Medically Fragile Daycare benefits cannot be terminated where required to prevent regression.

Topic: Health Law, Decided by: Judge Langston 
Docket Number: ****** , Decision Date: December 30, 2013 
Attachment: Click here to download the decision. 

Petitioner, a child in the Medically Fragile Daycare (MFDC) program, was granted six additional months in the program because she (1) meets the Skilled Nursing Level of Care, (2) receives 100% of her daily calories via a G-tube, (3) has services ordered by a physician, and (4) requires services that are so inherently complex that they cannot be safely or effectively performed by a non-skilled caregiver.  Contrary to the Department’s contention, these necessary and inherently complex services include physical, occupational, and speech therapy, which is provided at the MFDC.    In addition, Petitioner is not stable, as she has been hospitalized at least nine times in the last eleven months when her Mickey Button burst or was dislodged.  Finally, Petitioner needs continual care in order to prevent regression.

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