Parkinson's Disease
Nursing Services (including Private Duty Nursing)

The patient is a male with multiple past medical problems, most notably Parkinson's disease with ambulatory dysfunction. The patient requests an increase in services to a total of 84 hours a week of level 2 services, 12 hours a day ×7 days a week. The patient requested additional services secondary to pain, limited mobility of Parkinson's disease and frequent falls. He also noted a decline in health care status.

The health plan's determination is upheld. The Request for Increase in Personal Care Services, Level Two (2) to Total of 84 Hours per Week [12 Hours per Day / 7 Days per Week] is not medically necessary for this patient. The amount of services already being provided are sufficient to meet the patient's medical needs. Currently, the patient is noted to have medical necessity of 31.3 hours a week and he currently receives 56 hours a week of care.
The patient's evaluation, UAS State of New York showed a slight decrease in function in compared to the previous evaluation.
There were no noted medical conditions which would require additional services. The patient's level of function showed a slight decrease between last year's evaluation this year's evaluation. The patient was able to manage with 56 hours a week of care previously. Additional services are not medically necessary.