protein calorie malnutrition hospice criteriamicah morris golf net worth
0000038836 00000 n 0000032947 00000 n Skip to main content Skip to navigation Skip to navigation. Incontinent of urine, requires assistance toileting and feeding. recipient email address(es) you enter. copied without the express written consent of the AHA. There are multiple ways to create a PDF of a document that you are currently viewing. However, some are clearly more predictive of a poor prognosis than others; significant ongoing weight loss is a strong predictor, while decreased functional status is less so. Retain some knowledge of their past lives but this is very sketchy. 0000007316 00000 n The most severe malnutrition problems are associated with protein-calorie malnutrition (PCM), also known as protein-energy malnutrition or protein calorie undernutrition, which occurs in both chronic and acute forms. such information, product, or processes will not infringe on privately owned rights. Coverage for these patients may be approved if documentation otherwise supporting a less than six-month life expectancy is provided. 0000012375 00000 n Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Severe chronic lung disease as documented by both a and b: Disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, e.g., bed to chair existence, fatigue, and cough; (Documentation of Forced Expiratory Volume in One Second (FEV1), after bronchodilator, less than 30% of predicted is objective evidence for disabling dyspnea, but is not necessary to obtain. N. Christakis, E. Lamont. Progressive loss of abilities to walk, sit up, smile, and hold head up. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. 0000004098 00000 n While it is true that there is not a strict six month limit on the Hospice benefit, the underlying precept is that the beneficiary must have a prognosis of six months or less, if the illness runs its normal course. been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed CMS believes that the Internet is an effective method to share LCDs that Medicare contractors develop. Adult Malnutrition or Severe Protein Calorie Malnutrition PPS is < 40% Dependent for > 2 ADL's MI < 22 Weight loss (> 10% in 6 months, > 5% in 3 months) Hepatorenal syndrome Loss of muscle mass, subcutaneous fat Patient/family/DPOA wants hospice care and is refusing curative treatment Infections (aspiration pneumonia, urinary tract 1973 May 12;1(7811):1041-2. and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration of the been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed (1 and 2 should be present; factors from 3 will add supporting documentation. PMID . You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. ), Liver DiseasePatients will be considered to be in the terminal stage of liver disease (life expectancy of six months or less) if they meet the following criteria. Therefore, multiple clinical parameters are required to judge the progression of ALS. 0000061858 00000 n Muscle wasting with reduced strength and endurance; Continued active alcoholism (>80 gm ethanol/day); Hepatitis C refractory to interferon treatment. The score can help determine which patients can be managed in the home and which should be admitted to a hospice unit. Documentation of 3, 4, and 5, will lend supporting documentation. Please note that codes (CPT/HCPCS and ICD-10) have moved from LCDs to Billing & Coding Articles. ), Hypoxemia at rest on room air, as evidenced by pO2 less than or equal to 55 mmHg, or oxygen saturation less than or equal to 88%, determined either by arterial blood gases or oxygen saturation monitors, (these values may be obtained from recent hospital records) OR hypercapnia, as evidenced by pCO2 greater than or equal to 50 mmHg. While most healthcare facilities still follow the previous ASPEN criteria, in 2018, ASPEN joined with the . SERUM PROTEIN 0000039400 00000 n Coding professionals would use ICD-10-CM code E43 to report severe malnutrition, also known as starvation edema. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. Revision Explanation: Annual review no changes were made. Creatinine clearance < 10 cc/min (<15 cc/min. Patients will be considered to be in the terminal stage of dementia (life expectancy of six months or less) if they meet the following criteria. Our audit covered $3.4 billion in Medicare payments for 224,175 claims with a discharge date in fiscal year (FY) 2016 or 2017 that contained a severe malnutrition diagnosis code and for which removing the diagnosis code changed the diagnosis-related group (DRG). CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. 0000014923 00000 n All Rights Reserved. It was developed in British Columbia, Canada. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. This page displays your requested Local Coverage Determination (LCD). 0000015750 00000 n )Documentation should support the level of care being provided to the patient during the time period under review, i.e. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, Diurnal rhythm frequently disturbed. THE INFORMATION, PRODUCT, OR PROCESSES DISCLOSED HEREIN. Medicare contractors are required to develop and disseminate Local Coverage Determinations (LCDs). 1993:109.Friedman B, Harwood S. Barriers and enablers to hospice referrals: an expert overview. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. The two main criteria are the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Global Leadership Initiative on Malnutrition (GLIM). Copyright © 2022, the American Hospital Association, Chicago, Illinois. While not necessarily a contraindication to Hospice Care, the decision to institute either artificial ventilation or artificial feeding will significantly alter six-month prognosis. The CMS.gov Web site currently does not fully support browsers with End User License Agreement: Lupus or Rheumatoid Arthritis). 1993;24:320- 327.Doyle D, Hanks G, Cherny N and Calman K. Oxford textbook of palliative medicine. This is the American ICD-10-CM version of E43 - other international versions of ICD-10 E43 may differ. Disease with distant metastases at presentation ORB. Protein-calorie malnutrition (PCM) occurs when a child doesn't eat enough proteins and calories to meet nutritional needs. rVjh)aV 5%TO)i='@]Rx\EM~{m.3:t.UPu]*;bSj7U 0%q3- RJT40(?9O1UsFS3*CR|lf[`s40Q\r*u22,!5jc-+z ]o s Federal government websites often end in .gov or .mil. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. This policy describes guidelines to be used by Home Health & Hospice (HH&H) MAC in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits. Some patients may not meet these guidelines, yet still have a life expectancy of 6 months or less. These situations are obvious. No objective deficits in employment or social situations. The A.S.P.E.N. Patient can no longer survive without some assistance. Severity of malnutrition is based on phenotypic criteria only and requires one phenotypic criterion that meets the threshold of . on this web site. Decline in clinical status guidelinesPatients will be considered to have a life expectancy of six months or less if there is documented evidence of decline in clinical status based on the guidelines listed below. Section 322 of BIPA amended section 1814(a) of the Social Security Act by clarifying that the certification 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.'' Examination by a neurologist within three months of assessment for hospice is advised, both to confirm the diagnosis and to assist with prognosis. 0000017107 00000 n Many patients exhibit symptoms of both disease states. Large anterior infarcts with both cortical and subcortical involvement; Upper urinary tract infection (pyelonephritis); Medicare Contractor Medical Directors' Hospice Workgroup, B. Friedman, M. Harwood, M. Shields. Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF. These changes in clinical variables apply to patients whose decline is not considered to be reversible. It is intended to be used to identify any Medicare beneficiary whose current clinical status and anticipated progression of disease is more likely than not to result in a life expectancy of six months or less.Clinical variables with general applicability without regard to diagnosis, as well as clinical variables applicable to a limited number of specific diagnoses, are provided. The AMA does not directly or indirectly practice medicine or dispense medical services. ALS tends to progress in a linear fashion over time. 0000029167 00000 n and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only Symptoms of heart failure or of the anginal syndrome may be present even at rest. Barriers and enablers to hospice referrals: an expert overview. Also, the lack of certain documentation elements such as a tissue diagnosis for cancer will not create non-eligibility for the hospice benefit, but does necessitate other supportive documentation.Documentation submitted may include information from periods of time that fall outside the billing period currently under review. Frequently there is no speech at all - only grunting. Extent and determinants of error in doctors prognoses in terminally ill patients: prospective cohort study. May have difficulty counting from 10, both backward and sometimes forward. Protein-Energy Malnutrition / diagnosis Serum Albumin / analysis Substances Amino Acids . Stroke or coma. Since determination of decline presumes assessment of the patients status over time, it is essential that both baseline and follow-up determinations be reported where appropriate. Documentation of the applicable criteria listed under the Indications section of this policy would meet this requirement. The criteria refer to patients with various forms of advanced pulmonary disease who eventually follow a final common pathway for end stage pulmonary disease. Clin Cardiol. If your session expires, you will lose all items in your basket and any active searches. Documentation of 3, 4, and 5, will lend supporting documentation.). Patients with congestive heart failure or angina should meet the criteria for the New York Heart Association (NYHA) Class IV. Golden, AM. In critically ill patients, these alterations can. 0000002310 00000 n Percentage of patients receiving PN in the ICU who receive 80% of estimated energy requirements or 20 kcals/kg/day and a minimum of 1.2 g protein/kg/day. 646 0 obj <> endobj Since determination of decline presumes assessment of the patients status over time, it is essential that both baseline and follow-up determinations be reported where appropriate. By the time patients become end-stage, muscle denervation has become widespread, affecting all areas of the body, and initial predominance patterns do not persist. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, For services performed on or after 10/01/2015, For services performed on or after 11/14/2019, AMA CPT / ADA CDT / AHA NUBC Copyright Statement. endstream endobj 707 0 obj <>/Filter/FlateDecode/Index[47 599]/Length 42/Size 646/Type/XRef/W[1 1 1]>>stream Protein and calorie deficiencies alter insulin, growth hormone and cortisol levels, curtail hepatic function, and deplete mineral stores. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. You can use the Contents side panel to help navigate the various sections. required field. Applicable FARS/HHSARS apply. No memory deficit evident on clinical interviews. Critically impaired breathing capacity as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification: Vital capacity (VC) less than 30% of normal (if available); Patient declines mechanical ventilation; external ventilation used for comfort measures only. Although guidelines applicable to certain disease categories are included, this LCD is applicable to all hospice patients. Lab testing is not required to establish hospice eligibility. You can use the Contents side panel to help navigate the various sections. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Coverage for these patients may be approved if documentation of clinical factors supporting a less than 6-month life expectancy not included in these guidelines is provided. 0000001970 00000 n endstream endobj 660 0 obj <>stream MACs develop an LCD when there is no national coverage determination (NCD) (e.g., when an item or service is new) or when there is a need to further define an NCD for the specific jurisdiction. "JavaScript" disabled. Another option is to use the Download button at the top right of the document view pages (for certain document types). 0000040523 00000 n H\0E Chronic persistent diarrhea for one year; Absence of, or resistance to effective antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease; Congestive heart failure, symptomatic at rest; Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR) >1.5; End stage liver disease is present and the patient shows at least one of the following: Ascites, refractory to treatment or patient non-compliant; Hepatorenal syndrome (elevated creatinine and BUN with oliguria). Progressive inanition is documented by several measures such as 10% body weight loss, decreased albumin, and dysphagia leading to aspiration, among others. ; Supratentorial: greater than or equal to 50 ml. Stage 6 (Middle Dementia) Severe cognitive decline.May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. End Users do not act for or on behalf of the CMS. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not The guidelines for LCD development are provided in Chapter 13 of the Medicare Program Integrity Manual. FAST scale. of every MCD page. special, incidental, or consequential damages arising out of the use of such information, product, or process. See 1869(f)(1)(A)(i) of the Social Security Act. It is intended to be used to identify any Medicare beneficiary whose current clinical status and anticipated progression of disease is more likely than not to result in a life expectancy of six months or less.Clinical variables with general applicability without regard to diagnosis, as well as clinical variables applicable to a limited number of specific diagnoses, are provided. However, no single variable deteriorates at a uniform rate in all patients. Very sick; hospital admission necessary; active supportive treatment necessary. ), HIV DiseasePatients will be considered to be in the terminal stage of their illness (life expectancy of six months or less) if they meet the following criteria. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Revision Explanation: Annual review no changes made. Patients will be considered to be in the terminal stages of stroke or coma (life expectancy of six months or less) if they meet the following criteria: Patients at high risk of developing HF because of the presence of conditions that are strongly associated with the development of HF. Some patients decline rapidly and die quickly; others progress more slowly. (This value may be obtained from recent [within 3 months] hospital records.). Neither the United States Government nor its employees represent that use of Patients with dementia should show all the following characteristics: Patients should have had one of the following within the past 12 months: Note: This section is specific for Alzheimers Disease and related disorders, and is not appropriate for other types of dementia, such as multi-infarct dementia. 2000;320:469-472.Crooks V, Waller S, Smith T, Hahn TJ. (Documentation of serial decrease of FEV1>40 ml/year is objective evidence for disease progression, but is not necessary to obtain. Large anterior infarcts with both cortical and subcortical involvement. MACs develop an LCD when there is no national coverage determination (NCD) (e.g., when an item or service is new) or when there is a need to further define an NCD for the specific jurisdiction. 0000004710 00000 n of every MCD page. Almost always recall their own name. As with any other condition, an individual with renal disease is eligible for the Hospice benefit if that individual has a prognosis of six months or less, if the illness runs its normal course. 0000040858 00000 n Factors from 3 will add supporting documentation. Patients will be considered to be in the terminal stage of heart disease (life expectancy of six months or less) if they meet the following criteria. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. Such patients have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs or symptoms of HF.Example:Systemic hypertension; coronary artery disease; diabetes mellitus; history of cardiotoxic drug therapy or alcohol abuse; personal history of rheumatic fever; family history of cardiomyopathy.Stage BPatients who have developed structural heart disease that is strongly associated with the development of HF but who have never show signs or symptoms of HF.Example:Left ventricular hypertrophy or fibrosis; left ventricular dilatation or hypocontractility; asymptomatic valvular heart disease; previous myocardial infarction.Stage CPatients who have current or prior symptoms of HF associated with underlying structural heart disease.Example:Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF.Stage DPatients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.Example:Patients who are frequently hospitalized for HF or cannot be safely discharged from the hospital; patients in the hospital awaiting heart transplantation; patients at home receiving continuous intravenous support for symptom relief or being supported with a mechanical circulatory assist device; patients in a hospice setting for management of HF.Karnofsky Performance Scale (KPS)The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment. CEA, PSA); Progressively decreasing or increasing serum sodium or increasing serum potassium. Hospice Eligibility Criteria Patient has a terminal illness with a life . 0000015606 00000 n (1 and either 2, 3 or 4 should be present. Instructions for enabling "JavaScript" can be found here. These are quite variable and include: Stage 7 (Late Dementia) Very severe cognitive decline. xref These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). British Medical Journal 2000; 320; 469-472. LCDs are specific to an item or service (procedure) and they define the specific diagnosis (illness or injury) for which the item or service is covered. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). It is intended to be used to identify any Medicare beneficiary whose current clinical status and anticipated progression of disease is more likely than not to result in a life expectancy of six months or less. Baseline data may be established on admission to hospice or by using existing information from records. Co-morbidities. On the other hand, patients in the terminal stage of their illness who originally qualify for the Medicare hospice benefit but stabilize or improve while receiving hospice care, yet have a reasonable expectation of continued decline for a life expectancy of less than six months, remain eligible for hospice care. ]6o?7#qij]e]#mvb:~=y1\N(QhnX- }%h=#8At#ZRUpJK$\v&$&Np\KOI&'=%Oxu}j.bJBmv;]wy'.p|Wst]M3 \;y^zLGazW@ZzLgZ\$f29o"T=c(%/&Kp:,j{L Fu G 0000003355 00000 n C. Heart Disease. Applications are available at the American Dental Association web site. Medicare program. 0000037087 00000 n 844-4CHILDRENS (844-424-4537) 844-424-4537; Patient Login (MyChart . The information displayed in the Tracking Sheet is pulled from the accompanying Proposed LCD and its correlating Final LCD and will be updated as new data becomes available. CPT is a trademark of the American Medical Association (AMA). Pyelonephritis or other upper urinary tract infection; Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin <2.5 gm/dl. If you would like to extend your session, you may select the Continue Button. Recertification for hospice care requires the same clinical standards be met as for initial certification, but they need not be reiterated. Recurrent or intractable serious infections such as pneumonia, sepsis or pyelonephritis; Weight loss of at least 10% body weight in the prior six months, not due to reversible causes such as depression or use of diuretics; Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes such as depression or use of diuretics; Observation of ill-fitting clothes, decrease in skin turgor, increasing skin folds or other observation of weight loss in a patient without documented weight; Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption. A patient will be considered to have a life expectancy of six months or less if he/she meets the non-disease specific. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Patients who have current or prior symptoms of HF associated with underlying structural heart disease. Patients who meet the guidelines established herein are expected to have a life expectancy of six months or less if the terminal illness runs its normal course. 0000017875 00000 n 1991;155:384-387.Reisberg B. ElderCare online. K. Ogle, B. Mavis, T. Wang. ), Progression of end stage pulmonary disease, as evidenced by increasing visits to the emergency department or hospitalizations for pulmonary infections and/or respiratory failure or increasing physician home visits prior to initial certification. AHA copyrighted materials including the UB‐04 codes and Serum creatinine > 8.0 mg/dl (>6.0 mg/dl for diabetics). NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). Pulmonary Disease. History of increasing ER visits, hospitalizations, or physician visits related to the hospice primary diagnosis prior to election of the hospice benefit. 0000004185 00000 n Please do not use this feature to contact CMS. Proposed LCD document IDs begin with the letters "DL" (e.g., DL12345). . Unable to ambulate without assistance. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Also, you can decide how often you want to get updates. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. H\n0)B-FZBo>9X;frYQkh!:?^rt:wn/6]rO7go7c?[\zVi/6K]9bKCO1r{O=fU%=Xfey.)2"/g6_n. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, For services performed on or after 10/01/2015, For services performed on or after 06/30/2022, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Coverage Indications, Limitations, and/or Medical Necessity, Analysis of Evidence (Rationale for Determination), LCD - Hospice Determining Terminal Status (L34538). presented in the material do not necessarily represent the views of the AHA. Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions. Made a technical update to this LCD, to remove the empty Coding Information fields. <]/Prev 527120/XRefStm 1970>> 2002;5:85-92.O'Toole DM. Patients with dementia should show all the following characteristics: Stage seven or beyond according to the Functional Assessment Staging Scale; Urinary and fecal incontinence, intermittent or constant; No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words. K. Ogle, B. Mavis, G. Wyatt. It does not mean, however, that meeting the guideline is obligatory. Federal government websites often end in .gov or .mil. Unless elements in the record require explanation, such as a non-morbid diagnosis or indicators of likely greater than 6-month survival, as stated below, no extra or additional record entries should be needed to show hospice benefit eligibility.The amount and detail of documentation will differ in different situations. Normal no complaints; no evidence of disease. Disease Specific GuidelinesNote: These guidelines are to be used in conjunction with the Non-disease specific baseline guidelines described in Part II.Cancer Diagnoses. Made a technical update to this LCD to remove the empty Coding Information fields. hbbRc`b``3 1x4>.0 required field. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. This LCD describes guidelines to be used by National Government Services (NGS) in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits. The patient is not seeking dialysis or renal transplant or is discontinuing dialysis; Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics); Intractable hyperkalemia (>7.0) not responsive to treatment; Intractable fluid overload, not responsive to treatment. Factors from 5 will lend supporting documentation. There is no regulation precluding patients on dialysis from electing Hospice care. for diabetics); or < 15cc/min (< 20cc/min for diabetics) with comorbidity of congestive heart failure. 0000009368 00000 n Most facts and observations tending to suggest a greater than 6 month prognosis are predictable and apparent, such as a prolonged stay in hospice or a low immediate mortality diagnosis, as stated above. (1 and 2 should be present. ): Patients will be considered to be in the terminal stage of their illness (life expectancy of six months or less) if they meet the following criteria. This page displays your requested Local Coverage Determination (LCD). CMS and its products and services are LCDs are specific to an item or service (procedure) and they define the specific diagnosis (illness or injury) for which the item or service is covered. Such patients can be re-enrolled for a new benefit period when a decline in their clinical status is such that their life expectancy is again six months or less.
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protein calorie malnutrition hospice criteria