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Eligibility Guidelines

For Use by Referring Physicians

In order to make a referral to Mount Carmel Hospice, General or Disease-Specific Guidelines have been developed by Medicare that may be used to determine eligibility. In order to be eligible for Hospice services, the patient needs to meet only one set of criteria. Other criteria and professional judgment may be used to establish prognosis. According to Medicare, “terminal illness of an individual who elects hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.” This new language allows physicians to feel more comfortable referring patients to hospice early enough in their illness to experience the full benefit of hospice care.

This information is provided for general purposes only. Use it as a guide when making your referral. For specific coverage information or for assistance, contact Mount Carmel Hospice at 614-234-0200.

General Admission Guidelines

The patient may be eligible if:

  • The patient has a life-limiting illness (advanced disease without curative therapies)
  • The patient’s death within a year would not surprise you
  • The patient suffers from at least 2 of the following serious co-morbid conditions
    • Poor nutritional status
    • Serum albumin less than 2.5 gm/dl
    • Body Mass Index (BMI) less than 22 kg/m
    • Progressive, poor functional status
  • The patient has been previously discharged from an acute palliative care unit
  • The patient had multiple admissions to the hospital and/or ER as a result of similar symptoms (three or more visits within six months)

Disease-Specific Admission Guidelines

The patient may be eligible if their disease has advanced according to any of the following descriptions:

Cardiopulmonary Conditions

  • Identify specific structural/functional impairments
  • Identify relevant activity restriction
  • Poor appetite
  • Chest pain
  • Impaired heart function such as heart rhythm, contraction force of ventricular muscles, blood supply to heart
  • Tightness of chest and dyspnea
  • Structural damage to heart
  • Decreased mobility
  • Use of assistive devices and technology used for mobility, indoors and outdoors, and transportation

Cancer

  • Malignancy with widespread, aggressive or metastatic disease with failure to respond to treatment
  • Refusing treatment

Chronic Liver Disease (one of the following)

  • Liver disease with jaundice, ascites, and/or markedly abnormal liver enzymes
  • Bleeding disorder and elevated PT (not on anticoagulant therapy)

Demetia, Alzheimer’s or Stroke

  • Dependent in all ADIs, bedbound, garbles speech, weight loss

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Mount Carmel Health System  |  Columbus, Ohio

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