Richardson v. State of Wyoming, Ex Rel. Wyoming Department of Health
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The case revolves around Gracie and Jeff Richardson, the legal guardians of their adult son, JMR, who suffers from severe developmental and intellectual disabilities. JMR requires full-time care and receives the highest level of Medicaid benefits offered through the Home and Community Based Services Waiver Program (HCBS Program) administered by the Wyoming Department of Health. The HCBS Program offers numerous services to participants like JMR to meet their individually assessed needs. In 2017, the Department entered into a settlement agreement with the Richardsons to establish an individual plan of care for JMR that permitted him to spend his individual budget amount on adult day services, residential habilitation services (community living services), and respite services.
In 2021, the Department reviewed JMR’s individual plan of care pursuant to a quality improvement review. The Department discovered JMR’s providers had been billing for respite services at the same time JMR had been receiving community living services. Under the Department’s Comprehensive and Supports Waiver Service Index (the Index), providers are not authorized to bill for both the daily rate of community living services and the fifteen-minute units of respite services. The Department, relying on the Index, notified the Richardsons that it was required to remove respite services from JMR’s individual plan of care. The Richardsons requested an administrative hearing, which upheld the Department’s decision. The Richardsons appealed to the district court, which affirmed the decision. The Richardsons then appealed to the Supreme Court of Wyoming.
The Supreme Court of Wyoming affirmed the lower court's decision. The court found that the Department acted in accordance with law when it removed respite services from JMR’s individual plan of care. The court held that the Index, which was incorporated by reference in the Department’s Medicaid regulations, constituted a rule with the force and effect of law. The court also found that the Department’s quality improvement review, which was used to identify the billing deemed erroneous under the Index, was not considered a “rule” under the Wyoming Administrative Procedure Act and therefore did not require the rulemaking process before implementation. Finally, the court concluded that the Department’s removal of respite services from JMR’s individual plan of care did not violate the parties’ 2017 Settlement Agreement.
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