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Clarice Grote, MS, OTR/L

OT and the OASIS: End of the PHE

Yes! OT can still do the OASIS when the public health emergency ends!

I’ve already been receiving emails and comments with this question. So, let’s put together the evidence!  

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OT Can Initiate OASIS in all Cases under the Public Health Emergency

As you may remember, at the start of the PHE, CMS released a temporary waiver allowing OT, PT, and SLP to initiate and complete the comprehensive start of care (which includes the OASIS) even when nursing is on the order. Before this, OT could not initiate it for Medicare Part A patients 

During that time, Congress passed the language of the Medicare Home Health Flexibility Act. This bill required CMS to add a provision that OT can initiative the comprehensive SOC in therapy-only cases. Many agencies missed this announcement since it didn’t change practice at the time. 

The best resource to use to show evidence directly from the source is the Medicare Home Health Conditions of Participation (42 CFR §484.55).

Standard: Initial Assessment Visit (bold added for emphasis)

When rehabilitation therapy service (speech language pathology, physical therapy, or occupational therapy) is the only service ordered by the physician or allowed practitioner who is responsible for the home health plan of care, the initial assessment visit may be made by the appropriate rehabilitation skilled professional. For Medicare patients, an occupational therapist may complete the initial assessment when occupational therapy is ordered with another qualifying rehabilitation therapy service (speech-language pathology or physical therapy) that establishes program eligibility.

42 CFR §484.55 (a)(2)

What does this say in plain English? Well it says that an occupational therapist (OT), physical therapist (PT), or Speech Language Pathologist (SLP) can complete the initial assessment (which includes the OASIS Start of Care (SOC)) when skilled nursing isn’t on the order. Meaning, it is a “therapy-only” case.

The last line is saying that OT can only complete the initial assessment when there is another qualifying therapy service. This is because OT is still not a qualifying service. Meaning, that Medicare will not pay for care if OT is the only discipline on the initial order (there is nuance to this so read this article for more information).

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Standard: Completion of the Comprehensive Assessment (bold added for emphasis)

When physical therapy, speech-language pathology, or occupational therapy is the only service ordered by the physician or allowed practitioner, a physical therapist, speech-language pathologist, or occupational therapist may complete the comprehensive assessment, and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. For Medicare patients, the occupational therapist may complete the comprehensive assessment when occupational therapy is ordered with another qualifying rehabilitation therapy service (speech-language pathology or physical therapy) that establishes program eligibility.

42 CFR §484.55 (b)(3)

The comprehensive assessment includes the Start of Care OASIS. This again reiterates that an occupational therapist can initiate and complete the start of care visit in therapy-only cases. It also again confirms that OT is not a qualifying discipline at the start of care.

What about OTAs?

OTAs are unable to complete the initial visit since they are not licensed as evaluating clinicians and don’t meet the criteria of an eligible clinician as defined by Medicare. However, OTAs can contribute to data collection and inform OASIS scores by communicating observations and information from their visits.

It is up to the clinician responsible for completing the OASIS to incorporate information from the care team. Occupational therapy assistants are a vital and valuable part of the home health team and bring important observations to the table. Capturing the patient’s usual performance is essential for accurate scoring on the OASIS.

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How to Advocate for OT Initiating the OASIS

It is our job to advocate and educate agencies on the new laws that allow OT to initiate and complete the comprehensive SOC in therapy-only cases once the PHE ends. 

Using the resources is important in this case. Not only does it list OT as eligible to initiate and complete the comprehensive assessment in the OAIS-E Guidance Manual, but it also shows it in the Home Health CY 2022 Final Rule as well as the Home Health Conditions of Participation. I have those resources linked for you feel free to copy those and send ‘em on over to your agency.

Having accurate information helps patients receive the care they deserve and also supports the value of occupational therapy in home health long term.

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Here’s the information direct from the source! 

Other Changes When the PHE Ends

When the Public Health Emergency ends on May 11, 2023, there are other temporary flexibilities that will also end. Check out the full list from CMS HERE. For more info specific to OT and the PHE, check out our recent article.

Let me know if you have any questions and if you bring this to your agency!

Recommendations for further reading & listening:

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hi there,

I’m  Clarice

Occupational therapist & medicare specialist helping practitioners understand policy, engage in advocacy, and own their value!

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