‘Common-Sense Bills’ Seek to Dismantle Home Health Therapy Barriers

A bipartisan group of U.S. lawmakers is trying to make the delivery of home health therapy services more flexible by broadening Medicare rules on who can open cases.

Specifically, two identical bills that would allow occupational therapists to open home health therapy cases were introduced in both the U.S. Senate and House of Representatives earlier in June.

U.S. Reps. Lloyd Doggett (D-Tx.), Jason Smith (R-Mo.), Paul Tonko (D-Ny.) and David McKinley (R-W.Va.) introduced H.R. 3127 in the House of Representatives. Sens. Ben Cardin (D-Md.) and Todd Young (R-Ind.) simultaneously introduced S.1725 in the Senate.


Known as the Medicare Home Health Flexibility Act, the bills would not alter Medicare’s criteria for establishing eligibility for the home health benefit and would only apply to rehab cases.

“Unnecessary barriers to home therapy services increase costs and leave seniors at risk,” Rep. Doggett said in a statement. “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.”

Under current Medicare rules, occupational therapy alone cannot establish eligibility for home health services — which isn’t the case for nursing, physical therapy and speech-language pathology. Occupational therapy does, however, qualify an individual for home health services on a “continuing needs basis.”


Occupational therapy practitioners are not allowed to open home health cases, despite the fact that they are qualified to perform assessments based on their experience and training.

“What we are trying to do is … correct negative things that are happening in the system right now,” Christina Metzler, chief public affairs officer for the American Occupational Therapy Association (AOTA), told Home Health Care News. “[Right now], people may not [be getting occupational therapy] as soon as they would benefit from it. What we are really trying to do is give more flexibility to home health agencies, so that they can make better choices among their staff and contractors about who is the best and most available person to see a home health client.”

Bethesda, Maryland-based AOTA is a national organization that advocates on behalf of the more than 213,000 occupational therapists, assistants and students in the U.S.

In general, the introduction of S.1725 and H.R.3127 is another example of lawmakers’ attempts to reduce service delays and make it easier for older adults to gain access to home health care.

In April, for example, lawmakers introduced the Home Health Care Planning Improvement Act of 2019 (H.R. 2150). The legislation aims to broaden the scope of who is allowed to certify the need for home health services under Medicare rules by eliminating its physician-certification policy — which many home health industry insiders have critiqued as outdated.

Similar to H.R. 2150, supporters of S.1725 and H.R.3127 call for the modernization of Medicare procedures in regards to home health.

“It’s important to modernize Medicare procedures in home health in order to assure that agencies can use their staff and their contractors most effectively, and to assure that beneficiaries get the best and most correct services in a timely fashion,” Metzler said.

Additionally, the recently introduced bills are in-line with the Patient-Driven Groupings Model (PDGM), according to Metzler.

“PDGM is trying to make the system more effective and efficient, and that is the same purpose of these bills,” she said. “I think it will be useful for agencies to be able to use occupational therapy when people need it, to achieve the long-term outcomes that the Medicare home health benefit wants to achieve.”

“We are talking about ‘patient-driven,’ so what the patient needs should not be restricted by arbitrary limitations on which service can go in and what order they can go in to meet the patient’s needs,” Metzler added.

If some version of the Medicare Home Health Flexibility Act is enacted, home health providers in rural areas would likely benefit most.

“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,” Rep. Smith said.

In other legislative news, the House also voted 371-46 Tuesday to pass H.R. 3253 — which permanently extends spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting.

Companies featured in this article: