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201907-119213

2019

Healthfirst Inc.

Medicaid

Pregnancy/ Childbirth

Home Health Care

Medical necessity

Upheld

Case Summary

Diagnosis: Pregnancy
Treatment: Medical day care, three days per week
The medical day care, three days per week is not medically necessary.
The patient is a female with recent inter-uterine pregnancy. She receives medical attention at Brightpoint Health with psychiatric treatment at Keran Hill Mental Health. Medical diagnosis includes elevated cholesterol, depression, anxiety, bipolar, and asthma. The patient's medical conditions based upon medical records and recent uniform assessment survey; comprehensive care plan and existing care plan all demonstrate patient's current diagnosis are adequately managed and the patient's medical and mental needs are being met.
The comprehensive care plan and existing care plan all demonstrate that the patient's current diagnosis are adequately managed, and the patient's medical and mental needs are being met. Medical records reviewed do not demonstrate one or more care services that require provision by a credentialed staff member of an Adult Day Care Center.

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