Home Health & Hospice Week

Cases involving nursing are still status quo — at least for now.

A Consolidated Appropriations Act requirement is finally set for implementation nearly a year later.

Recap: In April 2020, the Centers for Medicare & Medicaid Services issued a COVID-19 Public Health Emergency waiver allowing “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” (see HCW by AAPC, Vol. XXIX, No. 14). Then the CAA of 2021 enacted last December required that the Department of Health and Human Services make that waiver permanent (see HCW by AAPC, Vol. XXX, No. 1).

Now CMS has codified the change in regulation in the 2022 home health final rule published in the Nov. 7 Federal Register.

However, commenters on the proposed rule would have liked CMS to go further — say, by making OT a qualifying service and allowing OTs to open any cases, not just therapy-only ones.

“CMS does not have the statutory authority to permit occupational therapy to be a qualifying service,” the agency points out in the final rule. “An act of Congress would be needed to change the statute.”

For therapists opening cases involving nursing, “when nursing is assigned to the case, it is likely the patient will have a greater need for nursing services than other services,” CMS maintains in the final rule. “So we believe that skilled nurses should conduct the initial assessment visit and initiate the comprehensive assessment,” it says.

“In therapy-only cases, it would be appropriate for the therapist to conduct the initial assessment visit and the comprehensive assessment,” CMS allows.

The door might not be completely closed on this issue, however. “We did not propose changes beyond those authorized under Division CC, Section 115 of The Consolidated Appropriations Act of 2021, but will consider this issue in future rulemaking,” CMS says.