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If the treatment has a poor track record, they will reject it. If the treatment does not prevent further decline, or the patient is terminal or non-compliant, they will not approve it. Mom is in PT rehab, but tries to get out of going when the aides come for her. She will say she has to poop, she will want to stay with visitors, she will tie herself up on the phone, says she has nothing to wear, etc. I know where this is going, soon they will just cut off the PT and she will not be able to return to her Assisted Living facility.