Can a Doctor Refuse to Recertify Hospice?

Yes — a hospice physician can and sometimes must decline to recertify a patient if they no longer have a life expectancy of six months or less if the illness runs its normal course. Recertification is a medical judgment, and the physician is required to make it honestly, not automatically renew it.

Why a doctor would decline to recertify

At the start of each benefit period, a hospice physician reviews the patient and signs a statement that the six-month prognosis still applies. If the patient has clearly stabilized or improved — gaining function, eating better, no longer declining — the physician may not be able to certify in good conscience. Medicare rules then require a live discharge for ineligibility. This is not a refusal to care; it is the benefit working as designed, reserving hospice for people who meet the prognosis standard.

The clinical markers physicians weigh — function scores, weight trends, infections, disease-specific indicators — reflect commonly cited Local Coverage Determination (LCD) guidance applied by the hospice physician and vary by region. They support the physician's judgment rather than dictating a single national rule.

How recertification works, period by period

Understanding the rhythm of recertification makes a non-recertification less alarming. Hospice runs in benefit periods: two initial 90-day periods, then an unlimited series of 60-day periods. Before each new period, a physician must recertify the six-month prognosis. Starting before the third benefit period and before each one after that, a hospice clinician must also conduct a face-to-face encounter with the patient — a visit, no more than 30 days before the period begins — to gather the clinical evidence behind the recertification. So a decision not to recertify is not random; it lands at a defined review point where the physician is legally obligated to take a fresh, honest look. For the full mechanics, see how recertification works.

Your rights when recertification is declined

If a hospice declines to recertify, you are entitled to a clear, plain-language explanation and a safe transition. You can:

• Ask why — request the specific clinical reasons the prognosis no longer fits.
• Appeal — you have the right to question a discharge decision; ask the hospice how to file an appeal or grievance, and use the expedited review process noted on your discharge notice.
• Seek a second opinion — another Medicare-certified hospice can perform a fresh evaluation, and a different physician may reach a different judgment if your loved one is genuinely declining.

If your concern is broader dissatisfaction rather than just this decision, read what to do if you're unhappy with your hospice.

The misconception to correct

Some families assume that once a person is on hospice, the doctor must keep recertifying them, or conversely that a refusal means the patient is being abandoned. Both are wrong. Recertification is never automatic — it requires an honest clinical judgment each period. And a non-recertification does not abandon the patient: care shifts back to regular Medicare, the hospice should coordinate a hand-off, and the patient can return to hospice if they decline again. A refusal to recertify is about prognosis, not about the patient's worth or the family's wishes.

Can a doctor refuse for non-medical reasons?

No. Recertification (or the refusal to recertify) must rest on the clinical determination of prognosis. It cannot legitimately be used to punish a family, settle a dispute, or cut costs. If you suspect a discharge was made for the wrong reasons, that is grounds to appeal and to request an evaluation from another hospice. You may also file a complaint with your state survey agency.

What if you and the doctor disagree about the decline?

Disagreements happen, especially with slow-moving illnesses. Bring concrete evidence to the conversation — recent weights, hospitalizations, choking episodes, loss of function over the past months. A documented downward trajectory is exactly what supports recertification, and presenting it clearly can change the picture. If the hospice still declines, a second evaluation elsewhere is your most direct path.

What happens to care after a non-recertification

A non-recertification ends the hospice benefit, but it does not end your loved one's health coverage. Regular Medicare Part A and Part B (and any drug plan) resume covering care as they did before hospice. The hospice should coordinate a hand-off to the primary doctor and, where appropriate, to home health services. Confirm before the discharge date who will manage prescriptions and what happens to equipment such as a hospital bed, so nothing lapses in the gap. If the illness later progresses, a new free evaluation can re-establish eligibility; there is no penalty for having been discharged and no permanent bar to returning.

Legitimate vs. improper reasons to decline recertification

It helps to separate the reasons a non-recertification is appropriate from the reasons it would be improper. The line is always the same: the decision must rest on the clinical prognosis, nothing else.

If the stated reason falls in the right-hand column, that is grounds to appeal, request another hospice's evaluation, and report concerns to your state survey agency.

Frequently asked questions

How much warning do we get before a non-recertification?

Because recertification happens at the start of each benefit period, the review is scheduled, not sudden. The hospice should discuss concerns about eligibility with you ahead of the decision and provide a written discharge notice that explains the reason and your appeal rights. If you sense the conversation is coming, ask directly what the physician is seeing.

Can the hospice's medical director overrule my loved one's own doctor?

The certification of prognosis must come from a hospice physician (the medical director or a hospice doctor), sometimes together with the attending physician. If your loved one's personal doctor believes the prognosis still fits but the hospice declines, that disagreement is a strong reason to seek an evaluation from a different hospice, whose physician makes an independent judgment.

Is appealing worth it if we have evidence of decline?

Often, yes. The expedited appeal exists precisely for cases where the family believes the patient remains terminally ill. Marshaling documented decline, weights, infections, hospitalizations, functional loss, gives the reviewer concrete grounds. Even if the appeal does not succeed, a fresh evaluation by another Medicare-certified hospice is a practical alternative.

Will we owe money if hospice ends?

Ending hospice returns you to standard Medicare cost-sharing for non-hospice care, which differs from the hospice benefit's minimal costs. Ask the hospice and the primary doctor to walk through what coverage looks like after discharge so there are no surprises.

If we switch hospices, does the prognosis clock restart?

Transferring to another hospice is treated as a change of provider, not a new start; the benefit-period sequence continues rather than resetting. A second hospice simply performs its own evaluation and, if its physician certifies the prognosis, admits your loved one. This is why a second opinion is the most direct remedy when you disagree with a non-recertification — a different physician may read the same decline differently.

What to do next

If a hospice declines to recertify and you believe your loved one is still terminally ill, ask for the clinical reasons in writing, request an appeal, and arrange a fresh evaluation from another provider. A hospice physician — not the family — makes the eligibility call, so a second medical opinion is the practical remedy. When you are ready to compare Medicare-certified hospices near you, search our directory by city, and review how recertification works to understand the process.