Bill Seeks OT Home Care Qualifying Rights

By E.J. Brown

Last February, when ADVANCE first added its name to those actively advocating for a law to qualify occupational therapists as case initiators under the Medicare Part A home health benefit, no such legislation had been filed in the past three years.

But on April 3, Georgia Democrat John Lewis (5th District) introduced HR 5704, the Medicare Home Health Flexibility Act of 2008, into the U.S. House of Representatives.

HR 5704 states: "a home health agency may determine the most appropriate skilled service to make the initial assessment visit for an individual who is eligible for home health services under title XVIII of the Social Security Act but who does not require skilled nursing care as long as that skilled service is included as part of the plan of care for home health services for such individual. An occupational therapist may make the initial assessment visit in such a case if occupational therapy is included in such plan in the initial physician referral in conjunction with physical therapy or speech language pathology services.

"ÉNothing in subsection (a) shall be construed to provide for initial eligibility for coverage of home health services under title XVIII of the Social Security Act on the basis of a need for occupational therapy."

The bill, in other words, will not provide for OT services independent of the need for either PT or SLP. But AOTA is hoping the fact that this new legislation won't cost Medicare any more (it won't add any extra people to the mix of beneficiaries) will reduce opposition to it.

This represents a major shift in AOTA's approach to getting OTs qualified to open cases in Part A Medicare. In 2005, when New Jersey Democrat Rob Andrews filed the Medicare Occupational Therapy Coverage Eligibility Act, the bill would have made occupational therapists independent providers in home health.

Christina Metzler, head of AOTA's Federal Affairs Department and chief public affairs officer, told ADVANCE that the National Association for Home Care (NAHC) is in favor of HR 5704, and that OTs and PTs working in home health have been talking with each other about it.

"This helps agencies to fully utilize all of their staff people to the maximum extent possible," Metzler explained. "There's a lot of need out there, and I think practitioners understand thatÉ"

Passage of the bill would mean that agency directors could then include OTs among their personnel qualified to open Medicare payment claims in home health. OTs are already filling out OASIS forms when they are the last discipline to leave the home.

Though 5704 is good news for home care therapists, they needn't be too elated yet. Since it was introduced, the bill has lain dormant in the health subcommittees of both Ways and Means, and Energy and Commerce to await hearings. So far, none have been scheduled. A spokesman for the Ways and Means committee told ADVANCE just after Labor Day that no hearing may even be held on it.

That isn't unusual, Metzler said. In order to get it to the House floor AOTA hopes to add it to the next Medicare legislation to come before the committees.

"This won't rise to the level of the physician fee schedule," she explained. "It's up to us to raise the profile on this so that when they begin to form the next Medicare bill, we are prepared to plant the seed to get this included," Metzler said. That should happen sometime next year, as amendments to both the physician fee schedule and the therapy cap are due to expire at the end of next year.

AOTA has to prove that this legislation is important to people.

"We need a substantial number of co-sponsors," she continued. The bill as yet has no Senate sponsor, and so far there are only five co-sponsors in the House: former presidential contender Ron Paul of Texas and Lincoln Diaz-Balart of Florida (both Republicans), and Democrats Brad Miller and David Price of North Carolina and Lloyd Doggett of Texas, who signed on last month.

Even if the bill passes, she added, what it will really offer OTs is "opportunity. They're going to have to step up the plate and be ready

"We hope that this will solidify the role of OT in rehab cases," Metzler said of the legislation.

A hearing could still happen if there is enough interest in it, she confirmed.

E.J. Brown is editor of ADVANCE.

WHAT YOU CAN DO

Attend

Capitol Hill Day, Washington, DC

Sept. 22, 2008

Where

Room B-339 of the Rayburn House Office Bldg.

When

8:30 a.m. Coffee with colleagues

9:00 a.m. Legislative briefing on issues in mental health parity, OT in home health and health care reform

10:30 a.m. Meet with your legislators on these issues. You can find your elected officials and their contact info at http://www.capwiz.com/aota/dbq/officials. Call or e-mail their Washington offices and ask to speak to the health legislative assistant to set up an appointment to meet with them. If you need help, email AOTA's federal affairs department at fad@aota.org.

OR

Access current legislation that AOTA supports or opposes by going to http://www.capwiz.com/aota/issues/bills. You can send email support from there.