Entry By: Eileen Bach, PT, M.Ed, DPT
If you are working in the home health care setting, you have probably already heard the buzz about the new PPS changes for 2011. The revised rules cover many areas such as case-mix, payments for outlier and LUPA cases, wage index and more and offered therapy clarifications.
Therapy clarifications included covered therapy, use of qualified therapist for assessment, goal determination and measuring progress towards goals and re-assessment time points for therapy. The use of specific, measurable and objective data in documentation is stated which is in keeping with professional standards and best practices of care. Therapy services to a home health care patient are not only recognized for the functional improvement they bring but also carry added reimbursement under PPS based on visit numbers. I think the 2011 rules are an opportunity for all therapists to show the importance of the interventions we bring into the lives of our home care patients and reflect our treatments in the medical record using evidence based care and professional standards.
I have worked in home health care for more than 2 decades and have certainly seen a lot of changes! So if you are a veteran HC therapist or just thinking about working in home health care, share your thoughts, questions and comments!
Thanks,
Eileen Bach
I attended your course in Burbank, CA on 2/24/11. You mentioned during this course that PTs must make a visit every 6 visits when a PTA is involved in the case. Can you give me a reference to this? I read through the Therapy Clarifications of 11/17/10 and did not find any mention of this 6th visit.
Hi, Elvirita, I hope I have not added any confusion to all this new 2011 information! The 30th day re-assessment is a new PPS 2011 expectation and how that will interact with state licensing law about PT:PTA and OT:COTA in home care is not perfectly clear. I know I use my state regs for PT in the discussion of this point – NY regs are plan of care when an assistant is involved is supervised by the PT every 6 visits or 30 days.
The 30 day re-assessment information is in section 409.44 (c) (2) (i)
“For those patients requiring 13 or 19 therapy visits, the patient will be functionally re-assessed by a qualified therapists minimally, on the 13th and the 19th therapy visit and at least every 30 days.”
So I understand that to mean that at least every 30 days a qualified therapist (not an assistant) must provide the needed therapy service and functionally reassess the patient at 30 days of therapy, even if the visit totals are not approaching 13 or 19. The re-assessment would include progress towards therapy goals as well as the assistant cannot document that.
One point that CMS has been asked to clarify is what happens when a state regulation for assistants has a number of visits such as 4 or 6 or 8 and a time period such as 30 days. NY has a statue such as that for PT where the patient receiving care with a PT:PTA in home care must have the plan of care re-assessed by the PT every 6 visits or 30 days whichever comes first. Using that state statue in a case where the PT plan is 2 times per week, the PT would need to re-assess on the 6th visit (3rd week) and with the new CMS regulation, re-assess again the next week by the 3oth day.
I have not seen any CMS clarifciations or Q & A regarding the April 1st, 2011 therapy regulations. I remain hopeful that the home health care industry will see additional information from CMS very soon.
Best wishes,
Eileen
Hi, Lisa. I am happy to see you are interested in adding adult based home care to your skill set. Many home care agencies provide rehab therapy utilizing therapist and assistant teams.
I do not have a specific name for you so I am pasting below the contact information for the Arizona Home Care assn. I am sure they can provide you with home care agencies in the Phoenix area so you can contact them to see if they have openings. The website also has a job board where you can post your resume.
Best wishes!
Eileen
Arizona Association for Home Care
Marie Fredette, CAE
Executive Director
Arizona Association for Home Care
3933 S. McClintock Drive, Suite 505
Tempe, AZ 85282
Phone: (480) 491-0540
Fax: (480) 603-4141
Email: info@azhomecare.org
Web: http://www.azhomecare.org
Hi. I am a Cota here in Phoenix,Az. I currently work in home health with kids,I would like to also work in home health with adults. Do you know of any companies that might utilize Cota’s in home health with adults in the Phoenix,Az area? Thanks, Lisa Allred
Hi Lisa,
You reached out to me regarding a home health position with adults, but, after several efforts, I have been unable to get in contact with you. Please call me at (480) 302-1623 and/or e-mail me at attrs42@yahoo.com with your contact information so we can discuss a position with my company. Thank you and I hope to hear from you soon!
Sincerely,
Kenya M. Lumpkin, PT, MHSPT
Owner of A Therapeutic Touch Rehab Services, P.L.L.C.
(480) 302-1623
attrs42@yahoo.com