: Health Law, Decided by Judge Howells 
Docket Number: 1627302 , Decision Date: 2016-02-18 
Attachment: Click here to download the decision. 

The Department of Community Health was authorized to fine a community living arrangement (CLA) based on the failure of the owner to be present, or ensure that a staff member was present, during an annual inspection.  However, the Department’s proposed fine amount was unsupported inasmuch [..] Read More..

Facility’s failure to provide adequate supervision during outing resulted in resident’s death.

Topic: Health Law, Decided by Judge Woodard 
Docket Number: 1630927 , Decision Date: 2016-04-20 
Attachment: Click here to download the decision. 

The owner of a personal care home organized a river tubing outing for four of its residents, all of whom had some level of cognitive impairment.  The owner was the only staff member on hand to supervise the residents during the outing, and was unable [..] Read More..

Functional limitations must be attributable to intellectual disability, not age, to meet ICF/ID level of care.

Topic: Health Law, Decided by Judge Woodard 
Docket Number: ******* , Decision Date: 2016-01-05 
Attachment: Click here to download the decision. 

The Department of Community Health denied Petitioner’s application for coverage under the Katie Beckett deeming waiver because her caregivers did not demonstrate that she met any institutional level of care. The Court upheld the denial, finding that, although Petitioner appeared to exhibit the requisite functional [..] Read More..

Evasive, unreliable testimony regarding criminal record insufficient to establish mitigation.

Topic: Health Law, Decided by Judge Miller 
Docket Number: 1616599 , Decision Date: 2015-11-04 
Attachment: Click here to download the decision. 

The Department of Community Health denied an application for authorization to work at a personal care home due to two felony convictions.  Although the applicant initially testified that she had since been involved in no criminal activity, she admitted during cross-examination that charges of financial [..] Read More..

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