South Carolina              
Administrative Law Court
Edgar A. Brown building 1205 Pendleton St., Suite 224 Columbia, SC 29201 Voice: (803) 734-0550

SC Administrative Law Court Decisions

CAPTION:
Ann Batson vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Ann Batson

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
00-ALJ-08-0148-AP

APPEARANCES:
Appellant & Representative: Ann Batson, Pro se

Respondent & Representative: South Carolina Department of Health and Human Services, George Burnett, Esquire
 

ORDERS:

ORDER

I. Statement of the Case



This matter is an appeal by Ann Batson (Batson) from a final decision of the Respondent, South Carolina Department of Health and Human Services (Department). The Department's final decision was to issue an Order of Dismissal based on Batson's failure to submit a timely request for a hearing. The Administrative Law Judge Division (Division) has jurisdiction to hear the appeal of the Department's decision. S.C. Code Ann. §§ 1-23-380 and 44-6-190 (Supp. 1999).



Oral argument was presented on August 3, 2000 at the offices of the Division in Columbia, South Carolina, after notice to the parties. However, at the conclusion of the arguments, the parties agreed to pursue settlement negotiations with this matter held in abeyance. Those negotiations have proven to be unsuccessful and thus this matter is now ready for decision.



Upon consideration of the briefs and the arguments presented at the hearing, together with a review of the applicable law, the Department's Order of Dismissal must be affirmed.



II. Issue On Appeal



The issue on appeal is whether the Department properly concluded that Batson failed to timely appeal the Anderson County Department of Social Services' decision to deny Batson's application for Medicaid Nursing Home Vendor payments.

III. Standard of Review



In addressing the issue on appeal, the South Carolina Administrative Procedures Act (APA) is controlling. Under the APA, the Administrative Law Judge may reverse or modify the decision of the Department if substantial rights of the appellant have been prejudiced because the administrative findings or decisions are "clearly erroneous in view of the reliable, probative and substantial evidence on the whole record," "affected by . . . error of law," or "arbitrary or capricious." Id; see also Lark v. Bi- Lo, 276 S.C. 130, 276 S.E.2d 304 (1981).



While broad authority exist to reverse or modify the decision made below, in making that determination the Division "shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact." S.C. Code Ann. § 1-23-380(A)(6) (Supp. 1999). Indeed, when examining the facts found by the agency, the judge is concerned with whether substantial evidence supports the factual findings.



Substantial evidence supports the factual findings when the evidence, considering the record as a whole, allows reasonable minds to reach the conclusion that the administrative agency reached. See, e.g., Jennings v. Chambers Development Co., 335 S.C. 249, 516 S.E.2d 453 (Ct. App. 1999). In making the determination on whether substantial evidence is present, the possibility that two inconsistent conclusions could be reached from the evidence does not prevent an administrative agency's finding from being supported by substantial evidence. Id. Indeed, even if a review shows that a conflict exists in the evidence, the agency's findings of fact are conclusive. Id.; see also Harbin v. Owens-Corning Fiberglas, 316 S.C. 423, 450 S.E.2d 112 (Ct. App. 1994). Given such a limitation on the ability to review factual findings by the reviewing body, the reviewing body cannot substitute its judgment for that of the Department if there is room for a difference of intelligent opinion. See, e.g., Chemical Leamen Tank Lines v. S.C. Pub. Serv. Comm'n, 258 S.C. 518, 189 S.E.2d 296 (1972).



IV. Analysis



Under the APA, substantial evidence supports the decision made by the Department.



A. Facts Reviewed



On December 3, 1999, the Anderson County Department of Social Services (ACDSS) mailed to Batson a Notice of Denial of Batson's application for Medicaid Nursing Home Vendor payments. On January 18, 2000, the ACDSS received Batson's request for a hearing but believed the request was not timely. Thus, while the ACDSS transmitted the request to the DHHS Appeals Division, a request to dismiss was also transmitted in the form of a Motion to Dismiss.



On January 24, 2000, the Appeals Division received the appeal request. In an effort to address the Motion to Dismiss, the Hearing Officer, pursuant to S.C. Code Ann. §44-6-90, Regs. 126-154 required Batson to explain in writing the reason for the delay in submitting the hearing request. The response was due by February 7, 2000.



On February 7, 2000, Batson submitted a response via facsimile. However, the statement did not adequately explain nor provide any details on the reason for the delay in filing the request for a hearing. The statement was as follows:



The Anderson County probate court's inventory and appraisal report regarding my deceased father's property is being revised. The property should not have been listed at $72,000.00. Therefore, I ask that this case remain in open status.



The response failed to address any reasons for the late request. The Hearing Officer found that while it may certainly be true that the property valuation was being reviewed by the Probate Court, such a factor did not adequately address any basis for the filing of a late request for a hearing. Given the lack of explanation, the Hearing Officer granted the Motion to Dismiss.



B. Applicable Law Applied



An individual denied Medicaid benefits may challenge that decision by filing a notice of appeal within thirty days of the written notice of the decision to deny benefits. Regs. 126-152(A). If the appeal is not filed within the thirty day period, the decision is final. Id.



Here, Batson's denial was dated December 3, 1999 but the request for a hearing was not received until January 18, 2000. The thirty day period in which to seek a hearing was not satisfied. Thus, in the absence of any other relief, the denial was final at the conclusion of the thirty days.



The Hearing Officer offered Batson an opportunity to establish sufficient reasons to excuse the failure to timely file. However, the response of February 7, 2000 failed to address any reasons for the late request. The Hearing Officer is authorized to "dismiss any appeal for failure to comply with the requirements of [Subarticle 3, Appeals And Hearings]." Regs. 126-154. Under the facts of this case as found below, the Hearing Officer acted within the authority granted, determined that the filing for a hearing was untimely, and properly dismissed the challenge.



V. Order



Accordingly, the Order to Dismiss is Affirmed.



_______________________________

RAY N. STEVENS

Administrative Law Judge



Dated: November 9, 2000

Columbia, South Carolina


Brown Bldg.

 

 

 

 

 

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