Neurologic Disease

(Chronic degeneration conditions such as ALS, Parkinson’s, Muscular Dystrophy, Myasthenia Gravis or Multiple Sclerosis)

The patient must meet at least one of the following criteria (1 or 2A or 2B):

  1. Critically impaired breathing capacity, with all:

    1. Dyspnea at rest

    2. Vital Capacity < 30%

    3. Need oxygen at rest

    4. Patient refuses to use artificial ventilation


  2. Rapid disease progression with either A or B below:

    1. Progression from:

      • Independent ambulation to wheelchair or bed-bound status

      • Normal to barely intelligible or unintelligible speech

      • Normal to pureed diet

      • Independence in most ADLs to needing major assistance in all ADLs


      A. Critical nutritional impairment demonstrated by all of the following in the preceding 12 months

      • Oral intake of nutrients and fluids insufficient to sustain life

      • Continuing weight loss

      • Dehydration or Hypovolemia

      • Absence of artificial feeding methods


      B. Life-threatening complications in the past 12 months as demonstrated by at least one or more of the following:

      • Recurrent aspiration pneumonia

      • Pyelonephritis

      • Sepsis

      • Recurrent fever

      • Stage 3 or 4 Ulcerations

Renal Failure

The patient has 1, 2 and 3

  1. The patientis not seeking dialysis or renal transplant


  2. Creatinine clearance is < 10 cc/min (<15 for diabetics)


  3. Serum creatinine > 8.0 mg/dl (>6.0 mg/dl for diabetics)

    Supporting Documentation Includes:

    • Uremia

    • Oliguria (Urine output < 400ml in 24 hours)

    • Intractable hyperkalemia > 7.0

    • Uremic pericarditis

    • Hepatorenal syndrome

    • Intractable fluid overload

    • Mechanical ventilation

    • Malignancy

    • Chronic lung disease

    • Advanced cardiac disease

    • Advanced liver disease

Detail 3

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