HHA Final Rule Raises Therapy Assessment Concerns

The Centers for Medicare & Medicaid Services (CMS) posted a notice on the Home Health website that the provisions of the PPS Update regulation are effective for episodes ending on or after January 1, 2013, unless otherwise specified in the final rule. However, for episodes that begin in CY 2012 and end in CY 2013, the therapy provisions of this final rule do not apply. The therapy provisions of this final rule are applicable to episodes that begin on or after January 1, 2013.

This notification by CMS came after concerns were expressed by the National Association for Home Care & Hospices (NAHC), and others, that home health agencies would not have sufficient time to educate therapy and billing staff and make software changes needed to comply with a January 1st episode ending timeline for therapy assessment requirements. CMS did consider delaying enforcement of therapy regulatory changes until April 1 st 2013, but decided instead to make the regulatory changes effective with episodes beginning on January 1, 2013.

CMS made three changes to the therapy reassessment regulation which they touted as actions taken to reduce burden on home health agencies. However, only one of the regulatory changes provides actual relief. Effective with episodes beginning on or after January 1, 2013, non-coverage of therapy visits in multiple therapy cases will be limited to the discipline that failed to comply with therapy assessment requirements in multiple therapy cases, rather than to all therapy services received by a patient.

Within this same regulation, CMS revised its therapy non-coverage policy to allow for coverage of the visit upon which a late therapy assessment is completed. However, coverage of a late assessment visit is being allowed in place of the current policy allowing coverage of the visit on which required assessment (13, 19, or 30) was missed. In short, if you missed the reassessment visit it will no longer be covered, but the day the reassessment is performed the visit will be covered. This change will have serious implications for counting covered therapy visits in multiple therapy cases.

42 CFR 409.22(2)(E) was amended to read:

As specified in paragraphs (c)(2)(i)(A), (B), (C), and (D) of this section, therapy visits for the therapy discipline(s) not in compliance with these policies will not be covered until the following conditions are met: (1) The qualified therapist has completed the reassessment and objective measurement of the effectiveness of the therapy as it relates to the therapy goals. As long as paragraphs (c)(2)(i) (E)(2) and (c)(2)(i) (E)(3) of this section are met, therapy coverage resumes with the completed reassessment therapy visit.

Another change made to the multiple therapy assessment regulation will present visit counting problems for agencies. Rather than allowing therapists to assess patients close, but prior to, visits 13 and 19 in multiple therapy cases, CMS changed the timelines at 42CFR 409.22(2)(C)(2) and (D)(2) to require multiple therapy assessments to be completed after the 10th but no later to the 13th and after the 16th but no later than the 19th therapy visit. Exceptions will be allowed in cases when a therapy discipline is not ordered during these visit windows. In these cases the therapy discipline will be required to conduct an assessment on the visit closest, but prior, to the 14th and 20th visits.

42 CFR 409.22(2)(C) and (D) were changed to read:

(C) (2) Where more than one discipline of therapy is being provided, the qualified therapist from each discipline must provide all of the therapy services and functionally reassess the patient in accordance with paragraph (c)(2)(i)(A) of this section during the visit associated with that discipline which is scheduled to occur after the 10th therapy visit but no later than the 13th therapy visit per the plan of care.

(D) (2) Where more than one discipline of therapy is being provided, the qualified therapist from each discipline must provide all of the therapy services and functionally reassess the patient in accordance with paragraph (c)(2)(i)(A) of this section during the visit associated with that discipline which is scheduled to occur after the 16th therapy visit but no later than the 19th therapy visit per the plan of care.

CMS promised to post new Questions & Answers on its website in mid-December. NAHC will continue to pursue therapy assessment policies and regulatory changes that will be less burdensome to home health agencies, while ensuring delivery of medically appropriate therapy services.

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