What are the Diagnoses that Qualify for Hospice Care?

In the United States, the Centers for Medicare and Medicaid Services, or CMS, determines the criteria for eligibility to be admitted to a hospice care program. Many factors are considered when determining whether a patient qualifies for this type of care, and the criteria are considered as guidelines, not inflexible laws. Some of these criteria are directly related to the patient’s diagnosis, and others are not. The final determination of whether a patient will begin hospice care is made by the patient’s physician, with the agreement of the patient and family.

Diagnoses That Usually Mean Eligibility for Hospice Care

Typically, patients who have a diagnosis of some type of incurable illness are eligible for hospice care. These diagnoses include cancer, AIDS, congestive heart failure, COPD, end-state liver and kidney disease, stroke, dementia, and various neurological conditions like Parkinson’s disease or multiple sclerosis. If a patient enrolls in a hospice care program and outlives his expected amount of time, he can be re-evaluated for continuing hospice care. Patients who get better and are discharged from hospice also still have the option of re-entering hospice care at a later time.

Other Types of Eligibility for Hospice

The factors related to eligibility for hospice care that are not directly from a particular diagnosis are many. They can include frequent hospitalizations for acute care, mental debility, skin breakdown, weakness and fatigue, weight loss, incontinence and inability to care for oneself, or other problems like repeated or chronic infections that do not heal. Just about any condition of patient deterioration that indicates he or she will not live much longer can be a valid criterion for admission to a hospice care program.

Insurances That Pay for Hospice Care

Many private or employer-sponsored insurances offer hospice care programs as part of their coverage. Both Medicare and Medicaid also offer insurance coverage for hospice care, and there are programs for low-income individuals as well. The eligibility criteria may vary with each type of insurance.

Get More Information About Hospice Care Today

If you’re interested in learning more about what it means to be in hospice care, contact Ameriprime Hospice today by calling 1-800-899-9790.

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