COVID-19: Updated Waiver Allows OTs, PTs & SLPs to Open Cases That Include SN

Thoughtware Alert May 13, 2020
Healthcare Event

On May 8, CMS updated its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers to allow physical therapists (PT) and speech-language pathologists (SLP) in addition to occupational therapists (OT) to perform initial and comprehensive assessments for home health patients when both nursing and therapy are ordered. The temporary blanket waiver regarding the initial and comprehensive assessments for home health was initially described in this recent BKD Thoughtware® alert. The original waiver temporarily suspended regulatory requirements for occupational therapy only through 1135 waivers so healthcare facilities can increase their frontline medical staff during the SARS-CoV-2 virus and incidence of COVID-19 public health emergency.

FAQ Update

The specific update to the waiver is stated as follows:

Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients. (Revised since 4/30 Release) CMS is waiving the requirements in 42 CFR § 484.55(a)(2) and § 484.55(b)(3) that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. This temporary blanket modification allows any rehabilitation professional (OT, PT, or SLP) to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. The existing regulations at §484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing-only cases. We would continue to expect HHAs to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. Expanding the category of therapists who may perform initial and comprehensive assessments provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services.”

Operational Items to Note

  • The §484.55(a) initial assessment and §484.55(b) comprehensive assessment can be separate assessments (and visits) completed by different individuals. Further, the regulations don’t prohibit them from being completed by two different disciplines.
  • The OASIS Guidance Manual reminds us that collaboration is sometimes necessary for the completion of the Drug Regimen Review as well as for other data accuracy.
  • COVID-19 blanket waivers also extended the five-day completion requirement for the comprehensive assessment and OASIS submission requirement to 30 days.
  • Therefore, once a skilled nurse has evaluated the patient, collaboration can happen on those OASIS items in which a therapist may have concern for data accuracy.
  • The intent of the waiver could be met in these circumstances for earlier initiation of care when skilled nursing (SN) is unavailable, and data accuracy could still be safeguarded.

As with most topics related to COVID-19, changes are being made rapidly. Please note that this information is current as of the date of publication. For more information, contact your BKD Trusted Advisor™ or use the Contact Us form below.

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