Patti's Comment: This case explains the STORY OF MY LIFE!! I spend hours fighting Bureaucratic Gobbledegook on behalf of people with disabilities and their families. I just do not understand how anyone can justify THIS TYPE OF RATIONED CARE. Where is the outrage over these potential “death panels???"
From Academy of Special Needs Planners:
On remand from the 11th Circuit Court of Appeals, a federal district court determines that Georgia's reduction of skilled nursing hours for a young woman with severe disabilities was arbitrary and capricious and based not on medical necessity but on "bureaucratic gobbledegook." Moore v. Cook (N.D.Ga., No. 1:07-CV-631-TWT, April 20, 2012).
Anna C. Moore, a 17-year-old Medicaid beneficiary who suffers from multiple disabilities, requires 24-hour care. Anna received 94 hours of weekly in-home nursing care based on her doctor's certification that such care was necessary, but the Georgia Department of Community Health, relying on an evaluation by its own medical staff, attempted to reduce the care to 84 hours.
Anna's case traveled back and forth between the district court and the 11th Circuit Court of Appeals for five years, and in April, 2011, the 11th Circuit remanded the case to the district court for a trial to determine whether the state's reduction in skilled nursing hours was reasonable and calculated to achieve the treatment's purpose.
The U.S. District Court for the Northern District of Georgia rules that the state's reduction in skilled nursing hours is "arbitrary and capricious and was not based upon medical necessity." The court finds that "the reasons given . . . for the reduction in nursing hours are bureaucratic gobbledegook having no relation to [Anna's] actual condition or needs."
For the full text of this decision: Anna C. Moore vs. Clyde L. Reese
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