New Requirements for Home Health Therapy Visits.

Medicare now requires episodes, where therapy is required, to have therapy assessments performed by qualified therapists at certain time points.  Medicare has issued changes to the Home Health guide, Publication 100-02, Chapter 7, and Home Health agencies must comply with the changes to the requirements as of April 1, 2011.  CMS has supplied a Fact Sheet on their website.

Assessments must include objective measureable treatment goals with a succession of comparable measurements to show progress toward the goal or the effectiveness of the therapy.  Assessments must measure and document the progress toward the goal at least once every 30 days during the course of treatment.

Patients needing 13 or 19 therapy visits will require the qualified therapist to perform a visit and assessment to measure and document the effectiveness of the therapy.  If progress toward the plan of care goal cannot be measured or documentation does not support the expectation of reasonable progress, CMS can discontinue coverage of therapy visits and reduce the episode payment.

Each therapy discipline required for the patient must be assessed by the 13th and 19th visits; for example, if Physical therapy and Occupational therapy were necessary by the 13th therapy visit, then both the Physical therapy and Occupational therapy assessments would need to completed.

Exceptions are provided for patients in rural areas or when documented circumstances, outside the control of the therapist, which would prevent the qualified therapist to visit on exactly the 13th visit.  In these circumstances, the therapist(s) could visit after the 10th but before the 13th visit.  Similarly, exceptions for the same would allow the visit and assessment before the 19th visit to happen between the 16th and 19th visit.