In re Appeal of D'Antonio

Summary

The Vermont Supreme Court reviewed a Human Services Board decision requiring Medicaid transportation reimbursement for a child's medically necessary out-of-state specialist appointments. The Court held that the Secretary of Human Services has authority to remand Board decisions when necessary to develop the record, but concluded that the remand in this case lacked a legal basis because the Board's findings were supported by the evidence and the Office had not rebutted the claimant's showing. The Court reversed the Secretary's decision and reinstated the Board's determination.

Holdings

1. The Secretary's statutory authority to reverse or modify a Board decision includes the authority to remand the decision for further findings when necessary to develop the record.
2. The Secretary lacked a legal basis to reverse and remand the Board's decision because the record contained evidence supporting the Board's finding that the out-of-state appointments were medically necessary.
3. Any error in excluding or failing to analyze the Office's additional submission was harmless because the submission did not address continuity of care and would not have rebutted the petitioner's prima facie showing.

Questions Presented

1. Whether the Secretary of Human Services has authority under 3 V.S.A. § 3091(h)(1)(A) to remand a Human Services Board Medicaid decision for further factual development.
2. Whether the Secretary had a legal basis to modify and remand the Board's order where the record contained evidence supporting the Board's finding that the out-of-state medical appointments were medically necessary.
3. Whether the Board erred in refusing to rely on the Office's additional submission concerning local providers, and whether any error was harmless.

Disposition

reversed