Opinion
January 27, 1998
Appeal from the Supreme Court, New York County (Walter Schackman, J.).
Supreme Court properly upheld the challenged regulation ( 18 NYCRR 505.14 [b]) as not "`arbitrary, capricious, or manifestly contrary to the statute'" ( Farley v. Sullivan, 983 F.2d 405, 407). The Medicaid Act ( 42 U.S.C. § 1396) confers "broad discretion" on participating States to determine the extent of services that are "`reasonable'" and "`consistent with the objectives'" of the Medicaid Act ( Beal v. Doe, 432 U.S. 438, 444), including the scope and duration limitations of coverage, provided such are in the best interests of the recipients ( see, Alexander v. Choate, 469 U.S. 287, 303). The amount of personal care services is not determined solely by the treating physician, but rather by the social services official "with the advice of a physician" (Social Services Law § 365-a), in conjunction with assessments performed by the local social services department ( 18 NYCRR 505.14 [b] [2]). Home care assessments involve more that medical determinations, and a social services agency is entitled to rely upon the views of its personnel, even in the face of conflicting medical evidence ( see, Matter of Denise R. v. Lavine, 39 N.Y.2d 279, 283). Thus, since neither the Medicaid laws nor due process mandates the imposition of a "treating physician's rule" as to the number of hours of personal care services, the court properly upheld that portion of the regulation ( 18 NYCRR 505.14 [b] [3] [i] [a] [3]) that forbids treating physicians from informing the agency regarding the number of hours of personal home care services needed by the patient. Inasmuch as the court's determination was based upon issues of law, there is no basis to remand this matter for a fact-finding hearing.
Concur — Sullivan, J.P., Ellerin, Tom and Andrias, JJ.