Should meet the following criteria:

• One or More Serious Illness* (see below)
• Impairment of at least 1 ADL (bathing, dressing, toileting, transfers, continence and feeding)
• Utilized acute care in the last 12 months (hospitalization, SNF or hospice)

Recommend exclusion of patients on transplant waiting list and those with primary psychiatric diagnosis *

*Serious Illness

• Cancer (metastatic or hematologic)
• End stage renal failure (aka ESRD or CKD V)
• Dementia
• Advanced liver disease or cirrhosis
• Diabetes with severe complications (ischemic heart disease, peripheral vascular disease, or chronic kidney disease)
• Amyotrophic lateral sclerosis
• AIDS
• Hip fracture
• COPD or interstitial lung disease – with oxygen use and hospitalization for the condition
• CHF – only if ever hospitalized for the condition
• Huntington’s
• Obesity hypoventilation syndrome
• Bronchiectasis
• Multiple sclerosis - with progressive functional impairment or progressive weight loss
• Stroke – with functional dependence/disability
• Peripheral vascular disease - with pain at rest or nonhealing wounds
• Parkinson’s disease – with progressive functional impairment or progressive weight loss

Medicare, Medicaid, and many private insurance plans cover home health palliative care services, according to the contract provisions of the policy. Adoray staff will check individual insurance benefits for each patient. If criteria are met, these insurances usually cover services at 80% to 100%