Skilled nursing hours reduced based upon a lack of medical necessity.
Docket Number: ****** , Decision Date: August 9, 2013
Attachment: Click here to download the decision.
Petitioner’s skilled nursing hours in the Georgia Pediatric Program (GAPP) were reduced from forty hours to thirty-two hours because the additional hours were not necessary to maintain Petitioner’s condition. However, his hours could not be reduced to twenty-four hours on the basis of the GAPP review nurse’s testimony at the hearing, because to do so would have conflicted with the opinion of the GAPP review physician that thirty-two hours were medically necessary. Furthermore, Petitioner had not been given notice of this further reduction before filing his appeal and the increased reduction was therefore not properly before the judge.