This is a patient with a medical history of suicidal attempt with methadone overdose, hypertension, hyperlipidemia, gastroesophageal reflux disease, chronic obstructive pulmonary disease (COPD), depression, memory loss, Vitamin D deficiency and wheelchair bound due to bilateral lower extremity contractures. Per the determination of the medical physician, nursing and physical medicine and rehabilitation assessments, it was determined the patient met medical necessity criteria for personal care assistance services Level II, 12 hours per day, 7 days per week; total of 84 hours per week. Due to lower extremity contractures and decreased mobility, the patient requires supervision for falls safety, transfers (bed/wheelchair), dressing, toileting and bathing and grooming. In addition, due to memory loss the patient requires assistance with activities of daily living such as making beds, housework such as dusting/vacuuming/dishwashing and partial assistance with medication administration and prepping meals. Personal care assistance services Level II, 12 hours per day, 7 days per week; total of 84 hours per week is medically necessary for this patient. Per Guidelines for the Provision of Personal Care Services in Medicaid Managed Care, the member is eligible for services that are essential to the maintenance of the enrollee's health and safety in his or her own home. Per the provided clinical information, the patient requires multiple level II services such as; bathing, dressing, grooming toileting, transferring from wheelchair to bed, preparing meals, and administration or prompting of medications. The patient was determined to have a stable medical condition that is not expected to deteriorate suddenly or require frequent medical or nursing care, the patient is self-directing and able to follow commands and make appropriate choices, would require partial help with activities of daily living such as managing medications, grocery shopping, taking transportation (e.g. bus, train) and full assistance with activities such as, house work such as dusting/vacuuming/dishwashing, making beds, laundry, prepping meals, bathing and grooming, dressing, toileting, transfers from bed to wheelchair and locomotion (rolling wheelchair). The HP determination is overturned in whole.