Medicare Home Health Accessibility Act introduced in the 118th Congress

Bill would enable OT to be ordered as a solo Medicare home health service

On January 30, Representatives Lloyd Smucker (R-PA), Lloyd Doggett (D-TX), John Joyce, MD (R-PA) and Paul Tonko (D-NY) introduced the Medicare Home Health Accessibility Act (H.R. 7148) which would establish occupational therapy (OT) as a qualifying Medicare home health benefit. Passage of the bill would mean that the need for occupational therapy would allow a beneficiary to receive home health care services without having to also receive nursing, physical therapy, or speech services as is now required under current Medicare policy.

Occupational therapy has long been recognized as an important home health service under Medicare; however, it is the only skilled service that does not qualify a beneficiary for the Part A home health benefit. As a result, some Medicare beneficiaries with conditions that do not require other home health services at the time will not receive OT which can impact their ability to live safely and thrive at home. This restriction can impact beneficiaries with low vision, dementia, diabetes, COPD or other conditions where the primary challenge at the time home health services are ordered can be managing activities of daily living.

Numerous studies indicate that OT services can generate savings to the Medicare system through the prevention of falls and other accidents that can result in emergency room visits, hospitalizations and even institutionalizations. Such savings have been demonstrated in acute care settings, and multiple studies have demonstrated that occupational therapy-led home safety evaluations paired with low-cost modifications decrease disability and result in significant cost savings.

Occupational therapy was added as a Part A Medicare home health qualifying benefit in 1980, but that status was changed in 1981 to non-qualifying as part of budgetary cost-saving measures. Under current rules, occupational therapy can already establish eligibility for the Medicare home health benefit on a continuing need basis after other services have been discharged and OT is the only service still needed by the beneficiary. Occupational therapy is also a stand-alone service in many states under the Medicaid home health benefit.

AOTA’s President Alyson Stover, MOT, JD, OTR/L, BCP notes that “occupational therapy services are ideally suited to home health given the ability of OTs to work with patients directly in their home environment to address safety and other issues that are difficult to identify in a clinical setting.” She adds that “AOTA worked with Congressional champions to support passage of legislation in 2020 that allowed occupational therapists to conduct the Initial and Comprehensive Assessments required to open a Medicare home health case when it is ordered with either physical therapy or speech services, and H.R. 7148 is the next logical step forward for Medicare beneficiaries and for the profession.”

Bill Dombi, President of the National Association for Home Care and Hospice, notes that “it is time that Congress rectify a long-standing weakness in the home health benefit by making occupational therapy a qualifying skilled service.” He adds that “OT is an essential service not only for patients, it also is a proven means to saving Medicare expenditures.”

Rep. Lloyd Smucker (PA-11) represents a Congressional district that includes Lancaster, and he is a member of the House Ways and Means Committee which has primary jurisdiction over H.R. 7148. He notes that “the Medicare Home Health Accessibility Act will ensure beneficiaries can receive the care they need in a setting that more and more prefer—at home. Our commonsense measure will ensure home health orders are better tailored to each patient as well as maximize their ability to thrive at home and avoid costly rehospitalizations. I thank my colleagues for joining me introducing and advocating for this legislation’s passage.”

Rep. Lloyd Doggett (TX-37) represents a district centered on Austin, and he is also a Ways and Means Committee member. He states that “home- and community-based care is a critical part of our health care system, and many of my constituents rely on home care while recovering from injury or illness.” He adds that “unnecessary barriers to receiving health care at home leave seniors with fewer choices and risks higher medical bills. This legislation will provide more patient choice and access by ensuring occupational therapy can qualify Medicare beneficiaries for home care, just as similarly positioned services already do.”

Rep. John Joyce, MD (PA-13) represents a district stretching from Gettysburg to Altoona, and he is a member of the Energy and Commerce Committee which also has jurisdiction over H.R. 7148. Dr. Joyce notes that “the Medicare Home Health Accessibility Act is a bipartisan solution that will allow more Medicare beneficiaries to lead safe, independent lives. Access to in-home occupational therapy – especially in rural communities – is a game changer for patients who wish to heal and recover in the comfort of their homes. This common-sense legislation would be a victory for thousands of patients nationwide, and it’s critical that the Medicare Home Health Accessibility Act receives a vote as soon as possible.”

Rep. Paul Tonko (NY-20) represents a district centered on Albany, and he is also a member of the Energy and Commerce Committee. He notes that “passage of this bill would be especially helpful to better target home health services to meet specific patient needs.” He adds that “OT services are often crucial to enabling a Medicare beneficiary to avoid falls and other accidents which could result in that person losing the ability to remain independently at home.”

Nationwide, more than 230,000 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.

Founded in 1917, AOTA represents the professional interests and concerns of occupational therapists, assistants, and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations, and serving as an advocate to improve health care. Based in North Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, visit www.aota.org.