Pediatric Palliative Care Eligibility Criteria

Waiver Eligibility Life-limiting CCS eligible medical condition, with a complex set of needs

Waiver Eligibility  Conditions for which curative treatment is possible, but may fail Advanced or progressive malignancy Complex and severe congenital or acquired heart disease

Waiver Eligibility  Conditions requiring intensive long- term treatment focused on maintaining quality of life Severe immune deficiencies Cystic fibrosis Muscular dystrophy Respiratory failure

Waiver Eligibility  Conditions in which treatment is exclusively palliative after diagnosis Progressive metabolic disorders Severe forms of osteogenesis imperfecta Certain chromosomal abnormalities

Waiver Eligibility  Conditions involving severe, nonprogressive disability or causing extreme vulnerability to health complications Extreme prematurity Neurologic sequalae of infectious disease or trauma Several cerebral palsy

Determining Eligibility  Complex set of needs? Case management and Coordination of medical services and Meeting three of the following six circumstances

 Immediate medical need(s) in a time of crisis  Coordination with family member(s) and providers required in more than one setting

 A life-limiting medical condition that impacts cognitive, social, and physical development  A medical condition with which the family is unable to cope

 A family member(s) and/or caregiver who needs additional knowledge or assistance with the client’s medical needs  Therapeutic goals focused on quality of life, comfort, and family stability