US Senators Ben Cardin (D-MD) and Dean Heller (R-NV) recently introduced the Medicare Home Health Flexibility Act (S. 2364), which would allow occupational therapists to conduct initial assessments in the home setting.

Occupational therapists are not allowed to conduct initial assessments because occupational therapy is not a qualifying service for home health eligibility. Per the current regulation, the initial assessment can only be made by the appropriate rehabilitation skilled professional when the need for that service establishes home health eligibility, explains a media release from the American Occupational Therapy Association (AOTA).

“This discrepancy causes unnecessary inefficiencies and barriers to providing patients with effective, timely, and appropriate therapy services in the home health setting,” says Christina Metzler, the AOTA’s chief public affairs officer, in the release.

The bill would correct this discrepancy by allowing home health agencies the flexibility to use the most appropriate skilled rehabilitation professionals to open cases and conduct initial assessments when related exclusively to rehabilitation cases and when skilled nursing care is not provided, the release explains.

It would not alter Medicare’s criteria for establishing eligibility for the home health benefit, would apply to rehabilitation only cases, and would be limited to instances in which skilled nursing is not identified by the ordering physician, the release adds.

Wording for the bill appears as follows:

Section 1. Short title

This Act may be cited as the Medicare Home Health Flexibility Act of 2015.

Sec. 2. Permitting occupational therapists to conduct the initial assessment visit under a Medicare home health plan of care for certain rehabilitation cases
(a) In general.—

Notwithstanding section 484.55(a)(2) of title 42, Code of Federal Regulations, or any other provision of law, an occupational therapist may conduct the initial assessment visit for an individual who is eligible for home health services under title XVIII of the Social Security Act if the referral order by the physician—

(1) does not include skilled nursing care;
(2) includes occupation therapy; and
(3) includes physical therapy or speech language pathology.
(b) Rule of construction.—

Nothing in subsection (a) shall be construed to provide for initial eligibility for coverage of home health services under title XVIII of the Social Security Act solely on the basis of a need for occupational therapy.

For more information, visit AOTA.

[Sources: American Occupational Therapy Association and]