U.S. Reps. Lloyd Doggett (D-TX), Jason Smith (R-MO), Paul Tonko (D-NY), and David McKinley (R-WV) introduced the Medicare Home Heath Flexibility Act (H.R.3127) in the House of Representatives, while Senators Ben Cardin (D-MD) and Todd Young (R-IN) simultaneously introduced identical legislation in the Senate (S.1725). These bills would allow occupational therapists to open home health therapy cases under Medicare. Each of the Congressional champions serves on Congressional committees that will determine whether the legislation will be adopted as part of larger legislative packages that will be considered this Congress.  

“Seniors should not be kept from their home health providers,” said Rep. Doggett, Chairman of the Ways and Means Committee Health Subcommittee which has jurisdiction over H.R. 3127. “Unnecessary barriers to home therapy services increase costs and leave seniors at risk. This bill will work to prevent these delays with a straightforward, no-cost solution that would allow occupational therapists to conduct the initial home health assessment and open therapy-only home health cases. We need to make care accessible for those who need it.”  

Rep. Smith noted that “the Medicare Home Health Flexibility Act is a common-sense solution that is especially critical in rural and less-populated areas where home health therapists can drive 100 miles or more per day when visiting home health patients.” He added, “This bill should simplify scheduling issues for home health providers by increasing the number of therapists who can initiate Medicare home health therapy services.”  

“It’s common sense that the earlier seniors can start needed therapies, the sooner treatments can start having a positive effect,” said Sen. Cardin, a member of the Senate Finance Health Care Subcommittee. “Home health services are a critical part of our health care system, and I am proud to partner with Senator Young on this legislation that will help to streamline the process for initiating Medicare home health therapy services for Maryland seniors and others nationwide who need home care while recovering from injury or illness." 

“Ensuring the health of our seniors begins with timely care,” said Sen. Young. “I’m encouraged that the Medicare Home Health Flexibility Act will help the way we approach healthcare home services for patients in rural areas. Our bipartisan legislation would use Medicare to ensure our seniors are quickly and comprehensively assessed in their homes in order to receive proper treatment.”

“Passing this bill will help reduce home health service delays in areas where access to physical therapy or speech-language pathology clinicians is limited,” said Rep. Tonko. “Delayed services often result in increased costs to Medicare, and this bill would help to address that problem by allowing occupational therapists to get involved sooner.”

Rep. McKinley noted that “this bill will simplify the scheduling process for home health providers and help to increase access for patients in rural areas like West Virginia. We need to make home care accessible and prevent needless barriers to home health therapy services for patients on Medicare.”

Occupational therapy has long been a valued component of home health care due to therapists’ expertise in identifying home safety issues and in establishing routines to maximize a client’s ability to follow his or her plan of care. This legislation recognizes those contributions and seeks to address the arbitrary restrictions currently in place. 

Amy J. Lamb, OTD, OT/L, FAOTA, President of the American Occupational Therapy Association (AOTA), called the bill a “win-win” for beneficiaries, the health care system, and policy makers because it increases access to services for Medicare beneficiaries, increases efficiency, and is a valuable investment of financial resources to support independent living without increasing costs.

“As baby boomers continue to age, more people have a desire to age in place,” said Lamb. “Simultaneously, the evolving health care system emphasizes increasing quality and efficiency, and decreasing costs. As a result, more patients are receiving care in their natural environment or their home, where occupational therapy has a pivotal role in facilitating participation and engagement in their everyday life, and enhancing quality of life while aging in place.”

Currently, occupational therapy alone cannot establish eligibility for home health services under Medicare, unlike nursing, physical therapy, and speech-language pathology. Occupational therapy does, however, qualify an individual for home health services on a “continuing need basis,” so a person can continue to receive occupational therapy even after they have been discharged from all other services.  

The Centers for Medicare & Medicaid Services (CMS) regulations, do not allow occupational therapy practitioners to open home health cases (i.e., perform the initial and comprehensive assessments at the start of care), even when occupational therapy is ordered alongside physical therapy or speech-language pathology. This regulation is burdensome as occupational therapists are qualified to perform the initial and comprehensive assessments based on their unique training and perspective, which focuses on functional capabilities.

The Medicare Home Health Flexibility Act would not alter Medicare’s criteria for establishing eligibility for the home health benefit, and it would only apply to rehabilitation cases. The Act enjoys bipartisan support and was previously determined by the Congressional Budget Office to have no impact on the federal budget. It is also supported by organizations representing physical therapists, speech-language pathologists, and home health providers.

Nationwide, more than 213,000 occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Legislation supporting access to occupational therapy and rehabilitation services can reduce overall health care costs by facilitating independence among patients.