Occupational therapy (OT) has long been recognized as a critical element of home health care given its distinct focus on functional capabilities and home safety. OT is frequently ordered on physicians' initial plans of care, alongside qualifying services such as skilled nursing. OT services alone, however, do not “establish eligibility” for home health services.
As a result, current Medicare regulations create an imbalance among the skilled therapy services. Even when ordered on the plan of care, occupational therapists are not permitted to conduct the required initial visit under Medicare. Additionally, they are not allowed to complete the comprehensive assessment unless OT is the qualifying service, such as under some Medicaid plans or when OT is the qualifying service on a “continuing need” basis for extended service under Medicare.
The Medicare Home Health Flexibility Act would specifically allow home health agencies the flexibility to use the most clinically appropriate skilled service to conduct the initial assessment visit and to complete the comprehensive assessments.
This legislation would only affect cases where skilled nursing has not been ordered and would not alter in any way Medicare's criteria for establishing eligibility for the home health benefit.