ALJ Review – Abuse of Discretion

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WI Court of Appeals – District IV

Case Name: J.T. v. Wisconsin Department of Health Services

Case No.: 2020AP2085

Officials: Blanchard, P.J., Kloppenburg, and Graham, JJ.

Focus: ALJ Review – Abuse of Discretion

Before September 2019, J.T. received behavioral health services from a therapy provider for J.T.’s disorder on the autism spectrum. Through his guardian, J.T. appeals a circuit court order that affirmed a decision of the Wisconsin Department of Health Services (the Department) following a contested case hearing. The challenged agency decision is the Department’s denial of a request by the therapy provider for an extension of Medicaid funding to cover therapy beyond August 31, 2019. The Department based its denial on the determination that the provider had not produced sufficient information in response to demands by the Department regarding specific types of progress that J.T. has made as a result of therapy by the provider and skills-instruction by his parents. We affirm for the following reasons.

First, J.T. contends that the circuit court should have reversed the challenged Department decision based on WIS. STAT. § 227.57(8) (“The court shall reverse … if it finds that the agency’s exercise of discretion … is inconsistent with … an officially stated agency policy …, if deviation therefrom is not explained to the satisfaction of the court by the agency.”). J.T. argues that the Department’s demands for information supporting the provider’s request for continued authorization, and its ultimate denial based on a lack of information, require reversal because the demands and denial were inconsistent with an officially stated policy of the Department, and because the Department fails to provide a satisfactory explanation for this alleged deviation. We assume without deciding that the Department’s challenged conduct deviated from an officially stated policy of the Department. With that assumption, we reject J.T.’s argument that the Department has not provided a satisfactory explanation for the assumed deviation.

Second, J.T. contends that the Department’s denial decision was not based on substantial evidence. We conclude that, taking into account all relevant evidence in the record, reasonable minds could come to the same conclusion as the Department and, therefore, substantial evidence supports its denial decision.

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