[Congressional Record Volume 163, Number 72 (Thursday, April 27, 2017)]
[Senate]
[Pages S2619-S2620]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN (for himself and Mr. Heller):
  S. 977. A bill to permit occupational therapists to conduct the 
initial assessment visit and complete the comprehensive assessment 
under a Medicare home health plan of care for certain rehabilitation 
cases; to the Committee on Finance.
  Mr. CARDIN. Mr. President, I wish to introduce the Medicare Home 
Health Flexibility Act of 2017. I am pleased that my colleague, the 
senior Senator from Nevada, Mr. Heller, has agreed to cosponsor this 
bipartisan, no-cost legislation that would allow occupational 
therapists to perform the initial home health assessment visit and 
comprehensive assessments in cases in

[[Page S2620]]

which occupational therapy is ordered by the physician, along with 
speech language pathology and/or physical therapy services, and skilled 
nursing care is not required. Our bill will help ensure that Medicare 
beneficiaries receive timely access to essential home health therapy 
care.
  Occupational therapists have long been recognized as a valuable 
component of our Nation's healthcare workforce and a critical aspect of 
home healthcare because of their focus on patients' functional 
capabilities and their expertise in home safety. Physicians frequently 
order occupational therapy as part of an initial plan of care for 
patients requiring home health care, alongside the qualifying services 
of physical therapy, speech-language pathology, and skilled nursing. 
Under certain circumstances, an occupational therapist is allowed to 
perform the comprehensive assessment to determine a Medicare 
beneficiary's continuing need for home healthcare. However, under 
current Medicare law, occupational therapists are not permitted to 
conduct the initial assessment for home health cases, even when 
occupational therapy is included in the physician's order and when the 
case is exclusively related to rehabilitation therapy. Additionally, 
occupational therapists are not allowed to complete the comprehensive 
assessment unless occupational therapy is the qualifying service.
  By permitting occupational therapists to perform initial home health 
assessment visits and comprehensive assessments in limited 
circumstances, the Medicare Home Health Flexibility Act can help 
prevent delays in the time it takes for Medicare beneficiaries to 
receive essential home healthcare, especially in underserved areas 
where access to physical therapists and speech language pathologists 
may be limited. On January 13, 2017, the Centers for Medicare & 
Medicaid Services, or CMS, released the final conditions of 
participation, or COPs, for home health agencies participating in 
Medicare and Medicaid. These new COPs expand the content of the home 
health comprehensive assessment to include the patient's functional, 
psychosocial, and cognitive status, all of which are areas of expertise 
for occupational therapists. The new COPs also require the creation of 
a patient-centered plan of care that is informed by the comprehensive 
assessment. As a result of their comprehensive education and unique 
training, occupational therapists are qualified to perform the 
necessary assessments to adhere to these new CMS home health 
guidelines.
  It is important to note that the Medicare Home Health Flexibility Act 
would apply only to rehabilitation therapy cases in which skilled 
nursing care is not required. Nurses would still be required to conduct 
the initial assessment for all home health cases in which skilled 
nursing care is ordered by the physician. Also, although the 
legislation would allow occupational therapists to conduct the initial 
home health assessment visit and comprehensive assessments, it would 
not alter the existing criteria for establishing eligibility for the 
Medicare home health benefit.
  I urge my colleagues to join me and Senator Heller and to support the 
Medicare Home Health Flexibility Act to correct the discrepancy in 
Medicare regulations between therapy providers and to help ensure 
timely access to essential, high-quality home health therapy care for 
Medicare beneficiaries.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 977

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Home Health 
     Flexibility Act of 2017''.

     SEC. 2. PERMITTING OCCUPATIONAL THERAPISTS TO CONDUCT THE 
                   INITIAL ASSESSMENT VISIT AND COMPLETE THE 
                   COMPREHENSIVE ASSESSMENT UNDER A MEDICARE HOME 
                   HEALTH PLAN OF CARE FOR CERTAIN REHABILITATION 
                   CASES.

       (a) In General.--Notwithstanding section 484.55(a)(2) or 
     484.55(b)(3) of title 42, Code of Federal Regulations, or any 
     other provision of law, an occupational therapist may be 
     designated to conduct the initial assessment visit and to 
     complete the comprehensive assessment for an individual who 
     is eligible for home health services under title XVIII of the 
     Social Security Act if the referral order by the physician--
       (1) does not include skilled nursing care;
       (2) includes occupation therapy; and
       (3) includes physical therapy or speech language pathology.
       (b) Rule of Construction.--Nothing in subsection (a) shall 
     be construed to provide for initial eligibility for coverage 
     of home health services under title XVIII of the Social 
     Security Act solely on the basis of a need for occupational 
     therapy.
                                 ______