WASHINGTON, D.C. (January 6, 2021)—Occupational therapy practitioners are celebrating passage of the large year-end omnibus legislative package because one measure will ease access to therapy for our nation’s most vulnerable populations. The Medicare Home Health Flexibility Act (H.R. 3127/S. 1725) was enacted among multiple health care priorities when signed into law on Dec. 27, 2020, meaning that the Centers for Medicare & Medicaid Services (CMS) now has one year to implement a new rule to enable occupational therapists to perform the initial and comprehensive assessments required to open Medicare home health therapy cases.
Wendy C. Hildenbrand, PhD, MPH, OTR/L, FAOTA, President of the American Occupational Therapy Association (AOTA) expressed her support. “Passage of this bill enables occupational therapists to further enhance their distinct value to Medicare beneficiaries receiving therapy services at home,” she said. “Occupational therapists are well suited to opening home health therapy cases based on their unique training and perspective which focuses on functional capabilities to support health and quality of life.”
Hildenbrand also noted that “the COVID-19 pandemic has demonstrated the increased importance of home health and the role that occupational therapy plays in this setting. We are thrilled that CMS and Congress recognized that unnecessary barriers and restrictions on home health occupational therapy should be permanently eliminated.”
The bill was introduced and championed by Reps. Lloyd Doggett (D-TX), Jason Smith (R-MO), Paul Tonko (D-NY), and David McKinley (R-WV) in the U.S. House of Representatives, while Senators Ben Cardin (D-MD) and Todd Young (R-IN) championed identical legislation in the U.S. Senate (S.1725).
Occupational therapists have been permitted to open Medicare home health cases on a temporary basis since April 2020 when CMS issued an emergency rule to reduce regulatory burdens for home health providers during the COVID-19 pandemic. This rule, however, will expire when the Public Health Emergency ends. The new rule passed last month allowing occupational therapists to open Medicare home health therapy cases will go into effect on a permanent basis no later than Jan. 1, 2022.
Occupational therapy is an essential 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 addresses the arbitrary restrictions currently in place. 
“Seniors should not be kept from their home health providers,” said Rep. Doggett, Chairman of the Ways and Means Health Subcommittee. “Unnecessary barriers to home therapy services increase costs and leave seniors at risk. Enactment of this bill will help to prevent delays by allowing 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 will 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 have partnered with Senator Young to enact 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 passage of the Medicare Home Health Flexibility Act will enhance the way we approach healthcare home services for patients in rural areas. Our bipartisan legislation will help ensure our seniors are quickly and comprehensively assessed in their homes in order to receive proper treatment.”

“Passage of 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 will help to address that problem by allowing occupational therapists to get involved sooner.”
Rep. McKinley noted that “improving access to timely health care for our seniors is essential. By passing this bill, we can ensure more accessibility and prevent needless barriers to home health therapy services for patients in rural areas like West Virginia.”

Until now, current policy dictated that occupational therapy practitioners 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. 
Passage of the Medicare Home Health Flexibility Act does not alter Medicare’s criteria for establishing eligibility for the home health benefit, and it only applies to rehabilitation cases. The bill was endorsed by organizations representing physical therapists, speech-language pathologists, and home health providers.
Nationwide, more than 230,000 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.