Therapy Reassessment Changes Could Impact Home Health Agencies

New Therapy Reassessment Requirements Could be Negative for Home Healthcare Providers 

The therapy reassessments by a qualified therapist at specific milestones in a home health episode are published CY 2011 HH PPS final rule (75 FR 70389).  In this rule, the Centers for Medicare & Medicaid Services (CMS) established new regulations mandating therapy reassessment at specified milestones (e. g. the 13th and 19th therapy visit in an episode and at least every 30 days) to determine continued need for skilled therapy services. Documentation requirements with continued coverage of therapy services being dependent on progress toward measurable goals were also listed in this rule.

The CY 2013 HH PPS proposed rule issued this month highlighted three areas of significance related to the implementation and enforcement of that regulation:

  1. Non-coverage of the therapy visit during which a late reassessment was conducted
  2. Non-coverage of all therapy services in multiple therapy cases even if only one of the therapy disciplines failed to meet assessment timelines
  3. Specific timing requirements for reassessments in multiple therapy episodes.

Proposed Change to Therapy Reassessment Requirements

CMS announced that it was proposing the following changes to regulatory language in response to requests from the public:

  • Amend §409.44. (c)(2)(i)(E) to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the visit during which the therapist completed late reassessment.
  • Amend §409.44(c)(2)(i)(E) to state that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline
  • Amend §409.44(c)(2)(i)(C)(2) and §409.44(c)(2)(i)(D)(2) that currently reads that the therapist’s visit need only be “close to” the 13th and 19th visits, and provide more precise guidance as follows: if the patient is receiving more than one type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

Although CMS’ proposal to extend coverage in multiple therapy cases to those disciplines that complied with reassessment requirements will provide welcome relief to an unfair policy currently in place, the other proposals will be problematic for home health agencies if finalized as written.

Adverse Effects of Proposed Changes

First, regarding CMS’ plan to extend coverage to include the visit on which a late assessment is completed, the National Association for Home Care & Hospice (NAHC) made an inquiry to CMS requesting clarification. In response to its inquiry NAHC was told that, when reassessment(s) are not completed timely, visits 13 and 19 will be non-covered. Should CMS finalize the rule as proposed, this regulatory change would not afford any advantage to home health agencies since it will simply replace one non-covered visit for another. In fact, a shift from coverage of the visit upon which a late assessment is completed to non-coverage of visit 13 and 19 could require costly operational and software programming changes. In addition, in multiple therapy cases it would be inappropriate to assign non-covered status to a therapy discipline providing the 13th  visit if that discipline had completed assessment requirements on an earlier visit.

Of greater concern is the proposal that all therapy reassessments must be completed on visits 11, 12, or 13 and visits 17, 18, or 19 in multiple therapy cases. This proposal will present roadblocks to the delivery of care in accordance with physician orders. For example, it is highly unlikely that patients receiving PT, OT, and SLP will require a scheduled visits by all of the three disciplines on the 11th, 12th, and 13th visit. Therefore, the only recourse for home health agencies will be to obtain changes to the physician ordered visit frequency to avoid non-compliance.

Responses from Home Health Agencies Sought

Home health agencies are urged to access the Federal Register notice to learn more details about the proposed therapy assessment requirements (as well as other provisions), and submit comments to CMS on about these proposals and the impact on their agencies by 5 p.m., on Sept. 4, 2012.