Appeal from the Order of the Department of Public Welfare in the case of Appeal of Marguerite Matthews, Case No. 106296.
David Gates, for petitioner.
Douglas Block, Counsel, with him Stanley Slipakoff, Assistant Counsel, for respondent.
Judges Craig, MacPhail and Doyle, sitting as a panel of three. Opinion by Judge Craig. This decision was reached prior to the resignation of Judge Mencer.
[ 66 Pa. Commw. Page 276]
Marguerite Matthews appeals the final order of the Pennsylvania Department of Public Welfare (department) affirming a hearing examiner's order denying Matthews' appeal from the decision of the Bucks County Board of Assistance (county office) to reduce the level of the patient's nursing care benefits under the Medical Assistance program.
The patient, a double amputee with bilateral below-the-knee amputations, has been treated at Centennial
[ 66 Pa. Commw. Page 277]
Springs Health Care Center (Centennial), a skilled nursing care facility, where she receives physical therapy.
In June, 1980, Centennial's utilization review committee (URC) submitted a one-page utilization review form to the county office, recommending a lower level of care for the patient. The block captioned "Utilization Review Committee Comments and Recommendations" reads:
The Utilization Review Committee and the attending physician recommend a change in the level of care of Marguerite Matthews. Patient admitted from home 7/12/79 with diagnosis of bilateral B/K [below the knee] amputation, Chronic Obstructive Pulmonary Disease, Occlusive Vascular Disease. Receiving therapy four time a week, is able to ambulate with maximum assist with prosthesis and walker. Is independent in transfers and wheel chair. Is alert, oriented. Minimal assist with bathing. Medically stable.
In the square next to the words "Recommendation Discussed With Attending Physician," the word "YES" was inserted.
On August 19, 1980, the county office's medical review team considered the utilization review form and recommended that the level of care be changed from skilled to ...