Hospice Eligibility Criteria

In order to begin hospice care, patients must meet the hospice eligibility requirements established by the U.S. Centers for Medicare & Medicaid Services. While no specific number of symptoms is required when qualifying for hospice, these guidelines can help determine if a patient’s condition is, or will soon be, appropriate for hospice care.

Hospice eligibility requirements:

• Patient has been diagnosed with a life-limiting condition with a prognosis of six months or less if their disease runs its normal course
• Frequent hospitalizations in the past six months
• Progressive weight loss (taking into consideration edema weight)
• Increasing weakness, fatigue, and somnolence
• A change in cognitive and functional abilities
• Compromised Activities of Daily Living (ADLs) such as eating, bathing, dressing, toileting, transferring/walking, and continence
• Deteriorating mental abilities
• Recurrent Infections
• Skin breakdown
• Specific decline in condition

Disease-specific hospice eligibility criteria.

There are also specific hospice eligibility criteria to consider based on the patient’s primary diagnosis. Choosing from the list of diseases below will let you read the applicable requirements for hospice care.

• AIDS
• Cancer
• Cerebral Vascular Accident (CVA) / Stroke
• Congestive Heart Failure / Cardiopulmonary Disease
• COPD / Cardiopulmonary Disease
• Dementia
• Liver Disease
• Neurological Conditions (non-Alzheimer’s dementia, Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)
• Renal Disease

Financial requirements for hospice are:

• Medicaid hospice eligibility criteria 
• Medicare  hospice eligibility criteria
• Private insurance hospice eligibility criteria

Please note: Co-morbidities, the presence of two or more chronic diseases or conditions at the same time, are also a factor to consider in qualifying for hospice.

If you have any doubt about whether the requirements for hospice care have been met, please contact us using the Help Bar above for a hospice consultation.