

4/10/2020

Updated 5/1/2020

Late on April 9, the Centers for Medicare & Medicaid Services (CMS) temporarily suspended certain regulatory requirements through 1135 waivers 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. After years of AOTA advocacy to allow occupational therapists to open Medicare home health cases, CMS has temporarily suspended the rule that would prevent OTs from opening Medicare home health cases, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. Occupational therapists may now perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. AOTA has obtained clarifications about the waiver from CMS staff—see this FAQ: Emergency Waiver Allows OTs to Perform Initial and Comprehensive Home Health Assessments for more details. 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 OTs 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 OTs 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 OTs and other therapists would not be permitted to perform assessments in nursing only cases. We would continue to expect HHAs 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 OTs provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services.

AOTA has been working for years to highlight the value of OT in home health. We have supported the introduction of federal legislation, filed numerous comment letters with CMS, and met with CMS and Department of Health and Human Services staff to advocate for the critical role of occupational therapy in home health. When OTs are not permitted to open cases, there is a chance that OT may not be utilized for patients who need occupational therapy services in the home to improve or maintain function. AOTA continues to believe that OT may be the most appropriate discipline to start a case, given that OTs 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); see the AOTA Fact Sheet Occupational Therapy's Role in Home Health). Having OT open home health cases addresses the need for patients to receive the skilled occupational therapy they need, when they need it.

We continue to support passage of the Medicare Home Health Flexibility Act (H.R.3127/S.1725), as this legislation would enable OTs to open Medicare home health therapy cases on a permanent basis. CMS has already provided Technical Assistance on this legislation, and House and Senate champions continue to work toward passage during this Congress. AOTA is pleased that CMS has recognized our vital role in home health, and we will continue our work to make this CMS policy permanent.

AOTA hosted two webinars to educate occupational therapists about opening home health cases. View the recordings for more information: Part 1 provides background and facts on the waiver, and Part 2 provides resources to prepare OTs for performing the initial and comprehensive assessments.



