CMS seeks public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. They are asking the public for data,…
CMS seeks public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. They are asking the public for data, detailed analysis, academic studies, or any other information to support their comments that provide a direct link to patient health and safety. Specifically, soliciting comments regarding the following:
- What types of mentorships, preceptorship, or training do these disciplines have qualifying them to conduct the initial assessment and comprehensive assessment?
- How do HHAs currently assign staff to conduct the initial assessment and comprehensive assessment? Do HHAs implement specific skill and competency requirements?
At the beginning of the COVID-19 Public Health Emergency, CMS waived the requirements at § 484.55(a)(2) and (b)(3) permitting rehabilitation professionals to perform the initial and comprehensive assessment in instances when both nursing and therapy services are ordered. This temporary blanket waiver reflected the unique circumstances of the PHE, with its acute pressures on the nursing workforce, and allowed rehabilitation professionals to perform the initial and comprehensive assessment for patients receiving therapy services as part of the broader nursing and therapy care plan, to the extent permitted under State law, regardless of whether the therapy service established patient eligibility to receive home care. Subsequently, section 115 of the Consolidated Appropriations Act (CAA) of 2021, permitted OTs to conduct the initial and comprehensive assessments only when OT is on the home health plan of care with either PT or speech therapy, and skilled nursing services are not initially on the plan of care. CMS proposed changes to § 484.55(a)(3) and (b)(2) in the CY 2022 Home Health PPS proposed rule and finalized the changes in the CY 2022 Home Health PPS final rule.
Some groups continue to advocate for CMS to permanently allow therapists to perform the initial and comprehensive assessment in the home health setting when both therapy and nursing services are ordered. CMS received limited feedback during the CY 2022 Home Health PPS proposed rule from several commenters supporting a change of this type, and they are now interested in obtaining additional feedback on this specific potential change.
CMS is seeking feedback on the following questions:
- Do the education requirements for entry-level rehabilitative therapists provide them with the skills to perform both the initial assessment and comprehensive assessment? Is this consistent across all the therapy disciplines? How does this compare with entry-level education for nursing staff?
- What, if any, potential education or skills gaps may exist for rehabilitative therapists in conducting the initial assessment and comprehensive assessment?
- What challenges did HHAs and therapists who conducted these assessments under the PHE waiver experience that may have impacted the quality of these assessments?
- For the HHAs and therapists that conducted the initial assessment and comprehensive assessment under the PHE waiver, what were the benefits, and were there any unintended consequences of this on patient health and safety?
- What challenges, barriers, or other factors, such as workforce shortages, particularly in rural areas, impact rehabilitative therapists and nurses in meeting the needs of patients at the start of care and early in the plan of care?
Link to the proposed rule here 2024-14254.pdf (federalregister.gov)
