ORDERS:
ORDER
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VACATED AND REMANDED
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STATEMENT OF THE CASE
Pursuant to Rule 33 of the Rules of Procedure for the Administrative Law Court (Court
or ALC), Pauline Bolin (Appellant) appealed the Final Order and Decision of the South Carolina
Department of Health and Human Services (Department) dated October 8, 2004. The
Department’s decision upheld the determination by its staff that Appellant did not meet its
published Level of Care Criteria for Long Term Care (care in a nursing facility) and therefore
did not qualify for Medicaid sponsored skilled or intermediate care in a long term care facility.
Oral arguments were heard by the Court on April 26, 2005 in Columbia, South Carolina.
After a review of the entire record, I find that the Department failed to provide detailed
findings of fact and conclusions of law in its Order that supported its decision that Appellant did
not meet the requirements for skilled or intermediate care. Accordingly, the Order of the
Department is vacated and the matter is remanded to the Department to prepare an order, within
forty-five (45) days from the date of receipt of this Order, which shall include detailed findings
of fact and conclusions of law that clearly explain the reasoning for its decision.
JURISDICTION AND SCOPE OF REVIEW
The standard of review in appeals to the Court is governed by the review criteria of S.C.
Code Ann. § 1-23-380(A)(6) (Supp. 2004). Section 1-23-380(A)(6) specifically provides:
The court shall not substitute its judgment for that of the agency as to the weight
of the evidence on questions of fact. The court may affirm the decision of the
agency or remand the case for further proceedings. The court may reverse or
modify the decision if substantial rights of the appellant have been prejudiced
because the administrative findings, inferences, conclusions or decisions are:
(a) in violation of constitutional or statutory provisions;
(b) in excess of the statutory authority of the agency;
(c) made upon unlawful procedure;
(d) affected by other error of law;
(e) clearly erroneous in view of the reliable, probative and substantial evidence
on the whole record; or
(f) arbitrary or capricious or characterized by abuse of discretion or clearly
unwarranted exercise of discretion.
Appellant argues that the Department’s decision is not supported by substantial evidence
and that a reversal of the Department’s decision is required because Appellant meets various
functional deficits as listed in the Department’s Assessment and Level of Care Manual for
Medicaid Sponsored Long Term Care Services. The Department seeks affirmance of the Order
of the hearing officer. Notwithstanding the arguments, I find that this matter must be remanded
to the Department because the hearing officer’s decision fails to make specific findings of fact
and fails to explain his rationale in sufficient detail to afford judicial review. Accordingly, the
Order of the hearing officer dated October 8, 2004 is vacated and this matter is remanded for
further consideration consistent with the explanation below.
SPECIFIC FINDINGS
Final Order and Decision of the Department-
Pursuant to its procedures, the Department appointed a Hearing Officer of its Division of
Appeals and Hearings to conduct the hearing, which was held on September 23, 2004. On
October 8, 2004, the Department issued a Final Order and Decision (Order) denying Appellant’s
eligibility for Medicaid sponsored skilled or intermediate care in a long term care facility.
The Order contained five pages. After some introductory provisions on page one, there is
a section captioned “Discussion” which contains a chronology of the events as they occurred as
well as the positions by both parties. The next section, captioned “Findings of Fact,” contains
three findings of fact which consist of both facts and legal conclusions. Following is a section
entitled “Conclusions of Law.” Under it the Hearing Officer included the Department’s
definitions of “Intermediate Services” and “Skilled Level of Care.” The final page of the Order
contains the “Order” provision. However, at no place in the Order does the Department provide
any rationale for its conclusion that Appellant does not meet its requirements to receive skilled
or intermediate care.
Applicable Standard-
The standard an administrative body must satisfy in issuing a decision is now well
established. Our courts have consistently held that written final orders and decisions issued by
an agency after a contested case hearing must comply with the statutory requirements of the
Administrative Procedures Act (APA), which requires that they make findings which are
sufficiently detailed to enable an appellate court to determine whether the findings are supported
by the evidence and whether the law has been applied properly to those findings. Porter v. S.C.
Public Serv. Comm'n, 333 S.C. 12, 507 S.E.2d 328 (1998). Further, S.C. Code Ann. § 1-23-350
(2005) of the APA requires that a final decision “include findings of fact and conclusions of law,
separately stated.” Section 1-23-350 also states that “[f]indings of fact…shall be accompanied
by a concise and explicit statement of the underlying facts supporting the findings.”
Although the APA requires the Department to set forth separate findings of fact and
conclusions of law, administrative agencies are not required to set forth their findings of fact and
reasoning in any particular format. However, it is better practice to present them in an organized
and regimented manner. Porter, supra at 21; see also Seabrook Island Property Owners Ass'n v.
South Carolina Public Service Comm'n, 303 S.C. 493, 401 S.E.2d 672 (1991). Thus, what is
necessary is that the reviewing body be able to clearly identify the factual findings, the
conclusions of law, and the rationale used to reach those findings and conclusions. Here, the
Department has not issued an order complying with the required standard.
Furthermore, since the Department has not provided the Court with any reasoning to
support its ultimate conclusion that Appellant has not met the requirements for skilled or
intermediate case, this Court is unable to conduct a meaningful review of its decision. The Court
will not accept an administrative agency's decision at face value without requiring the agency to
explain its reasoning. Kiawah Property Owners Group v. Public Service Comm’n of South
Carolina, 338 S.C. 92, 96, 525 S.E.2d 863, 865 (1999). The Court also will not sua sponte search
the record for substantial evidence supporting the decision by the Department when it has
inadequately set forth findings of fact and reasoning, nor is it the Court’s duty to do so. See
Porter, supra, n. 3.
While the Hearing Officer may have conducted an orderly analysis in reaching the
conclusion, he did not provide such an analysis in his Order. Thus, this appellate body is left to
speculate on the basis for the conclusion reached in the Order. Accordingly, for the reasons
stated above, the Court must vacate the Order of the Department and remand this matter to the
Department to prepare a Final Agency Decision in accordance with this Order to Vacate and
Remand.
ORDER
Therefore, it is hereby
ORDERED that the order of the Department dated October 8, 2004 is vacated and this
matter is remanded to the Department to consider the entire record below and issue an order,
within forty-five (45) days of the date of receipt of this Order, which sets forth detailed findings
of fact and detailed explanations to support it findings and conclusions.
AND IT IS SO ORDERED.
______________________________
Marvin F. Kittrell
Chief Administrative Law Judge
April 28, 2005
Columbia, South Carolina |
