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 method
• 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.