Do you need two doctors to certify for hospice or can just the medical director of a patient?

In the United States, two physicians are required to certify for hospice. The first physician must be the patient's attending physician, who is responsible for the patient's primary medical care. The second physician must be a hospice medical director or a physician who is board-certified in hospice and palliative medicine. Both physicians must agree that the patient meets the criteria for hospice care.