Hospice eligibility
DIAGNOSIS/ DISEASES APPROPRIATE FOR HOSPICE
A common misconception about hospice is that it is a service provided only to cancer patients. The fact is that we provide care to patients with any end stage diagnosis. These may include, but are not limited to:
Metastatic Cancer
Heart Disease
Kidney Disease
Liver Disease
Lung Disease
Stroke and/or Coma
AIDS
Neurological Diseases (Alzheimer’s, Parkinson’s, Dementia, etc.)
Lou Gehrig’s Disease (ALS)
Failure of Multiple Organ Systems
Failure to Thrive
Debility and Decline
Do you have to have only 6 months left to live to be eligible for Medicare Hospice Benefit?
No! Another common, and unfortunate, misconception about hospice is that the use of hospice care somehow guarantees the patient has less than six months to live. Medicare has provided the following explanation and clarification regarding the hospice benefit eligibility guidelines.
“Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less life expectancy. [However], the Medicare program recognizes that terminal illnesses do not have entirely predictable courses.
Recognizing that prognoses can be unpredictable and may change, Medicare’s benefit is not limited in terms of time. Hospice care is available as long as the patient’s prognosis meets the law’s six-month test. This test is a general one… based on the [attending] physician’s and/or Medical Director’s clinical judgment regarding the normal course of the individual’s illness. Medicare recognizes that making medical prognostications of life expectancy is not always an exact science.”
Under this philosophy, Medicare has specified a procedure for certification and periodic re-certification of the patient’s eligibility for care under the Medicare Hospice Benefit.
This procedure provides two 90-day eligibility certification periods followed by an unlimited number of 60-day eligibility certification periods. As long as the patient, in the judgment of the primary physician and hospice Medical Director, continues to meet the six month criteria during each certification period, the patient can continue to receive care under the Medicare Hospice Benefit.
