The American Occupational Therapy Association (AOTA) celebrates a decision by the Centers for Medicare & Medicaid Services (CMS) to allow occupational therapists to conduct initial and comprehensive assessments for Medicare home health cases.

CMS issued an order on April 9 to temporarily suspend certain regulatory requirements through waivers under Section 1135 of the Social Security Act so that health care facilities can maximize their frontline medical staff during the COVID-19 national health emergency, including a key rule for occupational therapy. 

“We are pleased that CMS has recognized occupational therapy’s vital role in home health and AOTA’s advocacy efforts on this topic,” says Sherry Keramidas, PhD, FASAE, CAE, Executive Director of AOTA, in a media release.

“Access to occupational therapy services is more important than ever as occupational therapy practitioners are helping clients to navigate COVID-19–related challenges of occupational deprivation, participation in daily living, using occupation to support mental wellness, and re-engaging in occupations while recovering from COVID-19.”

The CMS decision has a retroactive effective date of March 1, 2020, through the end of the emergency declaration. According to the CMS Fact Sheet, the waiver:

Allow[s] occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that occupational therapists may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows occupational therapists to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether occupational therapy is the service that establishes eligibility. The existing regulations at §484.55(a) and (b)(2) would continue to apply that occupational therapists and other therapists would not be permitted to perform assessments in nursing only cases. We would continue to expect home health agencies to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments, and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. Expanding the category of therapists who may perform initial and comprehensive assessments to include occupational therapists provides home health agencies with additional flexibility that may decrease patient wait times for the initiation of home health services.

AOTA has advocated for years to make this a permanent reality in order to increase access to services for Medicare beneficiaries, increase efficiency, and support independent living without increasing costs. Occupational therapy has long been a valued component of home health care due to therapists’ expertise in identifying home safety issues, providing self-care training and modifications to promote independence in critical ADLs such as dressing and bathing, and in establishing routines to maximize a client’s ability to follow his or her plan of care, per the release.

Keramidas says that while this a positive, immediate move for the profession and its clients, AOTA sees this as a temporary step toward a permanent resolution. AOTA continues to support passage of the Medicare Home Health Flexibility Act (H.R.3127/S.1725), which would enable occupational therapists to open these cases on a permanent basis and make access to vital services more attainable. AOTA has been working for years to highlight the value of occupational therapy in home health by supporting the introduction of federal legislation, filing numerous comment letters with CMS, and meeting with CMS and Department of Health and Human Services staff to advocate for the critical role of occupational therapy in home health. 

“When occupational therapists are not permitted to open cases, there is a chance that vital occupational therapy services may not be utilized for patients who need services in the home to improve or maintain function,” Keramidas comments.

“AOTA continues to believe that occupational therapy may be the most appropriate discipline to start a case, given that occupational therapists assess and evaluate the patient’s home environment, evaluate functional status, identify possible safety issues, and identify other needs and strategies immediately, such daily management of chronic conditions and adherence to daily medication administration routines. Affording occupational therapists the ability to open home health cases, especially during this COVID-19 pandemic, addresses the need for patients to receive the skilled occupational therapy they need, when they need it,” she adds.

AOTA is developing a webinar to educate occupational therapists about opening home health cases in the coming weeks. A full analysis is available here.