ÿWPC- …# VU>a %Ÿ 0(¥4Íáðw@ø 0L8 0J„ 0TÎ 0^" 0h€ 0rè 0|Z 0†Ö 0\ 1uì U,a 0d U,ñ U6B)SDC| 0N¿ B  AM*U*w#¡v~Ä D3BvÓu 0@H AOˆÆ× 0D D/á B˜HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPTÀÌÀääÀÀÌ0 <èÀ( 9Z &Courier RegularX($¡¡Gav x°°3|xU CDDEDF3eGDHUIDJKÓ€U> ÿÿ$Small Circleððà0 à2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)< Œ 9p`(ModernP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(Monaco< Œ 9p`(Courier New% Line 7 d""""7Border 1dd>‡¦$"Small Circleð"ðà0  à d€-#Cþÿ << Gÿÿ< Œ 9p`(Arial Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€ÔÔ€!ÔÝ  ÝÔ€'ÔÔ€'ÔÓ  Óò òÔ YYY ÔFILEDÔ€'XÔÌÌMarch€27,€1996ÌÌCecil€W.€CrowsonÌAppellate€Court€ClerkÔ  Ôó óPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'@%%%%'ÿÿdxdStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑMonacoÑÑ ÑÒ  BA: T Monaco ÒÒ  BA: T Monaco Ò("ÿÿ$££Ò  ÒÒ  Ò€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€ÔÓ&€  X„d&ÓÑ#€  Xd#ÑÔ€!ÔÝ  ÝÓ ` Ü‚Xœ ’X ÓÑ\R AØ'\ÑÑ7€nXdÈdÈ7ÑÑ  ÑRUBY›€HARDEN,€by€Conservatorà à)ÌWANDA€FUZZELL,à à)Ìà àà à)ÌÓ#` Ü‚Xœôx‘X#Óà àPetitioner/Appellant,à à)à àAppeal€No.Ìà àà à)à à01„A„01„9510„CH„00432Ìv.à àà à)Ìà àà à)à àDavidson€ChanceryÌFREDIA€WADLEY,€M.D.,à à)à àNo.€94„3616„IÌÙ€€ÙœßL€&(#;+'h|Gb` ç `€€Lß›Commissioner€Tennessee€à à)ÌDepartment€of€Health,€Bureauà à)Ìof€Medicaid,à à)Ìà àà à)à àÌà àRespondent/Appellee.à à)ÌÌÌÌÓ  ÓÔ€!¼ÔCOURT€OF€APPEALS€OF€TENNESSEEÌÌMIDDLE€SECTION€AT€NASHVILLEÌÌÌAPPEAL€FROM€THE€CHANCERY€COURT€FOR€DAVIDSON€COUNTYÌÌAT€NASHVILLE,€TENNESSEEÌÌÌTHE€HONORABLE€IRVIN€KILCREASE,€JR.,€CHANCELLORÌÓ ` Ü‚XœÈ“X ÓÌÌÓ  ÓÌÌÔ€!XÔSHEARON€W.€HALESÌDAVID€KOZLOWSKIÌLegal€Services€of€SouthÌ€Central€Tennessee,€Inc.ÌP.€O.€Box€l256ÌColumbia,€Tennessee€38402„1256Ìà àATTORNEYS€FOR€PETITIONER/APPELLANTÌÌÌÌCHARLES€W.€BURSONÌAttorney€General€and€ReporterÌÌLISA€A.€YACUZZOÌAssistant€Attorney€GeneralÌ404€James€Robertson€ParkwayÌNashville,€Tennessee€37243Ìà àATTORNEYS€FOR€RESPONDENT/APPELLEEÌÌÌÌÌÌÌÌÌÓ  ÓAFFIRMED€AND€REMANDEDÌÌÌÌÌÌÓ  ÓÔ€!¼ÔœÌSAMUEL›€L.€LEWIS,€JUDGEÌÓ  ÓÓÓòòÔ€!°ÔOÔ€!¼Ô€P€I€N€I€O€NÌÓ  ÓÓ#` Ü` ä œÈ“X#ÓóóÔ€!XÔà àPetitioner/appellant,€Ruby€Harden€by€conservator€WandaÏFuzzell€(ð ðMs.€Hardenðð),€appealed€and€asked€this€court€to€reverseÏthe€judgment€of€the€Chancery€Court€for€Davidson€County€whichÏaffirmed€a€denial€of€Medicaid€benefits€to€Ms.€Harden€for€nursingÏhome€care.€€Ms.€Harden€contends€that€the€decision€of€theÏrespondent/appellee,€Fredia€Wadley,€Commissioner€of€the€TennesseeÏDepartment€of€Health,€Bureau€of€Medicaid,€denying€her€MedicaidÏbenefits,€is€arbitrary€and€capricious.€€She€also€contends€that,Ïtaking€the€entire€record€into€consideration,€there€is€noÏsubstantial€and€material€evidence€in€support€of€the€decision.ÌÌà àThis€case€is€before€this€court€pursuant€to€theÏAdministrative€Procedures€Act,€Tennessee€Code€Annotated€titleÏfour,€chapter€five.ÌÌà àHillview€Healthcare€Center€(ð ðHillviewðð),€the€nursingÍfacility€in€which€Ms.€Harden€resided,€filed€a€pre„admissionÏevaluation€(ð ðPAEðð)€seeking€Medicaid€coverage€for€Level€1ÏIntermediate€Care€Facility€(ð ðICFðð)€services€on€behalf€of€Ms.ÏHarden€as€of€1€October€1993.€€The€Commissioner€denied€the€requestÏfor€Medicaid€coverage€on€the€ground€that€Ms.€Harden€did€not€needÏdaily€inpatient€nursing€care€as€required€by€the€Medicaid€coverageÏrequirements.ÌÌà àMs.€Harden€is€87€years€old.€€She€was€hospitalized€after€herÏneighbor€found€her€on€her€front€porch€with€œblurred›€vision,€slurredÏspeech,€and€possible€dizziness.€€Ms.€Harden€was€released€from€theÏhospital€into€the€care€of€Hillview€Healthcare€Center,€a€nursingÏhome€in€Columbia,€Tennessee.€€Ms.€Hardenððs€treating€physician,€Dr.ÏRobert€Robinson,€testified€that€he€initially€recommended€that€Ms.ÏHarden€enter€an€ICF€mainly€because€of€her€confusion€and€because€heÏdid€not€think€she€could€get€along€at€home.€€ÌÌà àDr.€Robinson€also€testified€about€Ms.€Hardenððs€daily€needs.€ÏHe€stated€that€Ms.€Harden€did€not€need€the€care€of€licensedÏpersonnel€on€a€daily€basis,€but€that€she€would€need€someone€to€doÏa€lot€for€her.€€He€also€stated€that€Ms.€Harden€needs€venipunctureÏand€thyroid€tests€done€only€one€time€per€year.€€Further,€Dr.ÏRobinson€testified€that€the€inpatient€nursing€care€that€Ms.€HardenÏreceives€at€Hillview€consists€of€the€administration€of€medicinesÏand€the€taking€of€vital€signs€along€with€periodic€assessments.€ÏAccording€to€Dr.€Robinson,€however,€each€of€these€functions€can€beÍperformed€outside€a€nursing€home€setting.€€He€further€testifiedÏthat€if€someone€watched€Ms.€Harden€swallow€her€medication€sheÏwould€not€need€a€licensed€professional€to€administer€herÏmedication.€€He€agreed€that€a€lay€person€could€monitor€Ms.ÏHardenððs€blood€pressure€to€determine€if€it€was€too€high,€check€toÏsee€if€she€was€alert€every€day,€and€monitor€her€nutritionalÏintake.€€It€was€his€testimony€that€Ms.€Harden€could€get€by€withÏhigh€quality,€nonprofessional€care.€€He€did€indicate€that€heÏdoubted€whether€Ms.€Harden€could€receive€such€special€attention€inÏa€residential€homes€for€the€aged€(ð ðRHAðð),€but€admitted€that€he€hadÏvery€little€knowledge€about€RHAððs.€ÌÌà àMaureen€Bearden,€a€registered€nurse€employed€at€Hillview,Ïhas€helped€take€care€of€Ms.€Harden€since€she€was€admitted.€€Ms.ÏBearden€testified€that€the€only€nursing€care€Ms.€Harden€needs€isÏto€help€her€take€her€medications.€€Ms.€Bearden€agreed€that€Ms.ÏHarden€is€not€taking€any€type€of€medication€that€a€person€outsideÏthe€nursing€home€could€not€administer.€€The€only€assistance€Ms.ÏHarden€requires€is€in€getting€a€proper€dosage€of€her€medications.€ÏShe€does€not€have€any€problem€physically€swallowing€herÏmedication.€€Ms.€Bearden€also€testified€that€Ms.€Harden€receivedÏservices€including€bathing,€making€sure€her€laboratory€work€wasÏdone,€notifying€Ms.€Hardenððs€physician€if€the€laboratory€work€wasÏabnormal,€providing€meals€to€her,€encouraging€participation€inÏsocial€activities,€and€encouraging€Ms.€Harden€to€change€herÏclothing.€€Despite€receiving€these€services,€Ms.€Harden€is€able€toÍbath,€feed,€and€dress€herself,€but€she€does€need€reminding.ÌÌà àCarol€Spurgeon,€a€licensed€practical€nurse€employed€atÏHillview€has€also€helped€care€for€Ms.€Harden.€€Ms.€SpurgeonÏtestified€that€she€provided€services€to€Ms.€Harden€such€as€helpingÏher€take€her€medication,€making€her€bed,€doing€her€laundry,Ïproviding€her€meals,€and€other€matters.€€Ms.€Spurgeon€was€of€theÏopinion€that€Ms.€Harden€could€not€be€cared€for€at€an€RHA€becauseÏshe€would€need€her€blood€pressure€and€pulse€monitored.€€As€we€haveÏstated,€however,€Ms.€Hardenððs€treating€physician€testified€that€aÏlay€person€could€perform€those€tasks.€€Ms.€Spurgeon€also€testifiedÏthat€she€believed€Ms.€Harden€would€need€assistance€in€evacuating€aÏbuilding€in€the€case€of€an€emergency.€€The€record€shows,€however,€Ïthat€Mary€Mahoney,€a€registered€nurse€working€for€the€DepartmentÏof€Health,€tested€Ms.€Hardenððs€ability€to€evacuate€in€case€of€anÏemergency€and€found€that€Ms.€Harden€could€safely€transfer€out€ofÏher€bed€from€a€lying€position€and€ambulate€150€feet€in€two€andÏone„half€minutes.€€Ms.€Mahoney€testified€that,€after€talking€withÏMs.€Hardenððs€caretakers€and€reviewing€Ms.€Hardenððs€records,€sheÏwas€of€the€opinion€that€Ms.€Harden€did€not€require€daily€inpatientÏnursing€care,€that€her€medical€condition€could€be€monitoredÏthrough€physicianððs€visits,€and€that€an€RHA€would€meet€her€needs.ÌÌà àDr.€John€Gore,€the€Medicaid€Medical€Director,€did€notÏexamine€Ms.€Harden,€but€reviewed€her€records.€€Based€on€hisÏreview,€he€concluded€that€Ms.€Harden€did€not€require€dailyÍinpatient€nursing€care.ÌÌà àMs.€Hardenððs€PAE€indicates€that€she€is€capable€ofÏcommunicating€information€to€others€such€as€the€presence€of€painÏand€the€need€for€assistance€with€her€toilet.€€She€is€sometimesÏdisoriented€and€has€difficulty€remembering;€however,€she€feedsÏherself€without€assistance,€her€vision€is€adequate,€and€she€isÏable€to€go€to€the€bathroom€without€assistance.€€She€is€capable€ofÏusing€a€wheelchair€without€assistance€and€of€self„transfer€from€aÏbed€to€a€chair€or€from€a€chair€to€a€bed.ÌÌà àMs.€Harden€presents€two€issue.€€The€first€is€whether€theÏdenial€of€benefits€was€arbitrary€and€capricious.€€She€argues€thatÏthe€ALJ€should€have€given€deference€to€the€opinions€of€theÏtreating€physician€and€the€ICF€nurses€regarding€Hardenððs€need€forÏdaily€inpatient€nursing€care.€€She€also€argues€that€the€ALJ€didÏnot€afford€proper€consideration€to€the€professional€opinions€andÏtestimony€of€Carol€Spurgeon,€LPN;€Tricia€Striklan,€ActivitiesÏDirector;€Wanda€Fuzzell,€public€guardian€and€conservator€for€Ruby€ÏHarden;€Arthur€Hamby,€District€Long€Term€Care€Ombudsman;€and€theÏlay€testimony€of€Mary€Atkins.€€The€second€issue€is€whether€thereÏwas€substantial€and€material€evidence€to€support€the€ALJððsÏdecision.ÌÌà àThis€courtððs€scope€of€review€is€the€same€as€that€of€theÏchancery€court.€€ò òòòEstate€of€Street€v.€State€Bd.€ofÍEqualizationó óóó,€812€S.W.2d€583,€585€(Tenn.€App.€1990).€€TennesseeÏCode€Annotated€section€4„5„322(h)€governs€the€chancery€courtððsÏreview€of€the€ALJððs€determination.€€In€reviewing€an€administrativeÏdecision,€the€chancery€court€ð ðððshall€not€substitute€its€judgmentÏfor€that€of€the€agency€as€to€the€weight€of€the€evidence€onÏquestions€of€fact.ðððð€€ò òòòSouthern€Ry.€V.€State€Bd.€ofÏEqualizationó óóó,€682€S.W.2d€196,€199€(Tenn.€1984)(quoting€Tenn.€CodeÏAnn.€ðð€4„5„322(h)(5)).€€We€are€to€review€the€factual€issues€uponÏthe€standard€of€substantial€and€material€evidence€which€is€ð ðsuchÏrelevant€evidence€as€a€reasonable€mind€might€accept€as€adequate€toÏsupport€a€rational€conclusion€and€such€as€to€furnish€a€reasonablyÏsound€basis€for€the€action€under€consideration.ðð€€ò òòòPace€v.ÏGarbage€Disposal€Dist.,ó óóó€54€Tenn.€App.€263,€267,€390€S.W.2d€461,Ï463€(1965)òòò ò.ó óóó€€This€standard€generally€requires€ð ðððsomething€lessÏthan€a€preponderance€of€the€evidence,€but€more€than€a€scintilla€orÏglimmer.ðððð€€ò òòòEstate€of€Street,€ó óóó812€S.W.2d€at€585„86€(citationsÏomitted).€€ð ðAn€arbitrary€decision€is€one€that€is€not€based€on€anyÏcourse€of€reasoning€or€exercise€of€judgment€or€one€that€disregardsÏthe€facts€or€circumstances€of€the€case€without€some€basis€thatÏwould€lead€a€reasonable€person€to€reach€the€same€conclusion.ðð€Ïò òòòJackson€Mobilephone€Co.€v.€Tennessee€Pub.€Serv.€Commððnó óóó,€876ÏS.W.2d€106,€111€(Tenn.€App.€1993)(citations€omitted).ÌÌà àThe€burden€was€upon€Ms.€Harden€to€prove€by€a€preponderanceÏof€the€evidence€that€she€needs€inpatient€nursing€home€care€daily.€ÏòòTenn.€Depððt€of€Health€and€Envððt€Bureau€of€Medical€Care€Serv.€Div.ÍOf€Medicaidóó,€Gen.€R.€1200„13„1„.10(3)(d)(July€1983)[hereinafterÏGen.€R.].€€ð ðInpatient€nursing€care€neededðð€means€ð ð[n]ursingÏ[s]ervices€must€be€such€that€as€a€practical€matter€they€can€onlyÏbe€rendered€on€an€inpatient€basis€or€it€is€the€general€medicalÏpractice€that€they€be€rendered€only€on€an€inpatient€basis.ðð€€Gen.€ÏR.€1200„13„1„.10(1)(b)(Dec.€1988).€€We€have€previously€held€thatÏan€individual€does€not€meet€the€Medicaid€criteria€when€theÏindividualððs€needs€can€be€provided€for€at€a€lower€level€of€careÏthan€nursing€home€care€on€an€inpatient€basis.€€ò òòòWheeler€v.ÏTennessee€Depððt€Of€Health€and€Envððtó óóó,€App.€No.€86„263„II,€1987ÏWL€5172,€at€*2€(Tenn.€App.€7€Jan.€1987).ÌÌà àMs.€Hardenððs€treating€physician,€Dr.€Robinson,€testifiedÏthat€the€majority€of€services€Ms.€Harden€requires€could€beÏprovided€by€an€unskilled€person€and€that€any€additional€servicesÏcould€be€provided€on€an€outpatient€basis.€€For€example,€a€layÏperson€could€watch€Ms.€Harden€to€be€sure€she€swallowed€herÏmedicine€and€could€€check€her€blood€pressure€and€vital€signs.€€Dr.ÏRobinson€also€testified€that€Ms.€Harden€could€get€by€with€highÏquality,€nonprofessional€care.€€In€addition,€he€testified€that€theÏmedical€procedures€needed€by€Ms.€Harden,€including€venipunctureÏand€thyroid€tests€are€only€needed€one€time€per€year.€€While€Dr.ÏRobinson€indicated€that€he€did€not€think€Ms.€Harden€could€get€highÏquality€care€in€an€RHA,€he€did€admit€that€he€was€not€familiar€withÏRHA€facilities.€€The€testimony€of€the€nurses,€who€have€cared€forÏMs.€Harden€in€the€nursing€home,€also€demonstrates€that€she€doesÍnot€need€inpatient€care€on€a€daily€basis.ÌÌà àIt€is€the€contention€of€Ms.€Harden€that€the€treatingÏphysician€rule,€which€is€commonly€applied€in€disability€cases,Ïshould€apply€here.€€The€rule€provides€that€the€trier€of€fact€mustÏgive€the€treating€physicianððs€medical€opinion€deference,€and€if€itÏis€not€contradicted,€the€trier€of€fact€should€give€it€completeÏdeference.€€ò òòòWalker€v.€Secretary€of€Health€and€Human€Serv.ó óóó,Ï980€F.2d€1066,€1070€(6th€Cir.€1992).€€The€reason€for€the€rule€isÏthat€ð ð[t]he€treating€physician€has€had€a€greater€opportunity€toÏexamine€and€observe€the€patient€[and]€is€generally€more€familiarÏwith€the€patientððs€condition€than€other€physicians.ðð€€ò òòòId.ó óóó€€TheÏultimate€decision€of€disability,€however,€rests€with€the€ALJ.€€ò òòòId.ó óóóÌÌà àWe€have€found€no€authority€nor€have€we€been€cited€to€anyÏfor€the€application€of€this€rule€to€Medicaid€PAEððs.€€TheÏapplication€of€the€treating€physician€rule€to€social€securityÏdisability€cases€is€specifically€set€forth€and€governed€by€theÏstatutory€and€regulatory€schemes€governing€those€cases.€€Such€aÏprovision€is€absent€from€the€statutes€and€regulations€governingÏthe€issue€addressed€in€this€case.€ÌÌà àMoreover,€the€rule€does€not€lend€itself€to€application€inÏthe€instant€case.€€The€question€of€whether€a€person€needs€dailyÏinpatient€care€requires€an€analysis€of€what€other€types€of€careÏare€available.€€This€court€has€held€that€a€person€who€can€get€theÍnecessary€care€at€a€lower€level€care€facility,€such€as€a€groupÏhome,€does€not€meet€the€Medicaid€requirements.€€ò òòòWheeler,€óóó ó1987€WLÏ5172,€at€*€2.€€ÌÌà àWhile€the€treating€physician€usually€is€in€the€bestÏposition€to€know€what€medical€care€a€patient€needs,€the€treatingÏphysician€is€not€necessarily€in€the€best€position€to€know€whereÏthose€needs€can€best€be€met€and€what€opportunities€for€care€areÏavailable.€€Dr.€Robinsonððs€testimony€demonstrates€this€point.€ÏWhen€asked€how€much€experience€he€had€with€RHAððs,€Dr.€RobinsonÏstated€as€follows:€€ð ðnot€very€much.€€I€have€a€lot€with€nursingÏhomes.€€But€not€very€much€with€residential...very€littleÏknowledge.ðð€€Nurse€Spurgeon€also€testified€that€she€did€not€knowÏanything€about€RHAððs.€€While€the€treating€physician€and€the€nursesÏcan€identify€a€patientððs€medical€needs,€they€are€not€always€in€theÏbest€position€to€determine€whether€a€patient€can€obtain€properÏcare€in€a€setting€other€than€a€nursing€home.ÌÌà àEven€if€we€were€to€adopt€the€treating€physician€rule€inÏregard€to€Medicaid€coverage,€Ms.€Harden€would€not€meet€theÏMedicaid€criteria.€€The€testimony€of€both€her€treating€physicianÏand€her€treating€nurse€demonstrates€that€Ms.€Harden€does€not€needÏinpatient€nursing€care€on€a€daily€basis.ÌÌà àThe€burden€of€establishing€a€need€for€inpatient€nursingÏcare€on€a€daily€basis€is€on€Ms.€Harden.€€While€the€CommissionerÍdid€not€have€the€burden€of€proof,€she€did€demonstrate€that€Ms.ÏHardenððs€needs€could€be€taken€care€of€on€an€outpatient€basis.€€TheÏCommissioner€also€gave€a€specific€example€of€a€facility€where€itÏwas€very€likely€that€Ms.€Harden€could€get€all€her€requiredÏservices.ÌÌà àThe€record€shows€that€an€RHA€can€provide€personal€servicesÏsuch€as€the€following:€ÌÓÓà8 à[T]hose€services€that€are€rendered€to€residents€whoÏneed€supervision€or€assistance€in€activities€ofÏdaily€living€[and]€must€include€protective€care€ofÏthe€residents,€responsibility€for€the€safety€of€theÏresident€when€in€the€facility,€daily€awareness€byÏthe€management€of€the€residentððs€functioning,€dailyÏawareness€by€the€management€of€the€residentððsÏwhereabouts€and€the€ability€and€readiness€toÏintervene€if€crisis€arise.€€ÌÌÓÓRules€of€Tenn.€Depððt€of€Health€and€Envððt,€Standards€for€Home€forÏAged,€R.€€1200„8„11„.01(9)(March€1992)[hereafter€Home€for€AgedÏR.].€€Residents€may€be€assisted€with€personal€care€such€asÏbathing,€grooming,€and€cleaning.€€Home€for€Aged€R.€1200„8„11„.09(5)(Sept.€1988).€€RHA€personnel€may€assist€a€resident€withÏmedication€by€reminding€the€resident€to€take€medications,Ïobserving€the€patient€taking€the€medicine,€reading€labels,€openingÏbottles,€checking€dosages,€and€reporting€any€noticeable€change€inÏthe€residentððs€condition€to€a€doctor.€€Home€for€Aged€R.€1200„8„11„.09(1),(2)(Sept.€1988).ÌÌà àA€resident€at€an€RHA€must€be€able€to€evacuate€the€home€inÏthe€event€of€an€emergency€within€13€minutes.€€Home€for€Aged€R.Í1200„8„11„.07(1)(March€1992).€€While€the€treating€physician€andÏnurses€indicated€some€concern€with€Ms.€Hardenððs€ability€to€self„evacuate€from€a€building€in€case€of€emergency,€Ms.€Mahoney,€aÏnurse€from€the€Department€of€Heath,€tested€Ms.€Harden€and€foundÏthat€she€was€able€to€self„evacuate€with€no€assistance€in€a€timelyÏfashion.€€The€PAE€application€supports€Ms.€Mahoneyððs€findings.€ÏFurther,€none€of€the€other€witness€indicated€that€they€had€everÏtested€Ms.€Hardenððs€ability€to€evacuate.€€There€is€no€RHA€ruleÏrequirement€that€a€resident€be€capable€of€evacuating€with€noÏassistance.€€To€the€contrary,€the€rules€specifically€state€thatÏð ð[r]esidents€may€be€assisted€by€staff.ðð€€Home€for€Aged€R.€1200„8„11„.01(13)(March€1992).ÌÌà àMs.€Harden€relies€on€ò òòòDemonbreun€v.€Department€OfÏHealth,€ó óóóDocket€No.€17.01„34„0655J€(Tenn.€Depððt€of€Health€7€MarchÏ1994).€€In€ò òòòDemonbreunó óóó,€however,€the€Administrative€Law€JudgeÏrelied€par„ticularly€on€the€petitionerððs€tendency€to€becomeÏaddicted€to€pain€killers,€her€history€of€frequent€anxiety€attacksÏand€complaints,€and€her€tendency€to€wail,€scream,€and€upset€herÏneighbors€in€finding€that€she€met€her€burden€of€proof.€€ò òòòId.€ó óóó€ThereÏis€no€evidence€in€the€instant€case€which€brings€Ms.€Harden€withinÏthe€situation€described€in€ò òòòDemonbreunó óóó.ÌÌà àThe€evidence€presented€by€both€Ms.€Harden€and€theÏCommissioner€indicate€that€Ms.€Harden€does€not€require€inpatientÏnursing€services€on€a€daily€basis.€€The€record€supports€theÍChancellorððs€affirmation€of€the€ALJððs€decision€to€deny€Ms.ÏHardenððs€claim.€€It€is€not€arbitrary€and€capricious.ÌÌà àMs.€Harden€next€insists€that€the€Commissioner€did€notÏafford€proper€weight€to€her€remaining€witnesses€and€that€heÏignored€their€testimony.€€Our€review€of€the€record€does€notÏsupport€her€insistence.€€Only€two€of€the€witnesses€identified€byÏMs.€Harden€have€a€medical€background:€€Carol€Spurgeon,€one€of€theÏnurses€who€cared€for€Ms.€Harden€at€the€nursing€home€and€theÏactivities€director,€who€once€worked€as€a€certified€nursesÏtechnician.€€The€others€included€the€neighbor€who€found€Ms.€HardenÏon€her€front€porch,€Ms.€Hardenððs€public€guardian,€and€the€DistrictÏLong€Care€Ombudsman.€€Our€review€of€the€record€does€not€supportÏMs.€Hardenððs€contention€that€the€Commissioner€ignored€theÏtestimony€of€these€witnesses.€€The€findings€of€fact€containÏseveral€facts€testified€to€by€those€witnesses€such€as€Ms.€HardenððsÏdizziness,€occasional€confusion,€and€the€manner€in€which€RHAððsÏsupervise€medication.ÌÌà àThis€court€cannot€substitute€its€judgment€as€to€the€weightÏto€be€given€evidence€when€determining€questions€of€fact€for€thatÏof€the€ALJ.€€The€record€shows€that€the€activities€director,€theÏpublic€guardian,€and€Ms.€Hardenððs€neighbor€primarily€testified€asÏto€Ms.€Hardenððs€occasional€dizziness€and€poor€memory.€€The€ALJÏspecifically€noted€these€conditions€in€his€finding€of€fact.€€TheÏpublic€guardian€and€the€Ombudsman€offered€testimony€regarding€theÍoperations€of€RHAððs.€€While€the€Ombudsman€offered€his€opinion€thatÏMs.€Harden€could€not€be€appropriately€cared€for€in€an€RHA,€otherÏfacts€in€the€record€contradicted€his€testimony.€€The€PAE€con„tradicted€his€concerns€regarding€Ms.€Hardenððs€ability€to€transferÏherself€from€her€bed€to€her€wheelchair€in€the€event€of€anÏemergency.€€The€Ombudsman€also€testified€that€Ms.€Harden€neededÏprofessional€care€despite€Ms.€Hardenððs€treating€physicianððsÏtestimony€to€the€contrary.€€The€Ombudsman€is€not€a€physician€andÏthe€record€does€not€show€that€he€had€any€medical€training.€ÏFinally,€Ms.€Spurgeon€testified€that€the€primary€reason€sheÏthought€an€RHA€would€not€be€acceptable€was€that€Ms.€Harden€neededÏher€blood€pressure€monitored.€€However,€Ms.€Hardenððs€treatingÏphysician€testified€that€a€lay€person€could€perform€that€task.ÌÌà àMs.€Harden€cites€ò òòòGartmann€v.€Secretary€of€U.S.€DepððtÏof€Health€and€Human€Serv.ó óóó,€633€F.Supp.€671€(E.D.N.Y.€1986),€inÏsupport€of€her€contention€that€the€ALJ€gave€too€much€weight€to€theÏdepartmentððs€medical€director.€€In€òòò òGartmannó óóó,€the€ALJ€reliedÏalmost€entirely€on€the€testimony€of€a€medical€advisor€who€neverÏexamined€or€treated€the€patient€and€who€failed€to€mention€theÏdiagnosis€and€certifications€of€the€need€for€skilled€care€made€byÏthe€treating€physician.€€ò òòòId.€ó óóóat€678„80.€òòò ò€Gartmannó óóó€is€inappositeÏto€this€case€because€it€applied€to€the€treating€physician€ruleÏwhich€is€not€applicable€in€the€instant€case.€€ò òòòSee€id.ó óóó€at€680.€ÏFurther,€the€ALJ€in€this€case€gave€little,€if€any,€weight€to€theÏtestimony€of€the€Department€of€Healthððs€medical€director.€€InÍfact,€the€ALJ€made€only€one€reference€to€the€medical€directorððsÏextensive€testimony.€€Ms.€Harden€has€failed€to€demonstrate€thatÏthe€ALJ€acted€arbitrarily€or€capriciously€or€that€it€improperlyÏgave€too€much€weight€to€the€Department€of€Healthððs€witnesses.ÌÌà àOur€review€of€the€record€shows€the€ALJ€properly€consideredÏand€weighted€the€testimony€offered€by€the€nonmedical€witnesses.€ÏWe€cannot€substitute€our€judgment€as€to€the€weight€given€thatÏtestimony.€€Our€review€of€the€record€show€that€substantial€andÏmaterial€evidence€supports€the€denial€of€Medicaid€coverage€andÏthat€the€decision€was€not€arbitrary€and€capricious.ÌÌà àThe€judgment€of€the€chancellor€in€affirming€theÏCommissionerððs€denial€of€Medicaid€benefits€is€affirmed,€and€theÏcosts€on€appeal€are€assessed€to€the€petitioner/appellant.€€TheÏcause€is€remanded€to€the€chancery€court€for€any€further€necessaryÏproceedings.€Ì€ÌÌÌÓÓà àà à__________________________________Ìà àà àSAMUEL€L.€LEWIS,€JUDGEÌÌÌÌCONCUR:ÌÌÌÌ_________________________________ÌHENRY€F.€TODD,€P.J.,€M.S.ÌÌÌÌ_________________________________ÌBEN€H.€CANTRELL,€JUDGEÌÌÌÌÌÌÌÌÌÌÌÌÌÌ