Worsening of medical condition warrants increase in GAPP nursing hours.

Topic: Health Law, Decided by: Judge Baxter 
Docket Number: ******* , Decision Date: November 5, 2013 
Attachment: Click here to download the decision. 

The State was not permitted to deny a medically necessary increase in the number of skilled nursing hours Petitioner receives under the Georgia Pediatric Program (GAPP). Petitioner needs daily monitoring by a skilled nurse or trained caregiver to assist with deep suctioning, breathing, monitoring, and administering narcotic medication.  Three of Petitioner’s doctors prescribed 112 hours of skilled nursing services per week after Petitioner’s condition worsened and she was hospitalized seven times in the span of four months.  Based on the testimony of Petitioner’s doctors, an increase from 84 hours to 112 hours  per week was determined to be medically necessary.

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