Home Health & Hospice Week

Your therapists could qualify for grandfathering, thanks to CMS' change of heart.

Some home health agencies and their therapists have dodged a regulatory bullet.

In the physician payment final rule the Centers for Medicare & Medicaid Services issued Nov. 1, the agency addresses therapist requirements for numerous settings, including home care. The rule sets out new requirements for physical therapists and PT assistants--but the new standards won't take effect until 2010.

And PTs currently practicing will qualify for a grandfathering clause that could exempt them from the new educational requirements, the rule explains. Originally, CMS didn't plan to extend the grandfathering to therapists in home health or hospice.

Commenters on the proposed rule said "there is no justification for the absence of a grandfathering provision for ... Home Health settings," CMS notes in the final rule. "Many also ... recommended that sufficient time be allowed before implementation of the new standards for new professionals to meet their training."

New requirements: PTs must graduate from a Commission on Accreditation in Physical Therapy Education-approved program, a successor organization or a program outside the U.S. deemed to be substantially equivalent. PTAs must also graduate from a CAPTE-approved program for assistants or an equivalent outside the U.S. and pass a national exam.

Occupational therapists must graduate from an Accreditation Council for Occupational Therapy Education-approved program and take the exam by the National Board for Certification in Occupational Therapy, Inc. OTAs must also graduate from an ACOTE-approved program and take the national exam.

"We will apply the grandfathering provision in all settings," CMS relents in the final rule.

Grandfathering will apply up to the new deadline for those who are licensed. "Therapists and assistants who met the qualifications of their State's practice act ... prior to December 31, 2009, will not be required to upgrade their qualifications," CMS explains in the rule. Therapists in states without licensure will have to comply with the new requirements, however.

Or those PTs and PTAs who qualify without licensure will be grandfathered if they meet Medicare requirements before Jan. 1, 2008, CMS adds.

Resource: More details on the new requirements are at www.cms.hhs.gov/PhysicianFeeSched/downloads/CMS-1385-FC.pdf starting on p. 1012.

CMS also removed a proposal to require therapists to practice without an interruption for two years to qualify for and maintain grandfathering. • Medicare has finalized a 10 percent cut to physicians' Medicare payment rates, and that's putting pressure on lawmakers to find the money to avoid the docs' cut--which could be bad news for home care.

Physician groups are lobbying hard to get members of Congress to pass legislation quickly averting the cut. CMS issued Nov. 1 the final rule instituting the 10.1 percent decrease.

"Congress must step in to replace the cut with payment increases that keep up with medical [...]