Thursday, September 17, 2009

MR waiver services - proof of MR before age 21 - post-21 evidence

Heraty v. DPW - Cmwlth. Court - September 16, 2009 - unreported memorandum opinion

The court remanded this case, in which the Petitioner requested mental retardation (MR) waiver-funded services. Petitioner is a 53 year old woman who has been registered with and receiving services from the county MR office for over 20 years. She sought additional funding, known as waiver funding due to the alleged severity of her mental retardation1 because her elderly mother, with whom she lives, will be unable to provide for her long-term care. Petitioner suffers from autism, is non-verbal and deaf, can use only rudimentary sign language and, aside from simple matters such as dressing and feeding herself, is completely dependent upon her mother for her care.

In order to qualify for the waiver services, Petitioner had to show that she was mentally retarded before her 22nd birthday, 55 Pa. Code §6210.63(3), which requires that "It has been certified that documentation to substantiate that the applicant’s or recipient’s conditions were manifest before the applicant’s or recipient’s 22nd birthday.

The ALJ rejected Petitioners application based solely on an evaluation in 1976 when she was 21, which showed that she had a partial IQ score of 98, making her not mentally retarded under the standards contained in 55 Pa. Code §4210.101a, a policy statement that lists IQ as one of various factors to consider when making a diagnosis of mental retardation.

By contrast, a 2008 psychological evaluation showed that she could not be adequately assessed due to her disabilities and, instead used adaptive functioning tests that could be substituted for IQ tests. On these tests, Petitioner scored at a one year, nine month level for communication, a six year, six month level for daily living, and a one year, nine month level for socialization. According to these tests, her composite age equivalent is three years, four months, which supports a classification of severe mental retardation, and that her disabilities have been present since childhood. The clinician’s report also stated that Petitioner’s developmental delay was present before 22 years of age.

Based on its opinion in Lycoming-Clinton County MH/MR Program v. DPW, 884 A.2d 382 (Pa. Cmwlth. 2005), the court held that it was error for the ALJ to rely solely on the 1976 IQ test, noting that "55 Pa. Code §4210.101(a) states that while an IQ score can be used, it is not always a reliable indicator of mental retardation, and other factors must also be considered where it does not accurately reflect the person’s real-life functioning abilities. Lycoming-Clinton County, 884 A.2d at 384-85...." [T]o rely solely on a full scale IQ score of 70 or below to diagnose MR [mental retardation] would be inconsistent with the statutory definition of MR....Notably, the statutory definition of MR does not require a base IQ score to diagnose an individual as mentally retarded and, in fact, does not mention IQ.... To determine if Petitioner is eligible for mental retardation waiver funded services, it is necessary for DPW to consider whether she is impaired in her maturation, learning and social adjustment, not to take an IQ score, let alone a partial IQ score, and automatically categorize her based upon that score."

All that the relevant regulation, 55 Pa. Code §6210.63(3), "requires is that 'documentation' is presented that “substantiates” that Petitioner’s mental retardation was manifest” before her 22nd birthday, not that the evaluation that resulted in the documentation occurred before her 22nd birthday."