Passage of Home Health Flexibility Act Enables OTs to Open Medicare Home Health Cases
The Medicare Home Health Flexibility Act (H.R.3127/S.1725) was passed by Congress as part of a large year-end Omnibus legislative package that addressed multiple healthcare priorities. The Centers for Medicare & Medicaid Services (CMS) now has 1 year to implement a new rule to enable occupational therapists to perform the initial and comprehensive assessments required to open Medicare home health therapy cases.
Occupational therapists have been permitted to open Medicare home health cases on a temporary basis since April 2020, when CMS issued an emergency rule to reduce regulatory burdens for home health providers during the COVID-19 pandemic. This emergency rule, however, will expire when the Public Health Emergency ends.
The bill (H.R.3127) was introduced and championed by Reps. Lloyd Doggett (D-TX), Jason Smith (R-MO), Paul Tonko (D-NY), and David McKinley (R-WV) in the House, while Senators Ben Cardin (D-MD) and Todd Young (R-IN) championed identical legislation in the Senate (S.1725). The new rule allowing OTs to open Medicare home health therapy cases will go into effect on a permanent basis no later than January 1, 2022.
Occupational therapy is an essential component of home health care due to 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. AOTA has long worked for passage of this legislation, in order to ensure these contributions are fully recognized and to address the arbitrary restrictions currently in place.
Under current policy, 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 Medicare Home Health Flexibility Act does not alter Medicare’s criteria for establishing eligibility for the home health benefit, and it only applies to rehabilitation cases. The legislation was endorsed by organizations representing physical therapists, speech-language pathologists, and home health providers.
Rep. Lloyd Doggett (D-TX), Chairman of the Ways and Means Health Subcommittee: “Seniors should not be kept from their home health providers. Unnecessary barriers to home therapy services increase costs and leave seniors at risk. Enacting this bill will help to prevent delays by allowing occupational therapists to conduct the initial home health assessment and open therapy-only home health cases. We need to make care accessible for those who need it.”
Rep. Jason Smith (R-MO), Ways and Means Committee: “The Medicare Home Health Flexibility Act is a common-sense solution that is especially critical in rural and less-populated areas where home health therapists can drive 100 miles or more per day when visiting home health patients. This bill will simplify scheduling issues for home health providers by increasing the number of therapists who can initiate Medicare home health therapy services.”
Sen. Ben Cardin (D-MD), Senate Finance Committee: “It’s common sense that the earlier seniors can start needed therapies, the sooner treatments can start having a positive effect. Home health services are a critical part of our health care system, and I am proud to have partnered with Senator Young on this legislation that will help to streamline the process for initiating Medicare home health therapy services for Maryland seniors and others nationwide who need home care while recovering from injury or illness.”
Sen. Todd Young (R-IN), Senate Finance Committee: “Ensuring the health of our seniors begins with timely care. I’m encouraged that passage of the Medicare Home Health Flexibility Act will enhance the way we approach healthcare home services for patients in rural areas. Our bipartisan legislation will help ensure our seniors are quickly and comprehensively assessed in their homes in order to receive proper treatment.”
Rep. Paul Tonko (D-NY), House Energy and Commerce Committee: “Passing this bill will help reduce home health service delays in areas where access to physical therapy or speech-language pathology clinicians is limited. Delayed services often result in increased costs to Medicare, and this bill would help to address that problem by allowing occupational therapists to get involved sooner.”
Rep. David McKinley (R-WV), House Energy and Commerce Committee: “Improving access to timely health care for our seniors is essential. By passing this bill, we can ensure more accessibility and prevent needless barriers to home health therapy services for patients in rural areas like West Virginia.”