Home Health & Hospice

Home Health Proposed Rule: Therapy Coverage and Reassessments

Homecare Insider, August 20, 2012

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule Friday, July 6, which will make changes to Medicare home health payments for 2013. As part of our continuing coverage, this week we will take a closer look at therapy coverage and reassessments.

A few revisions and clarifications have been proposed regarding therapy coverage:

  • Late assessment coverage. It is proposed that in cases where a qualified therapist misses a reassessment visit, therapy coverage should be allowed to resume with the visit during which the qualified therapist completes the late reassessment. Under current regulation, coverage is not resumed until the visit after the therapist completes the late reassessment.
  • Multiple therapy disciplines. Currently, in situations where multiple therapy disciples are used to treat the same patient, HHAs cannot bill for any therapy if one therapist missed a re-evaluation—until the therapist completed the reevaluation. The proposed rule states that just the “offending” discipline would not be eligible to bill, and coverage would continue for the other disciplines.
  • Assessment timelines. The proposed rule also clarifies when qualified therapists are allowed to complete the required assessments. In situations where the patient is receiving more than one type of therapy, qualified therapists would be allowed to 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.

As a reminder, CMS will accept comments on the proposed rule until September 4.

To read the proposed rule, click here.

The proposed rule will be final this fall and your agency will need to know how the rule will affect your agency. Sign up for Beacon Health’s December webcast, 2013 Home Health PPS Final Rule Analysis, which will analyze this year’s Home Health PPS final rule. When you understand where CMS is headed in 2013, you’ll be well equipped to plan and manage the education and process changes needed to respond. Learn more today!