Can Occupational Therapists Initiate the OASIS
Clarice Grote, MS, OTR/L

Clarice Grote, MS, OTR/L

Can Occupational Therapists Initiate the OASIS?

Can occupational therapists initate the OASIS in home health? Yes! But, under what circumstances? Learn the ins and outs of OTs and the OASIS in this article.

Can occupational therapists initiate the OASIS Start of Care? Yes!

The question is…

  • How do we spread the word? and
  • Under what circumstances can OTs initiate the OASIS?

Non-Medicare Patients Receiving Home Health

Can occupational therapists initiate the OASIS Start of Care for non-Medicare patients? It depends.

Private health insurance and Medicaid have their own rules about who can and cannot initiate the OASIS Start of Care and under what circumstances. The best thing to do in this scenario is to consult Medicaid and private insurer regulations. Keep in mind regulations may change with recent Medicare changes. So, if OTs previously couldn’t initiate and complete the OASIS Start of Care, it would be worth rechecking the guidelines.

Still no change? It sounds like a time for advocacy!

Medicare Patients Receiving Home Health Under Part A

Until recently, occupational therapists have been unable to initiate the OASIS in any situation. However, the Centers for Medicare and Medicaid Services (CMS) issued changes to the rules under the Public Health Emergency (PHE).

Under the COVID-19 PHE, CMS issued a special rule allowing occupational therapists could initiate the OASIS Start of care for Medicare Part A patients in ALL cases. This rule will expire when the PHE ends. This rule intends to help relieve some of the responsibility on nurses.

However… a permanent change is on the horizon!

The Medicare Home Health Flexibility Act was signed into law in December 2020 after many years of advocacy from AOTA and OT Advocates.

This legislation requires CMS to develop a permanent rule change to allow OTs to initiate and complete the comprehensive start of care assessment in therapy-only cases. Therefore, skilled nursing is not on the home health order. Before the PHE, physical therapists and speech-language pathologists were also only able to initiate the OASIS in therapy-only cases.

In June 2021, CMS released the proposed rule change to allow OTs to initiate the OASIS in therapy-only cases permanently. The rule will take effect on January 1, 2022.

Some agencies are hesitant to allow OTs to initiate the OASIS due to the rule change being temporary. This hesitance continues due to concerns there may be a gap between the end of the PHE and the start of this rule.

However, Health and Human Services stated the PHE is expected to be extended through the end of 2022 at a minimum. So, a gap between the rules is not expected.

What does all of this mean? OTs will permanently be able to initiate the OASIS Start of Care in therapy-only cases for Medicare Part A patients effective January 1, 2022.

Advocating for occupational therapists to initiate the OASIS

Occupational therapy practitioners must take it upon themselves to educate home health agencies of the change in regulation. Keep in mind you may need to speak to multiple people and make multiple attempts before having success.

Tips for educating your employer:

  • Do your research.
  • Be prepared to answer questions.
  • Bring evidence such as this article, AOTA articles, or the CMS proposed rule change.
  • Identify that the final rule is only for therapy-only cases.
  • Identify why OT is the perfect profession to initiatie the OASIS.
    • experts in function
    • experts in functional cognition
    • skilled in assessing and incorporating multiple elements in an evaluation such as social determinants of health
  • Identify how OT can improve accuracy on functional limitation reporting which directly impacts reimbursement under PDGM. Accurate scoring also helps agencies meet quality outcomes with accurate admit and discharge scoring.

What if your employer says no:

What if you or other OTs don’t want to do the OASIS?

  • Discuss the pros and cons.
  • Acknowledge income/pay concerns and discuss strategies to advocate for change.
  • Identify concerns over low caseload due to other disciplines cancelling OT orders – this won’t happen if OT opens the case.
  • Offer to provide education on how to complete the OASIS.

This change is great news for occupational therapy in home health and helps ensure the longevity of OT in this setting. Some agencies have resisted hiring OTs full-time due to concerns that OTs cannot do all the necessary job elements as a PT can. However, we are now able to combat this assumption. Remember, if you don’t advocate for OT, who will?

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