Amyotrophic Lateral Sclerosis (ALS)

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.

At least one of the following must also apply:

  • Critically impaired breathing capacity evidenced by:
    • Vital capacity (VC) less than 30% of normal
    • Significant dyspnea at rest
    • Requires supplemental oxygen at rest
  • Patient declines artificial ventilation
  • Critical nutritional impairment evidenced by:
    • Oral intake insufficient
    • Continuing weight loss
    • Dehydration or hypovolemia
    • Absence of artificial feeding methods
  • 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.


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