As a case manager/discharge planner I am finding patients with Medicaid only who are not able to function outside of an inpatient medical setting due to their complex medical needs and mobility dependencies are declined NHP as they are alert/oriented and have no behavior issues. The current guidelines usurp an entire Medicaid population from NHP with provision of 24 hour medical oversight needed to maintain the individuals health care needs.

Furthermore, if a patient does not meet criteria under the current guidelines he/she does not meet criteria for personal care aides in the community nor PACE program. Essentially the only option is for the patient to remain hospitalized which is an inappropriate disposition.

I respectfully request re-evaluation of the DMAS NHP guidelines to include patients who are alert/oriented with no behavior issues and are dependent for 2-4 ADLS and mobility, yet require 24 hour medical management due to complex medical needs which cannot be managed in a lesser level of care such as home with HHS, personal care aides, PACE program or ALF with HHS.

Respectfully Submitted,

Kathy Fowler

Kathy L. Fowler, B.S.W., M.S. OHRD, ACM

Clinical Social Work/Case Manager

UVA Transitional Care Hospital

#434-243-1229

.