Home Health & Hospice Week

Could this PHE-era ability be restored?

A new Request for Information could lead to some help for home health agencies struggling with the nursing shortage.

“Some groups continue to advocate for [the Centers for Medicare & Medicaid Services] to permanently allow therapists to perform the initial and comprehensive assessment in the home health setting when both therapy and nursing services are ordered,” CMS notes in its home health proposed rule released June 26. While CMS has heard about the topic in previous rulemaking cycles, “we are interested in obtaining additional feedback on this specific potential change,” it says in the rule.

“The RFI about therapists doing the comprehensive assessment when nursing is ordered is interesting,” Cindy Krafft with K&K Health Care Solutions tells AAPC. “That has been argued for for many years, so maybe this time it will work,” Krafft says.

Background: “When therapy services are the sole services ordered by the physician or allowed practitioner, the initial and comprehensive assessments can be conducted by rehabilitation professionals (specifically occupational therapists (OT), physical therapists (PT), or speech-language pathologists (SLP)),” CMS explains in the rule.

However, CMS waived that rule under the COVID-19 public health emergency. CMS “permitted rehabilitation professionals to perform the initial and comprehensive assessment in instances when both nursing and therapy services are ordered,” the agency recalls. “This temporary blanket waiver reflected the unique circumstances of the PHE, with its acute pressures on the nursing workforce, and allowed rehabilitation professionals to perform the initial and comprehensive assessment for patients receiving therapy services as part of the broader nursing and therapy care plan, to the extent permitted under State law, regardless of whether the therapy service established patient eligibility to receive home care.”

One concern with reestablishing this ability is that “the three types of rehabilitative therapists (OT, PT, and SLP) have different education requirements for entry into to practice,” CMS points out in the rule.

“We seek public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. We ask the public for data, detailed analysis, academic studies, or any other information to support their comments that provide a direct link to patient health and safety,” the rule says.

CMS includes a laundry list of specific questions it’s looking to answer, including “How do HHAs currently assign staff to conduct the initial assessment and comprehensive assessment?” and “Do HHAs implement specific skill and competency requirements?”

Comments are due by Aug. 26.