Diagnosis: Schizoaffective disorder, unspecified type
Treatment: Continued inpatient admission

The Continued inpatient admission was medically necessary for this patient.

The patient's symptoms of psychosis and mood disorder together with continued risk of impulsive behavior and issues with compliance warranted the continued acute inpatient level structure and monitoring through discharge. The case is complicated by non-compliance with medication adherence problems and by a formal thought disorder with poor insight and problems with executive functioning (organizing, sequencing, problems solving and decision making). The residual symptoms of mood disorder and psychosis and treatment issues related to arranging a safe and appropriate discharge plan to prevent non-compliance together with a history of medication non-adherence warranted the continued services at an acute inpatient level of care and support the medical necessity for continued inpatient level structure and 24-hour monitoring through the day of discharge when the patient had reached a level of stability that she could return to the community with clinically appropriate follow-up and aftercare.

This answer is consistent with the scientific literature and published practice guidelines, referenced below, as well as New York State instruction for medical necessity reviews.

The Continued inpatient admission could not have been safely or effectively provided at a lower level of care. Thus, the requested benefit of Continued inpatient admission is reasonable and in the patient's best interest, and is consistent with prevailing standards of medical practice for the treatment of the condition diagnosed in this case.