Home Health & Hospice

Confusion over Therapy Requirements Remains

Homecare Insider, June 6, 2011

Many homecare providers remain confused over the new therapy assessment, reassessment, and documentation requirements. The most often asked questions address the time points and re-setting of the clocks for reassessment. For each therapy discipline for which services are provided, a qualified therapist (not an assistant) must perform an initial therapy assessment, reassessment at least every 30 days, and reassessment prior to the 14th and 20th therapy visits. The reassessments must be performed in conjunction with a visit providing the ordered therapy service. The 30 day reasessessment may span episodes of care, re-setting with each therapist’s visit/assessment/measurement/documentation. The reassessment prior to the 14th and 20th therapy visits are required in every home health episode.

Some flexibility is provided in cases where a patient is receiving multiple therapies, in those cases, the reassessment can be performed “close to”, but not after, the 13th and 19th visits. It is important to note that the Centers for Medicare and Medicaid Services (CMS) do not define “close to”. Flexibility also exists when a patient resides in a rural area, or when documented circumstances outside the control of the therapist prevent the visit at exactly the 13th or 19th visit from occurring. In either of these cases, the reassessments may be performed after the 10th therapy visit but no later than the 13th and after the 16th visit but no later than the 19th visit.

CMS issued a change to the Medicare Benefit Policy Manual via Transmittal 144, Change Request 7374, regarding Home Health Therapy Services. Providers should incorporate this change into the manual.