MULTIPLE SCLEROSIS

The patient has critical nutritional impairment evidenced by:

• Oral intake of nutrients and fluids insufficient to sustain life
• Continuing weight loss

Rapid disease progression or complications in the preceding 12 months as 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 independent in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs

Life-threatening complications in the preceding 12 months as evidenced by one or more of the following:

• Critically impaired breathing capacity
• Dyspnea at rest
• The requirement of supplemental oxygen at rest
• The patient declines artificial ventilation
• Recurrent aspiration pneumonia (with or without tube feedings)
• Upper urinary tract infection (pyelonephritis)
• Sepsis
• Recurrent fever after antibiotic therapy
• Stage 3 or 4 decubitus ulcers

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.