Diagnosis: Parkinson's disease, brain meningioma
Treatment: Increase in personal care services to 24 hours day, 7 days/week, split shift (Health plan's approval is for 12 hours/day, 7 days/week)

The Increase in personal care services to 24 hours day, 7 days/week, split shift is not medically necessary.

The patient is a Russian-speaking female. She lives with her son in a large studio apartment in an elevator-accessible building. During recent nursing assessments, the patient found to be well-groomed and well-nourished. The patient is under the care of a neurologist, who she sees on a regular basis. The patient also has primary care physician. The patient's medical conditions include Parkinson's Disease and brain meningioma. Meningioma was removed previously. The patient has a history of falls but none within the last 90 days. She experiences urinary incontinence, and she uses pull-ups. Dentures are available and effective. She experiences no problems with chewing or swallowing. She had recently completed eight weeks of physical therapy. Her son and two daughters are very supportive. The patient requires assistance with preparing meals, housekeeping, laundry, shopping, dressing, bathing, personal hygiene and toileting.

Based on uniform assessment system, the patient's current personal care aide hours of 12 hours a day 7 days per week, total 84 hours per week, meet medical needs, based upon medical records and supporting documents presented for review.

The health plan's approved 12 hours/day, 7 days/week of personal care assistance meet the patient's needs on a daily basis. The approved services provide a level of assistance to perform all of the patient's ADL (activities of daily living) needs and IADL (instrumental activities of daily living) needs. There is nothing documented in the records to indicate that an Increase in personal care services to 24 hours day, 7 days/week, split shift is medically necessary.