HOSPICE ELIGIBILITY

Understanding Hospice Eligibility Guidelines

Medicare coverage of hospice depends on a physician’s certification that a patient meets certain criteria to qualify for hospice services.

Primarily, two physicians must agree that the patient’s life expectancy is six months or less if the disease were left untreated and allowed to run its normal course. Next, certain medical criteria must be considered for each terminal illness. Below you will find these illnesses and their qualification standards for admission to hospice.

NOTE: Patients often qualify for hospice even when their symptoms do not meet the criteria required by their primary diagnosis.

CMS (Center for Medicare & Medicaid Services) guidelines require providers to look at the full picture, not just the primary diagnosis. Many times, a patient qualifies based on a combination of factors related to both their primary diagnosis and other illnesses.

We have designed this tool to help you identify hospice-eligible patients. When a patient is declining but does not meet all of the criteria listed under his/her primary diagnosis, please consult your hospice team to determine eligibility.

Remember, hospice is intended to support the last 6 months of life. The vast majority of hospice patients are referred with only day or weeks left to live and cannot fully benefit from its services. We are here to ensure qualified patients are given the opportunity to fully benefit from our services and to ensure that ineligible patients are considered for Palliative Care and are monitored for changes that may impact eligibility.

We currently serve patients residing in Rock, Green, Walworth, Winnebago, Boone, Stephenson and McHenry Counties, at home, in senior living facilities, and in the hospital.

Reach out to us for chart reviews, patient assessments, family info sessions, goals of care conversations, or physician consultations any time. Call 608-363-7421 (24/7) or email HospiceReferralNotificationTeam@beloithealthsystem.org.

We thank you for the privilege of partnering with you to provide the highest quality end-of-life care for your patients.