Adtninistrative and Professional Issues for the Occupational Therapist in Hotne Health Care ( home care services , occupational therapy services , organization and administration , reimbursement mechanisms )

Administrative and proJessional issues Jor the occupational therapist working in home health care include contractual relationships, reJerral systems, third-party reimbursement, documentation, equipment, and ethics. In this paper, the regulations Jor third-party reimbursement by Medicare, Medicaid, and Blue Cross Jor occupational therapy in home health care are explained, including the Medicare deJinition oj homebound status and the requirement that treatment be restorative. The effect oj such regulations on occupational therapy treatment planning and documentation oj services is discussed. Coverage ojJrequently ordered equipment by M edicare and M edlcaid is explained. Both the issues related to standards oj practice, including the length and Jrequency oj occupational therapy treatment sessions, and the expected duration oj treatment are discussed. The effect on the proJessional relationship oj treating patients in their own environments is examined. Changes in third-party reimbursement Jor mpatient care have pn'sented 0(,cujJational therapists with the challenge oj worhing with acutely ill patients in their homes. Since the enactment of the Medicare legislation in 1965, all types of health services for the homebound have been expanded. The occupational therapist plays an essential role in helping home care patients attain their maximal levels of independence. As more occupational therapists are employed in home health, administrative and professional issues unique to this area of practice have emerged. Some of these issues are discussed in this paper. The care of most of the patients receiving occupational therapy at home is coordinated by home health agencies. A home health agency (HHA) has been defined by Medicare as a public agency or private organization primarily engaged in providing skilled nursing and other therapeutic services such as physical, occupational or speech therapy, home health aide services, and medical social services. To qualify as an HHA, a public or voluntary nonprofit health agency must furnish skilled nursing and at least one other therapeutic service directly to its patients. The HHA may make arrangements with another public or voluntary nonprofit agency to furnish the services that it does not provide directly. Some additional regulations apply to private organizations (1). Although the Medicaid law does not define "home health agency," Medicaid regulations define it as a public or private agency or organization, or its subdivision, that satisfies Medicare's conditions of participation of HHAs (2).