Medicare Guidelines for Non-Cancer

AMYOTROPHIC LATERAL SCLEROSIS (ALS)

1.    The patient has rapid progression of ALS in the preceding 12 months evidenced by:

·         Progression from independent ambulation to wheelchair or bed bound status

·         Progression from normal to barely intelligible or unintelligible speech

·         Progression from normal to pureed diet

·         Progression from independence in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs.

 

2.    At least one of the following must also apply:

 

 

 

 

 

 

A. Critically impaired breathing capacity evidenced by:

 

 

 

 

·         Vital capacity (VC) less than 30% of normal

 

 

 

·         Significant dyspnea at rest

 

 

·         Requires supplemental oxygen at rest

·         Patience declines artificial ventilation

 

       B. Critical nutritional impairment evidenced by:

·         Oral intake insufficient

·         Continuing weight loss

·         Dehydration or hypovolemia

·         Absence of artificial feeding methods

 

B.      Life-threatening complications

 

 

 

 

·         Recurrent aspiration pneumonia

 

 

 

·         Upper urinary tract infection (pyelonephritis)

 

 

·         Sepsis

·         Recurrent fever after antibiotic therapy

 

**A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present.  Co-morbidities also support eligibility for hospice care.