Home Health & Hospice Week

It's Friday afternoon at your home health agency, and you're scrambling to get your last load of referrals staffed for Monday. There's a rehab-only case with orders for physical therapy, occupational therapy and speech. Your PT and speech contacts are booked for Monday, but your OT contact has an opening. Wouldn't it be helpful if OT could open the case?

That's what Karen Vance and other advocates of the Medicare Home Health Flexibility Act (H.R. 5794) argue. But under the current Medicare Conditions of Participation for the comprehensive assessment, OT cannot open a case.

The home health agency in the example above would have to wait until PT or speech staff was available -- which could violate the CoP that requires admission within 48 hours of physician orders. H.R. 5794, however, would help prevent these scenarios -- and allow the HHA to use the most appropriate therapy discipline for the case.

At first glance, it's easy to mistake this bill as making OT a qualifying discipline in home health. But that is not the case, says Vance, an OT and consultant with Springfield, MO-based BKD who helped initiate the bill. "This bill allows OT to be an initiating service, not a qualifying discipline."

More clarification: "This bill would allow home health agencies the flexibility to use the most appropriate skilled rehabilitation professionals to open cases and to conduct the initial assessment for Medicare home health beneficiaries who do not require skilled nursing care," said Rep. John Lewis (D-GA) in the bill's introductory statement.

Who's all in: The National Association for Home Care & Hospice supports the bill, an association source confirms to Eli. And no surprise, the American Occupational Therapy Association is backing it as well, not only because it would help HHAs but also because it would help give OTs the equal stomping grounds they deserve. "It's certainly a professional integrity issue for us too; OT is a skilled service just the same as PT and speech," says Tim Nanof, legislative representative for AOTA.

And in many home health cases, OT is truly the best option, advocates argue -- especially if the rehab focus is on activities of daily living in the home setting. "I've so often seen agencies assigning PT to a case when OT is really the more appropriate discipline," Vance laments. "But this bill would allow the agency more flexibility in deciding which is the most appropriate discipline."

So when would this bill have a chance of becoming a reality? Its advocates are thinking around December 2009. "We'd like to convince the committee staff to include it in the next Medicare package, which will probably be 18 months from now," Nanof reports. That would allow time to build cosponsors -- and to show that there is "no opposition."

Why it's win-win: It doesn't threaten anyone else's Medicare funding because it's budget-neutral. Congress wouldn't have to crunch new numbers or cut funding from other groups to give OT the ability to open a case (when other qualifying therapies are involved).

"Making OT a qualifying service, however, would not be budget-neutral because that would be considered an expansion of coverage," Nanof explains. "And people get gun-shy about signing on to something that changes the scope of practice because of how it affects other groups."

"This is why it's so important not to misinterpret this bill as making OT a qualifying discipline," Vance stresses. Naturally, OT advocates would eventually like to see OT as a qualifying discipline for home health services right along with PT and speech, but that battle is for another time.