Proxy caregiver law cannot substitute for skilled nursing under GAPP.
Docket Number: ***** , Decision Date: November 18, 2013
Attachment: Click here to download the decision.
The Department of Community Health (DCH) cannot terminate a participant in the Georgia Pediatric Program (GAPP) where the participant is medically fragile, requires nursing facility level of care, and whose need for skilled nursing care is medically necessary. DCH cannot replace GAPP skilled nursing care with proxy caregiver services through other Medicaid programs. Where a participant’s health condition requires complex observations and critical decision making, the proxy caregiver statute, which only allows for the provision of “health maintenance activities,” does not apply.