Neurological Diseases

Neurological Diseases include the following: ALS (Amyotrophic Lateral Sclerosis), Parkinson’s, Muscular Dystrophy, Myasthenia Gravis, and MS (Multiple Sclerosis).

Must have either 1 or 2.

  1. Severely impaired breathing capacity with all of the following:
    1. Dyspnea at rest
    2. Vital capacity <30%
    3. The requirement of supplemental oxygen at rest
    4. The patient declines artificial ventilation


  2. Rapid disease progression as evidenced by all of the following the preceding (12) months:
    1. Progression from independent ambulation to wheelchair or bed-bound status
    2. Progression from normal to barely intelligible or unintelligible speech
    3. Progression from normal to pureed diet
    4. Progression from independence in most or all ADLs[1] to needing extensive assistance by caretaker in all ADLs
    5. One of the following conditions:
      1. Severe nutritional impairment demonstrated by all of the following the preceding (12) months:
        1. Oral intake of nutrients and fluids insufficient to sustain life
        2. Continuing weight loss
        3. Dehydration or hypovolemia
        4. Absence of artificial feeding
      2. Life-threatening complications demonstrated by one or more of the following in the preceding (12) months:
        1. Recurrent aspiration pneumonia (with or without tube feeding)
        2. Upper urinary tract infections (e.g. pyelonephritis
        3. Sepsis
        4. Recurrent fever after antibiotics
        5. Pressure ulcers Stage 3 and above

[1] Refers to Activities of Daily Living

In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care. 

Other guides:
CHF/Heart Disease
COPD/Pulmonary Disease
CVA /Stroke/Coma
Huntington’s Disease
Liver Disease
Renal Failure, Chronic or Acute

Assessment Tools
Palliative Performance Scale (PPS)
New York Heart Association (NYHA) Functional Classes
Functional Assessment Staging (FAST) Scale

Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition

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