The patient has multiple medical problems, and a past medical history for a cerebrovascular accident with left-sided hemiplegia. The patient also has noted mild cognitive deficits. The patient requests personal care services increase to 24 hours a day 7 days a week with a split shift. The health plans determination of medical necessity is upheld in whole. The requested health service/treatment of Personal Care Services, increase to 24 hours a day, 7 days a week (split shift) is not medically necessary for this patient. There was no new change in the patient's medical status noted. The change in the personal-care service hours were secondary to the fact that the patient's primary caretaker had illness and was unable to perform services independently of the personal care aide. Therefore, the requested health service/treatment of Personal Care Services, increase to 24 hours a day, 7 days a week (split shift) is not medically necessary for this patient.