Hospice - Determining Terminal Status
L33393
Medicare hospice coverage requires a physician’s certification that the beneficiary’s prognosis is six months or less if the illness runs its normal course, supported by clinical documentation. Eligibility may be established by documented progressive decline or by combining non-disease-specific baseline impairments (e.g., dependence for ≥2 ADLs, low KPS/PPS) with disease-specific criteria (cancer metastatic progression, ALS respiratory/nutritional failure, FAST stage ≥7 dementia with complications, NYHA Class IV heart failure, advanced pulmonary, renal, liver, HIV, stroke/coma criteria). Documentation of serial assessments, objective scores (KPS/PPS/FAST), relevant labs/imaging when available, and physician certification/recertification is required; patients who improve beyond a six-month prognosis should be discharged but may be re-enrolled upon subsequent decline.
"Physician or medical director certification that the beneficiary's prognosis is six months or less if the terminal illness runs its normal course, supported by clinical information documented in th..."