AOTA Victory for Occupational Therapy: Final Medicare Rule Allows Occupational Therapists to Open Home Health Cases
On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued its final CY 2022 home health prospective payment system (HH PPS) rule and finalized proposed provisions allowing occupational therapists to perform the initial and comprehensive assessments required to open Medicare home health therapy cases beginning on January 1, 2022. AOTA believes that allowing occupational therapists to open home health cases can prevent delays in providing critical services to ensure that the patient can safely perform the activities and routines they need and want to do while in their home.
The new rule updates Section 484.55 of the home health conditions of participation to allow an occupational therapist to conduct the initial assessment visit and complete the comprehensive assessment under the Medicare program:
- When occupational therapy is on the home health plan of care, with either physical therapy or speech therapy, and
- When skilled nursing services are not initially on the plan of care.
The new rule does not alter Medicare’s criteria for establishing eligibility for the home health benefit.
How Did We Achieve This Policy Change?
The final HH PPS rule implements the Consolidated Appropriations Act of 2021 that Congress enacted in December 2020, which included provisions of the Medicare Home Health Flexibility Act. The bill, which AOTA had supported for many years, was introduced and championed by a bipartisan group of Representatives and Senators, including Representatives Lloyd Doggett (D-TX); Jason Smith (R-MO); Paul Tonko (D-NY); David McKinley (R-WV); and Senators Ben Cardin (D-MD) and Todd Young (R-IN). This policy change would not have happened without the support, diligence, and dedication of AOTA members, especially our home health experts who stuck with the fight, and our champions in Congress. While this is positive news, we still have more work to do.
What Can Home Health OTs Do about This Permanent Flexibility?
Keep the momentum going—YOU are the critical piece to showing your value! If your home health agency (HHA) hasn’t yet trained its occupational therapists to open cases, you should:
- Make sure they know about this permanent flexibility
- Talk to your agency about how you can help ensure that patients receive timely assessments and put them on the right track for safe and successful home health episodes
- Advocate for OT training in your agency’s policies for opening cases, emphasizing how you can help to ensure timely patient access to care
- Complete AOTA’s upcoming micro-credential as part of a home care professional certificate for occupational therapists interested in learning more about opening cases and conducting home health assessments
- Use the AOTA micro-credential to help ensure your agency knows that occupational therapy is often the most appropriate discipline to assess and evaluate the patient in their home environment, and you are qualified to do it.
Additional Highlights From the Home Health Final Rule
- Updates CY 2022 Medicare home health payment rates and the wage index for HHAs; CMS estimates the HHA Medicare payments will increase in the aggregate by $570 million (3.2%).
- Recalibrates the Patient-Driven Groupings Model (PDGM) case-mix weights, functional levels, and comorbidity adjustment subgroups while maintaining the CY 2021 low utilization payment adjustment (LUPA) thresholds for CY 2022.
- Finalizes a policy to utilize the physical therapy LUPA add-on factor as a proxy for the occupational therapy add-on factor for the LUPA add-on payment amount related to conducting the initial and comprehensive assessments until CMS has CY 2022 data to establish a more accurate OT add-on factor.
- Permanently allows the limited use of interactive telecommunications systems when performing the 14-day supervisory visit requirement when a patient is receiving skilled services, not to exceed one virtual supervisory assessment per patient in a 60-day period. HHAs must document in the medical record the rationale for the virtual visit. CMS stated in the final rule: We expect that in most instances, the HHAs would plan to conduct the 14-day supervisory assessment during an on-site, in person visit, and that the HHA would use [the] interactive telecommunications systems option only for unplanned occurrences that would otherwise interrupt scheduled in-person visits.
- Finalizes proposals to end the original Home Health Value-Based Purchasing (HHVBP) Model 1 year early and expand the HHVBP Model nationwide beginning January 1, 2022.
- Finalizes changes to the HH Quality Reporting Program:
- Removes the OASIS-based Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure.
- Replaces two measures with the Home Health Within Stay Potentially Preventable measure.
- Requires public reporting of the Percent of Residents Experiencing One or More Major Falls with Injury measure (NQF #0674) and Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631) measure beginning in April 2022.
- Finalizes the proposal that effective January 1, 2023, HHAs begin collecting data on the Transfer of Health Information measures, as well as six categories of standardized patient assessment data elements.
The HH PPS final rule is scheduled to be published in the Federal Register on November 9, 2021.
More Information
Background about how we achieved this victory: Legislation and proposed rule