formerly Southern Tier Hospice and Palliative Care

607.962.3100

Diagnostic Eligibility Guidelines

  • "Our family would like to thank everyone involved in my husband's care. You helped us to fulfill his final wish and make his final journey from home. You are all amazing and special; you took great care of him as well as his family."

  • "Your caring staff is so valuable to families during critical times. Your support is very comforting and appreciated. We are truly grateful."

  • "We were blessed with the loving care you gave our Dad. The nurse was great and treated him like he was part of her family. We are forever grateful for all of you. Thank you."

  • "To the Hospice folks, words cannot express our thanks and appreciation for your tender touch and loving professionalism during our Dad's illness. We will always remember our nurse's expert skills and abilities as well as her personal touch. "

  • "We want to thank everyone who cared for our Mother. Everyone was so nice and caring and went over and beyond what we could have hoped for. Thank you all."

In the past, hospice eligibility was often defined as having a prognosis of “six months or less”. However, hospice providers and physicians were often frustrated by trying to make this very difficult, and somewhat arbitrary, determination. 

In 2008, the Center for Medicare and Medicaid Services (CMS) developed guidelines outlining specific clinical standards that indicated such a prognosis for multiple diagnoses. These guidelines now serve as the standard for the medical determination of hospice eligibility. 

CareFirst uses these guidelines to determine medical eligibility for hospice care. Physicians who cover patients on Hospice will be asked to use the guidelines, including signing them as certifying a patient’s prognosis, when their patients are admitted to hospice. The same guidelines will also be used when determining if patients continue to be eligible for hospice coverage over time. 

Familiarity with these guidelines will help physicians determine which of their patients may be eligible for hospice care, or when it may be appropriate to start adapting care plans to maximize the benefit of palliative care. 

CareFirst’s Medical Director is available to address any questions you may have at 607.962.3100, or to discuss eligibility for diagnoses not listed below.

Medicare Eligibility Guidelines:

Amyotrophic Lateral Sclerosis (ALS)

Breast Cancer

Dementia

Heart Disease

HIV/AIDS

Liver Failure

Lung Cancer

Prostate Cancer

Pulmonary Disease

Renal Disease

Stroke

General Guidelines

 

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Congratulations to Melissa Oakley, who has been promoted to Family Services Manager at CareFirst! Melissa will be overseeing our social work and spiritual teams.

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3805 Meads Creek Road • Painted Post, NY 14870-9509 •P: 607.962.3100 •T: 800.734.1570 •F: 607.962.4300
www.CareFirstNY.org info@CareFirstNY.org