Julie H. Firestone, Briggs and Morgan, P.A., Minneapolis, Minnesota, for appellant.
Lori Swanson, Attorney General, Patricia A. Sonnenberg, Assistant Attorney General, Saint Paul, Minnesota, for respondent.
Barnett I. Rosenfield, Justin M. Page, Pamela S. Hoopes, Minneapolis, Minnesota, for amicus curiae Mid-Minnesota Legal Aid, Minnesota Disability Law Center.
1. Under Minn. Stat. § 256B.0659, subd. 2(b)(6) (2012), the word "mobility" means the physical ability to move from one location to another location.
2. The record supports the determination of the Commissioner of the Department of Human Services that appellant is not dependent in the mobility activity of daily living.
This case requires us to determine whether a person who is physically able to move without assistance, but who lacks the ability to direct his movement to a specific location, has a dependency in "mobility" under Minn. Stat. § 256B.0659 (2012). Appellant A.A.A. challenges the decision of the Commissioner of the Minnesota Department of Human Services ("DHS"), who found that appellant is not dependent in "mobility, " and therefore reduced his authorized personal care assistant ("PCA") services covered through the Minnesota Medical Assistance program. The district court reversed the Commissioner's decision, concluding that the statute does not require appellant to be physically incapable of mobility to be eligible for covered services. The court of appeals reversed the district court and reinstated the Commissioner's decision because appellant is physically able to begin and complete moving from place to place without assistance. We affirm the court of appeals.
Appellant is a nine-year-old boy with severe autism, epilepsy, chronic seizures, chronic sinusitis and otitis, and sleep disturbances. Before 2010, appellant qualified for and received PCA services for dependencies in five activities of daily living ("ADLs"). They were dressing, grooming, bathing, eating, and toileting. He received additional PCA services because he had, among other things, behaviors resulting from cognitive deficits. Because appellant was determined to be independent in the activities of transfers, positioning, and mobility, appellant received no PCA services for those ADLs.
On March 18, 2010, a public health nurse ("PHN") visited appellant at his apartment to conduct a health care assessment of him, and then to determine his home care rating under the 2009 amendments to Minn. Stat. §§ 256B.0652, 256B.0659. See Act of May 14, 2009, ch. 79, art. 8, §§ 20, 21, 28, 31, 2009 Minn. Laws 690, 856-57, 875-90. The PHN assessed appellant as dependent in the same five ADLs for which he was previously found to be dependent; and not dependent in same three ADLs for which he was previously found to be independent. A base amount of PCA services per day was derived from appellant's assessed dependencies, his behaviors, and his complex medical needs. The PHN also determined that appellant was entitled to additional PCA services due to certain behaviors, including increased vulnerability due to cognitive deficits, resistance to care, and aggression; his complex health needs due to his seizure disorder; and his critical dependencies in the ADLs of eating and toileting.
Based upon the assessment, the PHN recommended that appellant receive 390 minutes (6 hours, 30 minutes) per day of PCA time. The decrease from the previous PCA time of 462 minutes (7 hours 42 minutes) per day was due to the statutory amendments that limited PCA time for behavioral needs to 90 minutes per day. See Minn. Stat. §§ 256B.0652, subd. 6(c)(3) (2012), 256B.0659, subd. 4(d) (30 minutes per day for each of the three statutorily-defined behaviors). As a result of the PHN's assessment, DHS notified appellant on March 24, 2010, that his authorized PCA services would be reduced from 462 minutes to 390 minutes per day.
Appellant challenged the reduction in his PCA time, and a DHS judge conducted an evidentiary hearing at which appellant's father, mother, and physician testified. Following the hearing, the judge recommended that appellant's PCA time be increased to 450 minutes per day because appellant "does not respond to verbal commands, [and] when he is walking, direct physical contact must continuously be maintained to cue and constantly maintain supervision." Pursuant to Minn. Stat. § 256B.045, subd. 5 (2012), the Commissioner rejected the recommendation of the judge and affirmed DHS's recommendation that appellant's PCA time be reduced to 390 minutes per day. The Commissioner concluded that appellant "does not have a dependency in mobility because he is physically able to walk" and his need "to be supervised so that he does not harm himself while out walking in public" is "properly accounted for by the daily PCA time allotted for his behaviors."
On appeal, the district court reversed the Commissioner's decision, concluding that appellant was entitled to 450 minutes of PCA time per day. The court concluded that because appellant requires direct physical contact to maintain control while walking in public, he "must be continuously cued and constantly supervised" and therefore has a dependency in mobility. The court of appeals reversed, determining that the plain meaning of mobility is " 'moving' (from place to place)." A.A.A. v. Minn. Dep't of Human Servs., 818 N.W.2d 552, 556 (Minn.App. 2012). The court of appeals concluded that because appellant is "able to begin and complete moving from place to place without assistance, and he does not need cuing and constant supervision or hands-on assistance to do so, " he is not dependent in the ADL of mobility. Id. Consequently, the court of appeals concluded that appellant was entitled to only 390 minutes of PCA time per day. Id.
Appellant argues that the court of appeals erred in concluding that he is not dependent in mobility under Minn. Stat. § 256B.0659, subd. 2(b)(6). According to appellant, he needs cuing and constant supervision to complete the task of mobility within the meaning of section 256B.0659, subdivision 4(b)(1), and therefore he is dependent in the activity of mobility. More specifically, appellant argues that his increased vulnerability when he is physically mobile is due to his cognitive deficits, which render him dependent in mobility.
The interpretation of a statute is a question of law that we review de novo. Premier Bank v. Becker Dev., LLC, 785 N.W.2d 753, 758 (Minn. 2010). When interpreting a statute we give the words and phrases of the statute their plain and ordinary meaning. Emerson v. Sch. Bd. of Indep. Sch. Dist. 199, 809 N.W.2d 679, 682 (Minn. 2012). Moreover, we examine the language of a statute as a whole to give effect to all of its provisions. Minn. Stat. § 645.16 (2012). The first step in interpreting a statute is to examine the language to determine whether it is clear and unambiguous. Id. A statute is ambiguous if, as applied to the facts of the case, it is susceptible to more than one reasonable interpretation. Staab v. Diocese of St. Cloud, 813 N.W.2d 68, 72-73 (Minn. 2012). If the statute is clear and not ambiguous, then we apply its plain and ordinary meaning. Emerson, 809 N.W.2d at 682. But if the statute is ambiguous, then we may look beyond the statutory language to determine legislative intent. See generally Minn. Stat. § 645.16.
To answer the question presented, we will first review the statutory framework governing the personal care assistance program to provide context. See Am. Family Ins. Grp. v. Schroedl, 616 N.W.2d 273, 277 (Minn. 2000) (stating that we examine statutes as a whole and interpret each section in light of surrounding sections to avoid conflicting interpretations). Generally, Minnesota provides medical assistance "for needy persons whose resources are not adequate to meet the cost" of a variety of medical services. Minn. Stat. § 256B.01 (2012). PCA services are part of the state medical assistance program. When a person is determined to be eligible for PCA services, that person may be eligible for medical assistance payments. Minn. Stat. § 256B.0659, subd. 2. The eligible needs for which PCA services and reimbursement are available are: (1) activities of daily living; (2) health-related procedures and tasks; and (3) observation and redirection of behaviors. Id., subd. 2(a)(1)-(3). It is the activities of daily living that are at issue in this case.
The methodology for determining the PCA services available and the amount of time eligible for reimbursement changed in 2009. Act of May 14, 2009, ch. 79, art. 8, §§ 20, 21, 28, 31, 2009 Minn. Laws 690, 856-57, 875-90. Prior to the 2009 amendments, the statute provided that "[t]he amount and type of services authorized shall be based on an assessment of the recipient's needs" in nineteen defined areas. Minn. Stat. § 256B.0655, subd. 2(c) (2008). After the 2009 amendments, the statutes currently authorize a specified amount of time eligible for PCA services reimbursement based upon: (1) the number of dependencies in ADLs, (2) the presence of complex health-related needs, and (3) the presence of aggressive or destructive behavior, which combine to determine an overall home care rating for the recipient. Minn. Stat. §§ 256B.0652, subd. 6(b), 256B.0659, subd. 1(c) (2012). Additional time, subject to a daily limit, is authorized for each critical ADL, complex health-related function, and behavioral issue. Minn. Stat. § 256B.0652, subd. 6(c) (2012).
The Commissioner follows a procedure outlined in the statutes to determine whether an individual is entitled to PCA services that are eligible for payment under the medical assistance program. Minn. Stat. §§ 256B.0652 (2012), 256B.0659, subd. 2. Initially, a PHN conducts a home visit to assess the recipient's need for services. Minn. Stat. § 256B.0659, subds. 3a, 4. The PHN prepares a report addressing (1) the total number of dependencies in activities of daily living; (2) the presence of complex health-related needs; and (3) the presence of Level I behaviors. Minn. Stat. §§ 256B.0652, subd. 6; 256B.0659, subds. 4, 6. The eligible ADLs are (1) dressing; (2) grooming; (3) bathing; (4) eating; (5) transfers; (6) mobility; (7) positioning; and (8) toileting. Minn. Stat. § 256B.0659, subd. 2(b); see also Minn. Stat. § 256B.0659, subd. 1(b). Transfers, mobility, eating, and toileting are identified as critical ADLs. Minn. Stat. § 256B.0659, subd. 1(e). A "dependency" in an ADL exists if the recipient "requires assistance to begin and complete" the designated ADL. Minn. Stat. § 256B.0659, subd. 1(f). Additionally, Level I behaviors qualify for PCA services if the recipient needs assistance at least four times per week for (1) physical aggression or property destruction that requires an immediate response; (2) "increased vulnerability due to cognitive deficits or socially inappropriate behavior"; or (3) verbal aggression or resistance that increases the time needed for ADLs. Minn. Stat. § 256B.0659, subd. 4(d)(1)-(3).
The Commissioner, or her designee, uses the information gathered in the home assessment to determine the recipient's home care rating, which translates to a daily amount of time for PCA services authorized and eligible for reimbursement. Minn. Stat. § 256B.0652, subd. 6.
With the statutory framework for personal care assistance services in mind, we return to the question of interpreting the meaning of "mobility" in section 256B.0659, subdivision 2(b)(6). Specifically, we must determine whether appellant, who is physically able to move without assistance but who has behavioral conditions that impair his ability to direct his movement to a specific location, has a dependency in mobility under the statute.
Chapter 256B does not explicitly define "mobility, " but two provisions in section 256B.0659 are relevant to determining its meaning: Minn. Stat. § 256B.0659, subds. 2 & 4. The starting point is the statutory description of the ADL of mobility in section 256B.0659, subdivision 2(b)(6). Subdivision 2(b)(6) describes "mobility" as "including assistance with ambulation, including use of a wheelchair." Minn. Stat. § 256B.0659, subd. 2(b)(6). It further states that "[m]obility does not include providing transportation for a recipient." Id.
The plain and ordinary meaning of "mobility" contemplates physical activity. The definition of "mobility" is "[t]he quality or state of being mobile." The American Heritage Dictionary of the English Language 1129 (4th ed. 2000). Other definitions of "mobile" include "[c]apable of moving or of being moved readily from place to place, " id., and "capable of moving or being moved, " Merriam-Webster's Collegiate Dictionary 745 (10th ed. 2001). The root verb "move" is defined as "[t]o change in position from one point to another, " The American Heritage Dictionary of the English Language at 1156, and "to go or pass to another place or in a certain ...