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POST-SURGERY HOUSING
88 CCC 335 (2023 LexisNexis) has an interesting case involving a homeless man needing shoulder surgery. The PTP included in the RFA the need for both the surgery and 8 weeks of post-surgery housing for recovery purposes. Housing was denied by UR.
On appeal, the IMR Reviewer noted the MTUS and ODG do not address housing. Alternatively, the Reviewer considered a peer-reviewed study of unique outpatient services that are sometimes needed for homeless patients, and determined the surgery and the subsequent 8 weeks of housing for recovery purposes was medically necessary.
[COMMENT: Rather than dealing with numerous potential post-surgical complications as a result of living in the streets, probably far more cost-effective, and humane, for the defense to spend the necessary funds for a Residence Inn (room, breakfast and housecleaning) or similar place for 8 weeks to insure the best surgical results and set the case up for closure.]
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