For physicians, nurses and discharge planners
Hospice discharge, revocation and transfer
A patient leaves hospice in one of three ways, and the rules differ for each. Revocation is the patient's act (42 CFR 418.28). Transfer is the patient's choice of another hospice (418.30). Discharge is the hospice's act, allowed only for the reasons in 42 CFR 418.26: the patient moves out of the service area or transfers, the patient is no longer terminally ill, or discharge for cause after the steps the rule requires. Every discharge needs a physician's order and a discharge plan, and live discharges are counted in the Hospice Care Index.
Medically reviewed by Oscar Chien, MD, Medical Director, October 19, 2026
On this page (7 sections)
Revocation, transfer and discharge compared
| Who acts | What is documented | What follows | |
|---|---|---|---|
| Revocation (418.28) | The patient or representative | A signed statement that the patient revokes the election, with the effective date; no backdating | Regular Medicare resumes on the effective date; the rest of the benefit period is forfeited; a later election starts the next period |
| Transfer (418.30) | The patient or representative | A signed statement naming the hospice the patient is leaving, the receiving hospice and the date; filed with both | Coverage continues without a gap; allowed once per benefit period; not a revocation |
| Discharge (418.26) | The hospice, on a physician's order | The reason under 418.26(a), the physician's discharge order (418.26(b)), the discharge plan (418.26(d)) and, for cause, the steps in 418.26(a)(3) | Regular Medicare resumes; the patient may elect hospice again later if eligible; the discharge is reported on the claim |
A hospice may not discharge a patient at its own discretion for any other reason, including the cost or difficulty of care.
What are the three permitted reasons for discharge?
- The patient moves out of the hospice's service area or transfers to another hospice (418.26(a)(1)). A move is a discharge; a change of hospice is a transfer under 418.30, not a discharge.
- The hospice determines the patient is no longer terminally ill (418.26(a)(2)). The everyday word is graduation. The determination is clinical, made by the hospice physician with the interdisciplinary group, and should be documented with the findings that no longer support a six-month prognosis.
- Discharge for cause (418.26(a)(3)): the patient's, or another person in the home's, behavior is disruptive, abusive or uncooperative to the extent that delivery of care or the ability to operate effectively is seriously impaired. Before discharging, the hospice must advise the patient that discharge is being considered, make a serious effort to resolve the problem, ascertain that the behavior is not due to the terminal illness, and document the problem and the efforts in the record.
What must the discharge order and plan contain?
Before discharging for any reason, the hospice obtains a written physician's discharge order from the hospice physician; if the patient has an attending physician, the hospice physician consults the attending physician and includes the attending physician's review and decision in the record (418.26(b)). The hospice also has a discharge planning process (418.26(d)): the plan is prepared with the patient and family, addresses the care that will follow, and is documented. For a patient discharged because they are no longer terminally ill, the plan says who manages the medicines, the equipment and the follow-up on the day after discharge.
The effective date is the date the patient is discharged; the hospice does not bill for days after it. A discharge does not count against a later election: if the illness progresses, the patient can be certified again and a new election begins with the next benefit period.
How does the Hospice Care Index count live discharges?
The Hospice Care Index, a claims-based measure in the Hospice Quality Reporting Program, includes indicators for live discharges, among them live discharges in the first seven days and after 180 days on service, and burdensome transitions around a hospitalization. The indicators score the hospice, not the patient, and are published on Care Compare. The rule for the patient is unchanged: a discharge is allowed only for the three reasons above, whatever the index shows. A documented discharge for one of those reasons, with the order and the plan, is what the record should show when a reviewer asks.
How does Beta handle a discharge or revocation?
For a revocation, we give the patient the statement, explain what changes on the effective date, arrange the pickup of equipment and the handoff of prescriptions, and tell the referring clinician the same day. For a discharge because the patient is no longer terminally ill, the interdisciplinary group reviews the case, the medical director writes the order after consulting the attending physician, and the social worker writes the discharge plan with the family. For cause, the steps in 418.26(a)(3) are documented before any decision, and the administrator reviews it. Our discharge planner page covers the hospital side: discharge planners.
Common questions about hospice discharge
Can a hospice discharge a patient who is too expensive to care for?
No. Cost is not one of the three reasons in 42 CFR 418.26(a). A hospice that cannot meet a patient's needs must arrange the care or a transfer, not discharge.
Is a patient who revokes counted as a live discharge?
In the claims data, yes: a revocation ends the hospice stay alive. The reason code on the claim distinguishes revocation from a hospice-initiated discharge.
What if the family refuses to let the hospice in?
Refusing visits can be a reason for discharge for cause only after the steps in 418.26(a)(3): advise, try to resolve, confirm the behavior is not the illness, document. Often the problem is resolved by a conversation about what the family fears.
Does a discharge need the patient's signature?
No. A discharge is the hospice's act on a physician's order. A revocation or a transfer needs the patient's or representative's signature.
Related guides
The family pages: can you leave hospice and switching hospice providers. The rules on benefit periods and recertification and the election statement and addendum.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 19, 2026
- Next review
- April 19, 2027
How we write and review this site
Sources
- 42 CFR 418.26: Discharge from hospice care (opens in a new tab)
- 42 CFR 418.28: Revoking the election of hospice care (opens in a new tab)
- 42 CFR 418.30: Change of the designated hospice (opens in a new tab)
- 42 CFR 418.22: Certification of terminal illness (opens in a new tab)
- CMS: Hospice Quality Reporting Program, current measures (Hospice Care Index) (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
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Patients have the right to choose their hospice provider.