Anna C. Moore v. M.D. Rhonda Medows

324 F. App'x 773

Opinion

PER CURIAM:

The District Court held that “[tjhe state must provide for the amount of skilled nursing care which the Plaintiffs treating physician deems necessary to correct or ameliorate her condition.” Moore v. Medows, 563 F.Supp.2d 1354, 1357 (N.D.Ga. 2008). While it is true that, after the 1989 amendments to the Medicaid Act, the state must fund any medically necessary treatment that Anna C. Moore requires, Pittman v. Department of Health and Rehabilitative Services, 998 F.2d 887, 891-92 (11th Cir.1993), it does not follow that the state is wholly excluded from the process of determining what treatment is necessary. Instead, both the state and Moore’s physician have roles in determining what medical measures are necessary to “correct or ameliorate” Moore’s medical conditions. Rush v. Parham, 625 F.2d 1150, 1155 (5th Cir.1980); 1 42 C.F.R. § 440.230 (“(d) The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures.”); see 42 U.S.C. § 1396d(r)(5). A private physician’s word on medical necessity is not dispositive.

Therefore, after oral argument and careful consideration, we REVERSE the District Court’s grant of partial summary judgment for Moore and REMAND for proceedings not inconsistent with this opinion.

REVERSED.

1 . In Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir.1981), the Eleventh Circuit adopted as binding precedent all Fifth Circuit decisions predating September 30, 1981.