A Guide for Navigating Hospice Eligibility

The information in this section, when used together with your expertise, is intended to assist you in identifying patients that may meet Medicare Hospice eligibility requirements. The criteria does not represent a final determination of eligibility as that must be based on a full patient evaluation performed in collaboration with the referring physician and a hospice medical director.

Basic Criteria

In order to meet eligibility requirements a physician must reasonably believe the patient’s prognosis to be six months or less if the disease runs its normal course. As each patient is unique in his or her response to disease processes, this guide assists providers in evaluating a patient’s clinical data to reasonably support an opinion of declining prognosis. Please contact a Tidewell Hospice nurse or physician at 941-894-1777 for assistance navigating this tool or to discuss questions regarding hospice eligibility.

GENERAL (non-specific) TERMINAL ILLNESS Guidelines

Rapid decline over the past 3 to 6 months as evidenced by:

  • Progression of disease evidenced by symptoms, signs & test results
  • Decline in PPS to ≤ 50%
  • Involuntary weight loss >10% and/or albumin <2.5 (helpful)