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ALS/Neurological conditions - For Physicians

The patient meets at least one of the following (1 or 2):

  • Severely impaired breathing capacity with all the following findings:
  • Dyspnea at rest
  • Vital capacity less than 30%
  • Requirement of supplemental oxygen at rest
  • The patient declines artificial ventilation


  • Rapid disease progression as evidenced by all the following in the preceding 12 months:
  • Progression from independent ambulation to w/c or bedbound status
  • Progression from normal to barely intelligent or unintelligible
  • Progressions from normal to puree diet
  • Progression from independence to dependence in most or all ADLs

a.  Severe nutritional impairment demonstrated by all the following in the preceding 12 months:

  • Oral intake of nutrients and fluids insufficient to sustain life
  • Continuing weight loss
  • Dehydration of hypovolemia
  • Absence of artificial feeding methods


b.  Life-threatening complications demonstrated by one or more of the following in the preceding 12 months:

  • Recurrent aspiration pneumonia (with or without tube feeding)
  • Upper urinary tract infection (Pyelonephritis)
  • Sepsis
  • Recurrent fever after antibiotics
  • Stage 3 or Stage 4 pressure ulcer(s)

In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care.