For the last 30 years, occupational therapy practitioners and the American Occupational Therapy Association (AOTA) have put in hours of work to add occupational therapists to the list of eligible practitioners to initiate and complete the Outcome and Assessment Information Set (OASIS) Start of Care (SOC). On December 21, 2020, the Medicare Home Health Flexibility Act (H.R.3127/ S.1725) passed the House and Senate as part of the Omnibus and COVID Relief legislation.
This legislation also included language to decrease the therapy cuts approved by CMS earlier this month. Read more about the therapy cuts in our article “The 9% Medicare Therapy Cut and What You Need to Know“
The Medicare Home Health Flexibility Act
Earlier this year, the Medicare Home Health Flexibility Act (H.R.3127/ S.1725) was introduced in the House and Senate. Bill sponsors included Reps. Lloyd Doggett (D-TX), Jason Smith (R-MO), Paul Tonko (D-NY), and David McKinley (R-WV) in the House and Senators Ben Carding (D-MD) and Todd Young (R-IN) in the Senate.
This legislation allows OTs to complete and initiate the OASIS Start of Care in therapy-only cases once the PHE expires. Thus, placing us on equal footing with our PTs and SLPs. This is a big win for OTs in home health. The ability to initiate and complete the OASIS Start of Care will help our patients gain access to therapy services sooner. It also provides an exceptional opportunity for OTs to demonstrated why they are one of the most qualified practitioners to complete the OASIS.
What is next?
First, President Trump has to sign this legislation into law. Because this bill is part of a larger package, the debates over stimulus checks have held up final approval. (Update: President Trump signed this legislation into law on 12/27/20)
Second, once signed into law, the Centers for Medicare & Medicaid (CMS) have one year to enact this change. AOTA’s Regulatory Team will work with CMS throughout the rule-making process to ensure the language appropriately approves OTs to complete the OASIS Start of Care. AOTA is hopeful CMS will move quickly, so there is little to no gap between the final rule and the end of the PHE.
Third, occupational therapists must advocate for their ability to complete the home health OASIS Start of Care. Arguably, occupational therapists are among the most qualified practitioners to initiate and complete the SOC assessment because of their holistic approach to care. OTs are experts in task analysis, including function, cognition, and fall safety. AOTA has many resources available to occupational therapy practitioners to help prepare for completing the OASIS listed at the end of this article.
I thought occupational therapists could already initiate the OASIS
Under the Public Health Emergency (PHE), the Centers for Medicare and Medicaid (CMS) approved occupational therapists to initiate and complete the home health OASIS SOC in all situations. However, this is only temporary as long as the PHE is in effect.
Therefore, a permanent solution was needed. The Medicare Home Health Flexibility Act is the solution to this problem. However, the Medicare Home Health Flexibility Act only allows OT to initiate the OASIS in therapy-only cases. The nurse must initiate the OASIS if ordered as part of the case.
This legislation does not make occupational therapy a qualifying service, so the prescribing clinician must still order PT, SLP, or nursing for Medicare patients. This change was not pursued as part of this legislation due to the associated cost of expanding services. Thus, making legislation more difficult to pass.
AOTA’s Federal Affairs Team has been working on this bill for several years. Although many important issues are facing the profession, this bill was just one of many successes over the past year. Additionally, with the changes enacted by home health agencies over the past year due to PDGM, many occupational therapy practitioners have experienced a decrease in caseload and utilization.
The ability to initiate and complete the OASIS provides opportunities for OTs to increase their caseload. It also decreases the risk of other professions initiating the OASIS and deciding that OT is not needed. Occupational therapists will now be on even footing with physical therapists and speech and language pathologists. This is a crucial step in encouraging increased occupational therapy utilization in home health and allows occupational therapy to demonstrate our unique value in this setting.
Additionally, many agencies have been hesitant to fully utilize the PHE waiver due to the uncertainty of if this change would be permanent. Hopefully, with the passage of this legislation, agencies will see the value in investing in their practitioners by training them on the OASIS Start of Care.
My agency isn’t listening to me when I say OTs can initiate the OASIS Start of Care
Remember, change does not happen overnight or after only one conversation. You may have to talk to several people several times. Be prepared with evidence that supports your argument. It can be beneficial to think of your employer/supervisor as you would a patient. Consider what their goals are when formulating your solutions. AOTA has several resources on their PDGM page for practitioners to use to demonstrate their value.
I don’t want to do the OASIS/ I don’t think I’m qualified to complete the OASIS
Although the OASIS involves extra time and effort, it is worth protecting the longevity of occupational therapy in home health care. We know we add value, so speak up and speak often. We need others to know we add value too.
Physical therapists and SLPs already initiate and complete the OASIS SOC, so why can’t OTs? OTs are experts in task analysis and function and have similar training compared to PTs and SLPs regarding wounds and medications. Additionally, CMS has multiple resources that make it very easy to score the OASIS, such as their OASIS-D Guidance.
Additionally, if the patient’s wounds or medications are so complex that the OT cannot address them during the assessment, they should request orders for nursing to address and assess this area. If a nurse is ordered when not under the PHE, the nurse must initiate the OASIS.
In conclusion, this is a big win for home health occupational therapy. OTs have an exciting opportunity to be innovative in our practice and demonstrate our value in a meaningful and objective way. To see what we expect might be coming up in the next Congressional session, check out our article on the latest advocacy initiatives for OT.
- Passage of Home Health Flexibility Act Enables OTs to Open Medicare Home Health Cases
- Opening Cases with CMS Waiver
- Home Health Flexibility Act
- Occupational Therapy’s Role in Home Health
- PDGM Page
- PDGM Resource List PDF
- Home Health Eval Checklist
- Demonstrating the Value of Therapy – CMS, AOTA, APTA
- OASIS User Manuals from CMS
- OASIS-D Guidance Manual (1.1.19)
- OASIS – D1 Updates from CMS
- CMS PDGM Overview
- The Role of Therapy Under PDGM
- CMS PDGM Guideline
- What OTs Need to Know About Starting Medicare Home Health Cases, Part I – AOTA FREE!!
- What OTs Need to Know About Starting Medicare Home Health Cases, Part II – AOTA FREE!!
- Medicare Part A: Law and Policy Update – AOTA
- Promoting Medication Adherence: An Occupational Therapy Approach to Evaluation and Intervention
- PDGM Specialty Conference Recordings – AOTA
- Medication-Related OASIS Items & Drug Regimen Review
- SPCC: Home Health Care: A Guide for Occupational Therapy Practice
- Home Health – Textbook
- Health Literacy: Effective Client Communication and Education
- Home & Community Health Poster Bundle 1