650 F. App'x 312
9th Cir.2016Background
- J.C., a child with disabilities, had occupational therapy in his IEP; CCS (California Children’s Services) determined which OT was "medically necessary."
- The California Dept. of Health Care Services (through CCS) maintains a separate medical-necessity determination and an internal CCS appeal procedure for parents.
- Parents disagreed with CCS’s medical-necessity decision, pursued a due process hearing under California’s IDEA procedures, and obtained an ALJ order awarding additional OT, compensatory therapy, reimbursement for independent assessments, and a stay-put placement.
- The Department sought writ relief in district court; the district court granted the Department’s petition, dismissed parents’ counterclaims, and denied attorney’s fees and the stay-put relief.
- The Ninth Circuit reviewed statutory interpretation de novo and considered whether ALJs have jurisdiction to review CCS medical-necessity determinations when those services are included in an IEP.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether parents may seek IDEA due process review of CCS’s medical-necessity OT determination included in an IEP | Parents: Due process hearings may review disputes over OT in IEPs; state law allows review | Dept.: §7575 vests medical-necessity determinations exclusively in CCS and CCS’s appeal process precludes ALJ review | Held: Parents may invoke IDEA due process; ALJs have jurisdiction to review CCS determinations when OT is in the IEP |
| Whether occupational therapy deemed medically necessary by CCS is a “related service” under IDEA and California law | Parents: OT in an IEP—medical or educational—assists benefit from special education and is a related service | Dept.: Medically necessary determinations are separate and not subject to ALJ review as related services | Held: OT in an IEP is a related service; ALJs can resolve related-service disputes, including medically necessary OT in IEPs |
| Whether an ALJ may order compensatory services and reimbursement for independent assessments | Parents: ALJ can order compensatory therapy and reimbursement when OT in IEP is necessary for benefit from special education | Dept.: Such remedies exceed ALJ authority over CCS medical findings | Held: ALJ had authority to order compensatory therapy and reimbursement under IDEA and California law |
| Whether parents were entitled to a stay-put order and attorney’s fees after ALJ ruled for additional services | Parents: ALJ’s decision creates a state–parent agreement triggering IDEA stay-put; prevailing party entitled to fees | Dept.: ALJ order does not trigger stay-put against CCS; fees not warranted | Held: ALJ’s order triggers stay-put and parents are entitled to attorney’s fees; remanded to calculate fees |
Key Cases Cited
- Beeman v. TDI Managed Care Servs., Inc., 449 F.3d 1035 (9th Cir. 2006) (standard for de novo review of statutory interpretation)
- R.P. ex rel. C.P. v. Prescott Unified Sch. Dist., 631 F.3d 1117 (9th Cir. 2011) (ALJ authority to order compensatory services)
- Meridian Joint Sch. Dist. No. 2 v. D.A., 792 F.3d 1054 (9th Cir. 2015) (prevailing party standard for IDEA fee awards)
- V.S. ex rel. A.O. v. Los Gatos-Saratoga Joint Union High Sch. Dist., 484 F.3d 1230 (9th Cir. 2007) (remand for calculation of attorney’s fees)
- Sch. Comm. of Burlington v. Dep’t of Educ. of Mass., 471 U.S. 359 (U.S. 1985) (stay-put and reimbursement principles under IDEA)
- Clovis Unified Sch. Dist. v. Cal. Office of Admin. Hearings, 903 F.2d 635 (9th Cir. 1990) (stay-put application to state administrative proceedings)
- A.I. ex rel. Iapalucci v. District of Columbia, 402 F. Supp. 2d 152 (D.D.C. 2005) (role of ALJs in weighing medical evidence)