Appeal from the Order of the Department of Public Welfare in the case of Appeal of: Barry B. Baker, Case No. 49089, dated September 5, 1984.
Thomas F. Meister, for petitioner.
William D. Lenahan, with him, Mary Frances Grabowski, Assistant Counsel, and Jean E. Graybill and John Kane, for respondent.
Judges Craig and Doyle, and Senior Judge Blatt, sitting as a panel of three. Opinion by Judge Doyle.
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Barry B. Baker (Petitioner) appeals the order of the Department of Public Welfare (DPW) which affirmed a hearing officer's determination denying Petitioner's request of medical assistance.
Petitioner is a Medicaid recipient who suffers from morbid obesity and from paralysis of his right side as a result of a stroke. On January 22, 1984, Petitioner's treating physician submitted a request to the Department's Program Exception Unit*fn1 for a "wheelchair
[ 93 Pa. Commw. Page 634]
adequate to accommodate a 500 lb. male" to allow Petitioner "to sit up and to be moved from room to room." Petitioner's request was denied by DPW's Program Exception Unit, and an administrative appeal was taken.
At the hearing, DPW's witness, Dr. O. K. Stevenson testified that Petitioner's request was denied because it did not satisfy the criteria established by DPW for the granting of a program exception request. These criteria stated as follows:
1. The Recipient is eligible, and not in an institution.
2. Lack of the requested service or item will result in serious harm to the individual.
3. The case must be truly exceptional; the exception process cannot be used as a back door to program expansion, for example, paying for ...