NC Register Volume 21 Issue 09 - Office of Administrative Hearings

CONTESTED CASE DECISIONS
• Letter of Denial, Western Highlands, dated 9/8/05, Petitioner’s Ex. 3
• Letter of Denial, Western Highlands, dated 11/09/05, Petitioner’s Ex. 4, Respondent’s Ex. 5
• Excerpts of Respondent’s Community Alternatives Program-MR/DD Manual, Respondent’s Ex. 6
• Psychological Evaluation by Michael S. Grandis dated 8/30/05, Respondent’s Ex. 7
• Vocational Rehabilitation Progress Review dated 10/25/05, Respondent’s Ex. 8
• Electronic message to Jesse Smathers from Bertha Gail Levi, dated 11/14/05, Respondent’s Ex. 9
• Centers for Medicare/Medicaid Services, Approval letter, dated June 30, 2005 and 1915(c) Waiver Application, dated
September, 30, 2004, Respondent’s Ex. 10
OTHER STIPULATIONS
Community Alternatives Program (CAP) MR/DD
The parties stipulated that at all times relevant to this matter Petitioner was and continues to be eligible for the Community Alternative
Program for Persons with Mental Retardation/ Developmental Disabilities. The parties stipulated that a legal guardian may provide
waiver services to CAP-MR/DD recipient/ward.
Petitioner
The parties stipulated that Petitioner:
• is age 21;
• resides with his mother;
• is subject to a guardianship, with his mother serving as his guardian;
• is diagnosed with Personality Disorder due to Medical Condition – Combined Type: Disinhibited & Aggressive, Mild Mental
Retardation, Moyamoya Disease (a progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in
an area called the basal ganglia); Transcerebral Ischemia; History of Major Motor Seizure/Petit mal absent; and, Asthma;
• is appropriate for Supported Employment Services; and,
• currently receives paraprofessional services delivered by his mother.
WITNESSES
Witnesses for Petitioner:
• Gail Levi, Petitioner’s mother
• David Piper, Qualified mental health professional, Mountain Area Community Services (by deposition)
Witnesses for Respondent:
• Jesse Smathers, CAP-MR/DD coordinator, Western Highland Area Authority
• Dalton McCrary, Case manager, Skills Creation
• Vivian Leon, CAP-MR/DD manager, North Carolina Department of Health and Human Services, Division of Mental Health,
Developmental Disabilities, and Substance Abuse Services
APPLICABLE LEGAL AUTHORITIES
Supported Employment:
• Is for persons for whom competitive employment at or above the minimum wage is unlikely and who,
because of their disabilities, need intensive ongoing support to perform in a work setting;
• Is conducted in a variety of settings, particularly worksites in which persons without disabilities are
employed; and
• Is supported by any activity needed to sustain paid work by persons with disabilities, including supervision,
training and transportation.
State Medicaid Manual, §4442.3 B.3(c) (available at: http://www.cms.hhs.gov/manuals/ downloads/P45_04.zip).
The qualifications for the staff who deliver Supported Employment services are:
Worker Qualifications: must meet requirements for paraprofessional in 10A NCAC 27G .0100-.0200. Client specific
competencies to be met as identified by the individual’s person centered planning team and documented in the plan of care.
Direct care staff must have a criminal record check. A healthcare registry check is required in accordance with 10A NCAC
27G.0200. Driving record must be checked if providing transportation.
N.C. 1915(b) Home and Community Based Services Waiver, approved June 30, 2005, p. 49 (available at
http://www.dhhs.state.nc.us/mhddsas/developmentaldisabilities/operations/ capwaiver10-04a-f.pdf).
The standards for paraprofessional, as defined in 10A N.C.A.C. 27G .0103:
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