Reed v. Missouri Soc. Serv. Family Support, ED 87348.
| Decision Date | 20 June 2006 |
| Docket Number | No. ED 87348.,ED 87348. |
| Citation | 193 S.W.3d 839 |
| Parties | Eileen REED, Plaintiff/Respondent, v. MISSOURI DEPARTMENT OF SOCIAL SERVICES, FAMILY SUPPORT DIVISION, Defendant/Appellant. |
| Court | Missouri Court of Appeals |
Elizabeth Laflamme, St. Louis, MO, for Appellant.
Vincent Gerard Rapp, St. Charles, MO, for Respondent.
Missouri Department of Social Services, Family Support Division (the Division) appeals from the judgment of the trial court reversing the decision of the Division that Eileen Reed (Reed) was ineligible for medical assistance vendor benefits for four months. The judgment is affirmed.
On July 25, 2003, Reed entered the Blanchette Place Care Center (the Care Center). On September 30, 2003, Reed and her daughter, Sandra Teson (Teson), entered into a "Personal Care Contract" (the Contract) identifying Reed as the "Care Recipient" and Teson as the "Care Provider." The Contract set out duties of the Care Provider such as preparation of nutritious, appropriate meals, house cleaning and laundry; assistance with grooming, bathing, dressing, and personal shopping, including purchase of clothing, toiletries and other personal items; assistance with purchasing hobby, entertainment or other goods for Reed's use and enjoyment, taking into account Reed's ability to pay for such items; monitoring of Reed's physical and mental condition and nutritional needs in cooperation with health care providers; arranging for transportation to health care providers and to the physician of Reed's choice, as well as arranging for assessment, services and treatment by appropriate health care providers for Reed; assisting Reed in carrying out the instructions and directives of Reed's health care providers; arranging for social services by social service personnel as needed; visiting at least weekly and encouraging social interaction; arranging for outings and walks, if reasonable and feasible for Reed; and interacting with and/or assisting any agent of Reed in interacting with health professionals, long-term care facility administrators, social service personnel, insurance companies, and government workers in order to safeguard Reed's rights, benefits, or other resources as needed.
On October 6, 2003, Teson, as Reed's Conservator, filed the Contract as well as a Petition for Expenses (Petition) with the probate court. That same day, the court approved the Petition, permitting a payment of $11,000.00 to be made to Teson as the Conservator under the Contract. On October 14, 2003, an $11,000.00 check was written to Teson. Two days later, the Division received Reed's Application for Medical Assistance Vendor Benefits (the Application). The Application was submitted with the Petition, the Contract and a copy of the $11,000.00 check.
On October 23, 2003, a request for interpretation of policy was submitted to the Income Maintenance Section, Program and Policy in Jefferson City. The Application and Contract were forwarded for evaluation as to whether or not the $11,000.00 was a transfer of property rendering Reed ineligible for medical assistance vendor coverage. On December 3, 2003, Reed was notified that her Medicaid application was rejected because the $11,000.00 given to Teson was determined to be a transfer of property disqualifying her for vendor coverage until February 2004.
Reed submitted an Application for State Hearing. At the hearing, the hearing officer considered evidence from the Division and Teson on Reed's behalf, and issued a decision affirming the Division's rejection of Reed's application for medical assistance vendor benefits. Reed appealed to the circuit court, which reversed the Division's decision and found in favor of Reed. The Division now appeals.
Reed maintains that the Division erred in its decision that the $11,000.00 payment by Reed to Teson was made without consideration because the weight of the competent and substantial evidence established that in exchange for the payment Reed received a binding and enforceable personal care contract to receive personal services for the rest of her life, which is, as a matter of law, fair and valuable consideration.
When the circuit court reverses an administrative agency's ruling, the appellate court "reviews the agency's decision, not that of the circuit court." Collins v. Department Of Social Services, Family Support Division, 141 S.W.3d 501, 503 (Mo.App. S.D.2004). An agency's decision is presumed to be correct, however. Id. The reviewing court must examine the record in the light most favorable to the administrative decision and disregard evidence that might support findings different from those of the agency. Id. The typical scope of review is whether the agency's decision is supported by competent and substantial evidence on the record as a whole. Id. at 503-504. However, when the agency decision involves the interpretation of law and application of the law to undisputed facts, the court must form its own independent conclusions, and is not bound by the interpretation of the agency. Id. at 504. Some deference, however, is appropriate when the issue involves an agency interpretation of its own regulation. Id.
The Division maintains that it correctly determined that the $11,000.00 payment through the Contract was a transfer of property because the Contract lacked fair and valuable consideration in that the services rendered by Teson were largely duplicative of the services provided by a licensed skilled nursing facility. In its decision, the Division concluded that:
[T]he fact that the [circuit court] approved of this payment does not change the overwhelming appearance that this was a transfer without receiving fair and valuable consideration. Protection of non-exempt assets in this manner has not been allowed by that Agency in the past. Ms. Teson, acting as conservator simply took [Reed's] money for doing things that a reasonable person might have expected to do for no compensation. If she is unable or unwilling to do those things without consideration, perhaps she should relinquish the role as conservator to a public administrator.
We find this conclusion is against the weight of the competent and substantial evidence on the record as a whole for the following reasons. There were substantial services provided by Teson under the Contract that were not duplicative of the nursing home's services, and for which $11,000.00 was fair compensation over an eleven-year plus period.1 Namely, the Contract provided that Teson would provide a communication link between Reed and her doctors and nurses regarding the status of her health, as well as interact with facility personnel to safeguard Reed's rights and benefits. Reed, as a result of her medical...
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