New Legislation Allows Occupational Therapists to Order Home Health

WASHINGTON, D.C. (June 20, 2019)—

New bipartisan legislation has been introduced in both the United States Senate and House of Representatives that would grant occupational therapists the authority to open home health cases. Under current law, only nurses, physical therapists and speech language pathologists can open a home health case by performing the patient assessment.

The National Association for Home Care & Hospice (NAHC) is strongly in support of the Medicare Home Health Flexibility Act (S 1725/HR 3127) because the discipline that will be most heavily utilized throughout care should be the one performing the initial patient assessment. This legislation would accomplish that long-overdue goal, while also bringing occupational therapy into parity with the other skilled care providers.

Occupational therapy (OT) has long been recognized as a critical element of home health care given its distinct focus on functional capabilities and home safety. OT is frequently ordered on physicians’ initial plans of care, alongside qualifying services such as skilled nursing. OT services alone, however, do not establish eligibility for home health services.

As a result, current Medicare regulations create an imbalance among the skilled therapy services. Even when ordered on the plan of care, occupational therapists are not permitted to conduct the required initial visit under Medicare. Additionally, they are not allowed to complete the comprehensive assessment unless OT is the qualifying service, such as under some Medicaid plans or when OT is the qualifying service on a “continuing need” basis for extended service under Medicare.

It makes common sense to allow home health agencies the flexibility to use the most clinically appropriate skilled service to conduct the initial assessment visit and to complete the comprehensive assessments.

Senators Ben Cardin (D-Md.) and Todd Young (R-Ind.) introduced the Medicare Home Health Flexibility Act in the Senate, while Reps. Lloyd Doggett (D-Texas), Jason Smith (R-Mo.), and Paul Tonko (D-N.Y.), and David McKinley (R-W.V.) introduced its companion bill in the House of Representatives.
Versions of this legislation have been introduced in past Congresses and NAHC supported those bills, as well.

Included in the original Patient Protection and Affordable Care Act (ACA) effort in 2009, this legislation was assessed a score by the Congressional Budget Office as having no impact on the federal budget. This particular piece of legislative language was included in the House version of the ACA but was removed with many other provisions when the Senate took up consideration of the ACA.

This legislation would only affect cases where skilled nursing has not been ordered and would not alter in any way Medicare’s criteria for establishing eligibility for the home health benefit.

NAHC is completely in support of this legislation and will be partnering with the American Occupational Therapists Association (AOTA) on advocacy efforts.

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