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Medicare Home Health Flexibility Act Introduced in House

AOTA works to correct inefficiencies by establishing regulations to maximize patient care

Washington, DC (Sept. 25, 2017) — Today, U.S. Reps. Pat Meehan (R-PA), Lloyd Doggett (D-TX), Ryan Costello (R-PA), and Paul Tonko (D-NY) introduced the Medicare Home Heath Flexibility Act (H.R. 3820), a bill that would allow occupational therapists to open home health therapy cases by conducting the initial assessment and completing the required comprehensive assessments under Medicare.   

“Passage of this legislation would eliminate unnecessary inefficiencies and barriers to providing home health services to seniors,” according to Rep. Meehan. “This would enhance the ability to provide patients with effective, timely, and appropriate therapy services.”

“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,” said Rep. Doggett. “Unnecessary barriers to home therapy services increase costs and leave seniors at risk. This bill will work to prevent these delays, and is a straightforward, no-cost solution that would allow 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. Costello supported introduction, saying, “The Medicare Home Health Flexibility Act is a bipartisan solution to remove the unnecessary red tape that prevents my constituents from having access to the home health services they need to lead safe, healthy, and independent lives.”

“Passage of this bill would be especially helpful to reduce home health service delays in areas where access to physical therapy or speech-language pathology clinicians is limited,” said Rep. Tonko. “Delayed services often result in increased costs to Medicare, and this bill would help to address that problem.”

Occupational therapy has long been a valued 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. This legislation recognizes those contributions and seeks to address the arbitrary restrictions currently in place.

Amy J. Lamb, OTD, OT/L, FAOTA, President of the American Occupational Therapy Association (AOTA), called the bill a “win-win” for beneficiaries, the health care system, and policy makers because it increases access to services for Medicare beneficiaries, increases efficiency, and is a valuable investment of financial resources to support independent living without increasing costs.

“As baby boomers continue to age, so does the increased desire to age in place,” said Lamb. “Simultaneously, the evolving health care system emphasizes increasing quality and efficiency, and decreasing costs. As a result, more patients are receiving care in their home or community where occupational therapy has a pivotal role in facilitating participation and engagement in their everyday life, and enhancing quality of life while aging in place.”

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. 

CMS regulations, however, do not allow occupational therapy practitioners to open home health cases (i.e., performing 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.

Identical legislation (S.977) was introduced in the Senate in April by Senators Dean Heller (R-NV) and Ben Cardin (D-MD). 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 has previously received a zero score from the Congressional Budget Office.

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. Occupational therapy reduces hospital readmission and costs to patients, according to a 2016 independent study in the Medical Care Research and Review.

Founded in 1917, AOTA represents the professional interests and concerns of more than 213,000 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 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.

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To interview a member of AOTA's leadership or policy staff, contact AOTA's Manager of Media & Public Relations Katie Riley at 301-652-6611 x2963 or email kriley@aota.org.