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Georgia Dep't of Community Health v. Freels

The state department of community health applied the wrong legal standard in denying a petition for Medicaid reimbursement for experimental cerebral palsy treatments.

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James Freels suffers from a severe form of cerebral palsy. On September 3, 1999, the then five-year-old Freels, through his parents and a treating physician, petitioned the Georgia Department of Community Health the “Department” seeking reimbursement under Medicaid for his hyperbaric oxygen therapy “HBOT”. After the Department denied his petition, Freels requested a hearing before an administrative law judge “ALJ”. The ALJ upheld the Department’s refusal to reimburse Freels, and the Department then issued a final decision denying Medicaid coverage for Freels’ HBOT. Freels appealed to the superior court, which reversed the Department’s final decision. We granted the Department’s application for a discretionary appeal, and for the reasons set forth below, we affirm in part, reverse in part, and remand the case to the superior court.

“On appeal our duty is not to review whether the record supports the superior court’s decision but whether the record supports the initial decision of the local governing body or administrative agency. . . .”1 Our function “is to determine whether the superior court has in its own final ruling committed an error of law.”2 The “any evidence” standard applies to the superior court’s review of the findings of fact of the ALJ.3

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