Opinion ID: 214263
Heading Depth: 2
Heading Rank: 2

Heading: Moore's Nursing Requirements

Text: Beginning in 1998 when she was three years old, Moore has received Medicaid-funded private duty nursing services at home. [3] To be eligible for these nursing services, Moore must require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of [a] hospital or skilled nursing facility. 42 C.F.R. § 440.80. Since 2002, DCH has employed the Georgia Pediatric Program (GAPP) as its service-delivery model for providing nursing care in the home to medically fragile children with multiple systems diagnoses, such as Moore. [4] As discussed later, Moore is a GAPP member, and DCH publishes a manual that sets forth the policies and procedures for GAPP, including the process for requesting and receiving private duty nursing hours. See PART II POLICIES AND PROCEDURES FOR THE GEORGIA PEDIATRIC PROGRAM (GAPP Manual). Dr. Charles L. Braucher, Jr. [5] has treated Moore since she was an infant. He examines Moore approximately six to eight times a year. In a 2007 deposition, Dr. Braucher detailed the myriad duties Moore's nurse or caregiver must perform, including, among other tasks: (1) monitoring her seizures to determine what medication is needed, (2) checking her oxygen levels, (3) assisting with gastric tube feedings, (4) administering a complex regimen of medications, and (5) repositioning her body approximately every two hours to prevent pressure sores. Dr. Braucher estimated that there was not a four-hour period in which Moore did not require the services of a skilled nurse or someone with comparable training and experience, such as Moore's mother Pam. [6] Although Moore suffers occasional health setbacks, her care and treatment needs have largely stabilized during the previous eight years. [7]