Center to Advance Palliative Care

Hi Barb,
Great question -- and one that many people are asking. The first level of the answer has to do with the fact that the concurrent care legislation doesn't change the eligibility criteria for children in the sense that all hospice eligibility criteria still have to be met. That means that children who are eligible for hospice services (and concurrent care under 2302) must have a life-limiting condition with a life expectancy of less than 6 months, if the disease or condition follows its normal course. Having said that, most of the conditions that are on the palliative care referral criteria would fit that bill, since we often ask the question, "Would you be surprised if this child died within a year?" in wondering if a child would be palliative care-eligible.

That being said, many programs are defining palliative care as appropriate for any child with a chronic, complex and/or life-threatening condition, which is a much more upstream definition. Upstream is still appropriate for hospice -- but there still needs to be the definition of terminality as specified above. Children are always eligible to be recertified, of course, and some states have been successful in changing their Medicaid criteria to be 12 months or more -- Medicaid hospice criteria can always be less restrictive than the Medicare adult hospice regulations, but not less.

So I'm not sure this fully answers your question, except to say that most of the diagnoses on the Referral Criteria for palliative care are also appropriate for hospice.
Thanks!
Sarah Friebert, MD