Physicians Guide to Hospice Eligibility

Coverage of hospice care depends upon a physician's certification that an individual's life expectancy is six months or fewer if the illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, the National Hospice and Palliative Care Organization has published medical criteria for determining prognosis of certain diagnoses. These guidelines form a reasonable approach to the determination of life expectancy based on available research.

If a patient meets the medical criteria, they are, by definition, eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care because of other co-morbidities or rapid functional decline. It is the physician's clinical judgment regarding the normal course of the individual's illness that determines a prognosis of six months or fewer.

Beacon Hospice is dedicated to providing hospice care to every person eligible for hospice services, regardless of their age, diagnosis or ability to pay. The Medicare criteria for hospice guide is designed to assist physicians in determining hospice appropriateness.

Select from the left column to see the medical criteria necessary for Hospice care.