Support S. 1725 / H. R. 3127

Sharon Hamilton MS, RN, CFDS
Clinical Consultant, Briggs Healthcare

The Medicare Home Health Flexibility Act would specifically 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. The need for in-home service is growing as baby boomers continue to age, adding to the amount of people who want to age in place.

US Reps Lloyd Doggett (D-TX), Jason Smith (R-MO), Paul Tonko (D-NY), and David McKinley (R-WV) have recently introduced the Medicare Home Heath Flexibility Act (HR 3127) in the House of Representatives, while Senators Ben Cardin (D-MD) and Todd Young (R-IN) simultaneously introduced identical legislation in the Senate (S 1725).

Occupational therapy has long been a valued component of home health care due to the therapists’ expertise in identifying home safety issues and in establishing routines to maximize a client’s ability to follow his or her plan of care. This legislation recognizes those contributions and seeks to address the arbitrary restrictions currently in place.

Currently, occupational therapy alone cannot establish eligibility for home health services under Medicare, unlike nursing, physical therapy, and speech-language pathology. Occupational therapy does, however, qualify an individual for home health services on a “continuing need basis,” so a person can continue to receive occupational therapy even after they have been discharged from all other services.

The Centers for Medicare & Medicaid Services (CMS) regulations, do not allow occupational therapy practitioners to open home health cases (i.e., perform the initial and comprehensive assessments at the start of care), even when occupational therapy is ordered alongside physical therapy or speech-language pathology. This regulation is burdensome as occupational therapists are qualified to perform the initial and comprehensive assessments based on their unique training and perspective, which focuses on functional capabilities.

The Medicare Home Health Flexibility Act would not alter Medicare’s criteria for establishing eligibility for the home health benefit, and it would only apply to rehabilitation cases. The Act enjoys bipartisan support and was previously determined by the Congressional Budget Office to have no impact on the federal budget. It is also supported by organizations representing physical therapists, speech-language pathologists, and home health providers.

Nationwide, more than 213,000 occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Legislation supporting access to occupational therapy and rehabilitation services can reduce overall health care costs by facilitating independence among patients.

Source: The American Occupational Therapy Association, Inc.

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