Medicare Home Health Accessibility Act reintroduced in 119th Congress
H.R.2013 would enable OT to be ordered as a solo Medicare home health service
On March 10, Representatives Lloyd Smucker (R-PA), Lloyd Doggett (D-TX), John Joyce, MD (R-PA) and Paul Tonko (D-NY) reintroduced the Medicare Home Health Accessibility Act (H.R.2013) 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 services without having to also receive nursing, physical therapy, or speech-language pathology services as is now required under current Medicare policy. This bill was first introduced in 2024.
Reps. Smucker and Doggett are members of the House Ways and Means Committee which has primary jurisdiction over H.R.2013, and Rep. Smucker highlighted the importance of passing the bill during a Ways and Means hearing on post-acute care on March 11. He also wrote an OpEd in McKnights Homecare in 2024 which described the benefits of OT services in the home both for patients and to Medicare by reducing falls and accidents which result in ER visits, hospitalizations and other costs to Medicare:
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 start of care, 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 and hospitalizations. 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 President Alyson Stover, MOT, JD, OTR/L, BCP, notes that “occupational therapy services provided in a patient’s home environment enable OTPs to address specific safety and other issues that are difficult to identify in a clinical setting.” She adds that “we are proud to endorse the Medicare Home Health Accessibility Act which would enhance access to OT services which can enable individuals to live safely at home by addressing issues that often result in costly emergency room visits, hospitalizations and even institutionalizations.”
Rep. Lloyd Smucker (R, PA-11) represents a Congressional district that includes Lancaster. He notes that "the Medicare Home Health Accessibility Act will help ensure beneficiaries receive the care they need in the setting they increasingly prefer—home. This common-sense measure improves the personalization of home health orders, empowering patients to thrive at home while reducing costly rehospitalizations. I appreciate my colleagues for joining me in introducing and advocating for this important legislation.”
Rep. Lloyd Doggett (D, TX-37) represents a district centered on Austin. He notes 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. Unnecessary barriers to receiving health care at home leave seniors with fewer choices and risk 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 (R, 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.2013. He reports that "access to in-home occupational therapy is critical, especially in rural areas, to allow patients to heal and recover from home. I am proud to join my colleagues on the bipartisan Medicare Home Health Accessibility Act, a common-sense piece of legislation to ensure Medicare beneficiaries have access to the occupational therapy services they need without unnecessary barriers."
Rep. Paul Tonko (D, NY-20) represents a district centered on Albany, and he is also a member of the Energy and Commerce Committee. He notes that “the Medicare Home Health Accessibility Act will play a key role in expanding access to high-quality home health care for seniors across the nation. By enabling occupational therapy (OT) to be included as a stand-alone home health service for Medicare beneficiaries, this legislation will help thousands of seniors avoid falls and other accidents that often result in their losing the ability to remain independently at home. This bill will help us better target home health services to meet patients’ specific needs, helping thousands of Medicare beneficiaries to recover from injury and illness in the comfort of their own homes.”
H.R.2013 was also endorsed by several other healthcare organizations.
Steve Landers, MD, MPH, CEO of the National Alliance for Care at Home, notes that “occupational therapy is a critical service to support the recovery and independence of countless older and disabled Americans. Access to home health OT can improve quality and reduce overall Medicare spending. Homebound patients often need OT services in their own homes, but OT is the only skilled home health service that cannot be ordered under current law unless a Medicare beneficiary also needs nursing, physical therapy, or speech therapy. This means that people can be denied essential OT services in the home unless other services are also ordered. The Medicare Home Health Accessibility Act, H.R.2013, would correct that oversight, and it has the full support of the National Alliance for Care at Home.”
Cynthia K. Morton, MPA, Chief Executive Officer of ADVION, notes that “the Medicare Home Health Accessibility Act is a positive step forward in increasing access to essential care for seniors. Allowing occupational therapy to be ordered as a stand-alone home health service for Medicare beneficiaries will ensure equitable access to OT services and promote independence and quality of life for Medicare beneficiaries nationwide. This low-cost healthcare solution will eliminate unnecessary barriers to care, improve patient functionality and help reduce costly hospitalizations.“
Kelly MacNeill-Cooney, President of the National Association of Rehabilitation Providers and Agencies (NARA), notes that “the Medicare Home Health Accessibility Act is a win for beneficiaries as this growing population wishes to age at home. The addition of OT as a qualifying service to start home care will allow them to receive these critical services to return to and thrive in their homes independently. As providers continue to grapple with staffing shortages, the more we can utilize all options when appropriate, the better for beneficiaries.”
Alan Morgan, CEO of the National Rural Health Association (NRHA), adds that “occupational therapy is an essential component of positive health outcomes for individuals with home health care, yet current Medicare regulations create unnecessary barriers for beneficiaries in need of these services. That’s why the NRHA supports the Medicare Home Health Accessibility Act which would allow occupational therapists to initiate home health care independently when appropriate. This bill would improve access to care, particularly in rural communities where provider shortages already limit options for patients. We commend Representative Smucker for his leadership in advancing policies that strengthen rural health care and urge Congress to act on this important legislation.”