Texas – Hospice Referral Guidelines
Below are the Medicare/Medicaid approved diagnoses for hospice. Please call 281-570-4072 with any questions.
Cancer Diagnoses
- Disease with metastases at presentation
- Progression from early stage of disease to metastatic disease
- Disease process stage III with or without lymph node involvement
- Continued decline in spite of therapy
- Patient declines further disease directed therapy
Note: Certain cancers with poor prognoses (e.g., small cell lung cancer, brain cancer and pancreatic cancer) may be hospice eligible without fulfilling the other criteria
End-Stage Pulmonary Disease (e.g. COPD)
- Severe chronic lung disease
- Corpulmonale/right-sided heart failure
- Cardiogenic embolic disease
- Recurrent pulmonary infections
- Dyspnea at rest
- Resting tachycardia > 100/min
- p02 < 55 mmHg – or 02 sat < 88% on room air
- FEV 1 < 30% after bronchodilators
End-Stage Renal Disease
- Not seeking or a candidate for dialysis, renal transplant or discontinuing dialysis (prognosis < 6 months if on dialysis) • Serum Creatinine > 8 mg/dl (> 6 mg/dl for diabetics)
- Creatinine Clearance < 10 cc/min (< 15 cc/min for diabetics) • Hyperkalemia (> 7.0 meq/l)
- Signs of uremia/oliguria < 400 cc/24 hrs
End-Stage Neurologic Disease (ALS)
- Critically impaired respiratory function
- Severe nutritional insufficiency
- Sleep disordered breathing
- FVC < 40%
- Dyspnea at rest/orthopnea
- Use of accessory respiratory musculature
- Weakened cough
- Reduced speech/vocal volume
HIV
- Karnofsky Performance Scale (KPS) < 50%
- CD4+count < 25cells/mcl • Viral load > 100,000 copies/ml
- CNS lymphoma, visceral Kaposi’s sarcoma
- Recurrent infections unresponsive to therapies
- Chronic persistent diarrhea > 1 year
End-Stage Heart Disease (e.g. CHF, CAD)
- Functional Class IV NYHA Assessment
- Symptomatic despite optimal medical management with diuretics and vasodilators
- Not a candidate for or declining surgical procedures
- Supraventricular/ventricular arrhythmias resistant to treatment
- Angina at rest
- Ejection fraction < 20% • History of; cardiac arrest or resuscitation, cardiogenic embolic disease, unexplained syncope
End-Stage Liver Disease
- Not seeking or a candidate for liver transplant
- Ascites refractory to treatment
- Peritonitis
- Hepatorenal syndrome
- Encephalopathy
- Recurrent variceal bleeding
- Progressive malnutrition
- PTT > 5 seconds above control
- Serum albumin < 2.5g/dl
End-Stage Dementia/Alzheimer’s
- FAST score > 7
- Unable to walk, bathe or dress without assistance
- Increasing urinary and fecal incontinence
- No consistent meaningful verbal communication
- Medical complications: aspiration pneumonia, septicemia, stage 3-4 decubiti, recurrent fever
- Insufficient fluid/caloric intake
- Weight loss >10% over previous six months
- Serum albumin < 2.5g/dl
Stroke and Coma
- Karnofsky Performance Scale (KPS) < 40%
- Palliative Performance Scale (PPS) < 40%
- Absent verbal response
- Urinary and fecal incontinence
- Dysphagia
- Insufficient fluid/caloric intake
- Weight loss > 10% over past 6 months
- Serum albumin < 2.5g/dl
- Medical complications: aspiration pneumonia
- Stage 3-4 decubiti, recurrent fever
- Life-limiting conditions (prognosis < 6months)
- Karnofsky Performance Scale (KPS) < 70%
- Palliative Performance Scale (PPS) < 70%