Here's an excerpt from Medicare's HH Manual:
=======================================================================
30 - Conditions Patient Must Meet to Qualify for Coverage of Home Health
Services
30.4 - Needs Skilled Nursing Care on an Intermittent Basis (Other than
Solely Venipuncture for the Purposes of Obtaining a Blood Sample),
Physical Therapy, Speech-Language Pathology Services, or Has Continued
Need for Occupational Therapy (Rev. 1, 10-01-03) A3-3117.4, HHA-204.4
The patient must need one of the following types of services:
1. Skilled nursing care that is:
• Reasonable and necessary as . defined in §40.1;
• Needed on an "intermittent" based as defined in §40.1;
and
• Not solely needed for venipuncture for the purposes of
obtaining blood sample as defined in §40.1.2.13;or
2. Physical therapy as defined in §40.2.2; or
3. Speech-language pathology services as defined in §40.2.3; or
4. Have a continuing need for occupational therapy as defined in
§§40.2.4.
The patient has a continued need for occupational therapy when:
1. The services which the patient requires meet the definition
of "occupational therapy" services of §40.2, and
2. The patient's eligibility for home health services has been
established by virtue of a prior need for skilled nursing care
(other) than solely venipuncture for the purposes of obtaining a
blood sample), speech-language pathology services, or physical
therapy in the current or prior certification period.
EXAMPLE: A patient who is recovering from a cerebrovascular accident
(CVA) has an initial plan of care that called for physical therapy,
speech-language pathology services, and home health aide services. In
the next certification period, the physician orders only occupational
therapy and home health aide services because the patient no longer
needs the skills of a physical therapist or a speech-language
pathologist, but needs the services provided by the occupational
therapist. The patient's need for occupational therapy qualifies him for
home health services, including home health aide services (presuming
that all other qualifying criteria are met).
======================================================================
The HH manual is a behemeth; lots of rules and regs. What I quoted is
only a small excerpt of the manual. In my quick review of the HH manual,
I did not see any sepfice requirement for a PT/RN visit before/after an
OT eval. I would ask the supervisor to show me in writing.
Here's a link to the on-line HH manual: http://tinyurl.com/yw2fhu
You will find HH in chapter 7; Be forewarned, the Chapter is almost 100
pages long. <smile>
On a completely unrelated topic, why do you state "with OT-only deficits
such as visual-field cut, hand or shoulder injury, that has no nursing
or PT needs." Why is a hand/shoulder injury and OT only deficit?
Thanks,
Ron
----- Original Message -----
From: Sue Hossack <[EMAIL PROTECTED]>
Sent: Saturday, October 06, 2007
To: [email protected] <[email protected]>
Subj: [OTlist] OT as stand-alone therapy in home health
SH> Hi all,
SH> I have a question that I am hoping someone on the list can answer.
SH> According to AOTA, although OT cannot open a Medicare home-health
SH> patient, we can be a stand-alone therapy once the Start-of-care has been
SH> performed by the PT/SLP/RN. This makes sense for a patient with OT-only
SH> deficits such as visual-field cut, hand or shoulder injury, that has no
SH> nursing or PT needs. However, my supervisor has told me that we have to
SH> have at least 2 skilled PT or ST visits - one before the OT visit during
SH> which the initial assessment also is conducted and one after the initial
SH> OT visit. Continuing OT may then be provided as needed and ordered.
SH> I.e the PT must provide a skilled visit even though the patient has no
SH> PT needs.
SH> Does anyone have any experience of this or any documentation that says
SH> otherwise?
SH> Thanks
SH> Sue
SH> --
SH> Sue Hossack MOT, OTR/L, ATP
SH> Occupational Therapist
SH> http://www.ot-care.com
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