Diagnosis: Diabetes mellitus, CHF, CVA Treatment: Personal Care Assistance, Level II 24 hours per day, seven days per week (split shift or live in). This patient with a history of Diabetes Mellitus, Congestive Heart Failure, Cerebrovascular Accident with residual left sided weakness, poor visual acuity and gait ataxia. Due to the severity of his multiple comorbid conditions, he requires assistance with the majority of his activities of daily living (ADLs). Although it is clear that this patient needs 24/7 assistance, his current needs actually require a higher level of care then what a Personal Care Aid/Home Health Aid can provide. Admission and long term residence in a skilled nursing facility is warranted, as the patient cannot be left alone. He requires safety supervision at all times. He is unable to self-direct his own care. He requires maximum assistance with transfers and requires two-person assistance. Furthermore, he requires total assistance with pouring and administering 15 medications up to four times a day. For these reasons, the proposed treatment of Personal Care Assistance, Level 11 24 hours per day, seven days per week (split shift or live in); for a total of 168 hours per week is not deemed medically necessary.

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