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Medicare Home Health Flexibility Act introduced in House

On Thursday, Dec. 1, U.S. Con. Charles Boustany (R-LA) and Lloyd Doggett (D-TX) introduced the Medicare Home Heath Flexibility Act, (HR 6404), a bill that would allow occupational therapists to open cases and conduct the initial assessment for rehabilitation cases in the home health setting.

“Home- and community-based care is a critical part of our healthcare system, and many of my constituents rely on home care while recovering from injury or illness,” said Doggett. “Unnecessary barriers to home therapy services increase costs and leave seniors at risk. The Medicare Home Health Flexibility Act will work to prevent these delays, and is a straightforward, no-cost solution that would allow occupational therapists to conduct the initial home health assessment and open therapy-only home health cases. We need to make care accessible for those who need it.”

Occupational therapy has long been a valued component of home health care due to therapists’ expertise in identifying home safety issues and in establishing routines to maximize client compliance with the plan of care. This legislation recognizes those contributions and seeks to address the arbitrary restrictions currently in place.

Amy J. Lamb, President of the American Occupational Therapy Association (AOTA), called the bill a “win-win” for beneficiaries, the health care system, and policy makers because it increases access to services for Medicare beneficiaries, increases efficiency, and is a valuable investment of financial resources to support independent living without increasing costs.

“As baby boomers continue to age, so does the increased desire to age in place,” said Lamb. “Simultaneously, the evolving health care system emphasizes increasing quality, efficiency, and decreasing costs. As a result, more patients are receiving care in their natural environment or their home where occupational therapy has a pivotal role in facilitating participation and engagement in their everyday life, and enhancing quality of life while aging in place.”

Current regulation allows for the initial assessment to be made by the appropriate rehabilitation skilled professional only when the need for that service establishes home health eligibility. Since occupational therapy is not a qualifying service for home health eligibility, practitioners are prohibited from performing the initial assessment. The Medicare Home Health Flexibility Act would not alter Medicare’s criteria for establishing eligibility for the home health benefit, would apply to rehabilitation only cases, and would be limited to instances in which skilled nursing is not identified by the ordering physician.

Occupational therapists are qualified to perform the initial rehabilitation assessment based on their unique training and perspective, which focuses on functional capabilities; however, unlike physical therapists and speech language pathologists they are unable to initiate home health rehabilitation cases. Currently, occupational therapists are unable to conduct initial assessments in the home health setting.

The bill enjoys bipartisan support and has previously received a zero score from the Congressional Budget Office (CBO).

Nationwide, more than 213,000 occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Legislation supporting access to occupational therapy and rehabilitation services can reduce overall health care costs by facilitating independence among patients. A recent independent study ( found that occupational therapy reduces hospital readmission and costs to patients.

Founded in 1917, AOTA represents the professional interests and concerns of more than 213,000 occupational therapists, assistants, and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations, and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, visit ( .