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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