On Feb. 13, Georgia Democrat John Lewis (5th District) re-filed a bill in Congress to gain OTs the right to do initial evaluations that qualify patients referred for rehab only for home care benefits under Medicare Part A.

The bill he sponsored last year died in committee with five House co-sponsors, but it got the word around to Lewis' colleagues as to what OT is and what it can do.

AOTA has been trying to get OTs initial treatment rights in home health for two decades and failed because studies done by the Government Accountability Office in the late 1970s indicated that sending in OT alone could raise the cost of home care by involving social services and other disciplines. At present, under the law, OT must follow physical therapy, speech-language pathology or other services that qualify under the law into a home care case. OT may continue as the sole treatment provider in the home after the others have left.

Lewis' bill does not ask for new treatment rights. The other services still would have to treat first before OT could become clinically involved. But enactment of this law would allow home health agencies to use occupational therapists to assess a patient's eligibility for the home care benefit in a rehab-only referral as long as OT is one of the services requested on the doctor's plan of care. This would give home health agencies more people to juggle for collecting the initial OASIS data on the case, which is very performance-oriented.

That's why HR 1094 is called the Medicare Home Health Flexibility Act.

This bill is extremely important to the future of OT in home care, and to the highest quality of care that home care patients should be able to receive.

In a statement to ADVANCE, Lewis said, "I introduced [the act] because.it will lead to fewer delays in necessary care for Medicare rehabilitation clients who need OT services. Currently, occupational ­therapists cannot conduct the initial assessment for Medicare home health cases even when occupational therapy is included in the physician's order along with one of the other qualifying services. This simply doesn't make sense.I look forward to working with my colleagues to enact this legislation so that home health agencies can better manage their staff and better meet the needs of Medicare patients."

The bill currently sits in the House Ways and Means and Energy and Commerce committees. Lewis is a member of Ways and Means, chaired by Pete Stark (D-CA). At least seven members of that committee were also on the health subcommittee of Ways and Means in the 110th Congress and are familiar with the Flexibility Act. Henry Waxman, another California Democrat, chairs Energy and Commerce.

Legislation like this hardly ever flies solo. It usually makes it to the floor of Congress attached to related pending legislation, in this case possibly health care reform or some kind of Medicare maintenance bill to come later in the year.

In order to make HR 1094 a law, Lewis needs co-sponsors and a Senate sponsor. So far he only has one: Rep. Lincoln Diaz-Balart (R-FL), who also supported last year's bill. So lawmakers need to hear from as many OTs, OTAs and advocates as possible. You can start by logging onto AOTA's Web site at www.aota.org. Under "Advocacy Highlights" click on "AOTA Home Health Legislation Re-introduced." You can take immediate action by sending a letter to your congressional representatives.

Targeting members of the House Ways and Means and Energy and Commerce committees in whose jurisdictions you reside is important. You can find Ways and Means members at http://waysandmeans.house.gov/members.asp and Energy and Commerce members at http://energycom merce.house.gov.

But Medicare is not the only game in town when it comes to home care. Though many don't realize it, home care therapists in many states do have sole practicing rights under Medicaid and under some private insurances; but agencies ignore that fact or are not aware of it, and tend to keep occupational therapists restricted in home care treatment. Giving them "first-encounter" visibility would make the profession better known.

AOTA has produced a fact sheet on these policies available at www.aota.org/Practioners/Docs/FactSheets/Home/38512.aspx. Please read this and then make sure your agency's policies are consistent with current payer coverage and federal rules. You may be surprised what you are actually able to do.

E.J. Brown is editor of ADVANCE.