The current Therapy Reassessment Timeframes in home health have been fairly problematic at best, and CMS has proposed some significant changes to those timeframes under the premise of simplification.  There is a reasonable basis for their proposal, and we would welcome any regulations that actually do simplify our work flow without creating additional unbillable services, but I have some concerns about how this provision is proposed.  See the following:

If it is a multi-discipline (therapy) episode, yet only one discipline (let’s say PT) is scheduled to provide services between days 10 through 25, this requirement is going to require non-chargeable visits for the other therapies involved in this case, and theoretically, this could happen four-times during this episode.

I can understand the premise and it seems to have some merit, but I think that the initial frequency of every 14-days is probably too high and that maybe it should be at every 21 days.

In the Proposed Rule you state the following “Therefore, we propose to simplify § 409.44(c)(2) to require a qualified therapist (instead of an assistant) from each discipline to provide the needed therapy service and functionally reassess the patient in accordance with §409.44(c)(2)(i)(A) at least every 14 calendar days.”

  • Is this really a simplification?
  • Seems to me that this has all the ambiguity to become every bit as problematic as the F2F provision has become!


What if therapy was done (completed) on day 10?

  • Is there still a need for an assessment on day 14?
  •   … day 28? … day 42? … day 56?
    • These would all be non-chargeable visits! That is, costs that you are forcing on the industry that you have no intention of compensating the industry for! 
    • I believe that is in conflict with the original Medicare Charter.

What if therapy was done on day 20?

  • Is there still a need for an assessment on day 28?
  • … day 42? … day 56? 
  • Etc…


What if you only do two or three therapy visits in the first week of the episode and are then done?

  • Are assessment visits still necessary for the remainder of the episode even though there is no intention of providing therapy visits? 
  • How is that reasonable and/or a simplification?


What if you’re going to do a fair amount of therapy visits, but because of a wound or some other issue, you don’t begin therapy visits until day 20?

  • … day 30?
  • How does that impact the assessment schedule?
  • Would this require more non-chargeable visits on days 14 & 28?

What about the above with multi-therapy cases?

  • Especially if staggered staring dates for the different therapies exists!
    •  So how practical is it having all three therapies doing reassessments on day 14; 28; 42; 56?
    • Don’t you not think that this will create a lot of non-chargeable visits?
    • Is this really going to be easier and less problematic in the real-world application than what we are currently doing?


You want to have assessment visits to justify high-therapy use episodes, and to a degree that is reasonable, but every 14 days is just way too often and if this provision is implemented, the time-frame should be no more frequent than every 21 days. But even at every 21 days, the above issues/questions are still applicable, just at different time intervals and need to be addressed.

And there is another concern that we have with the semantics used in part of this provision, and that is from the following:

“… to require a qualified therapist instead of an assistant from each discipline to provide the needed therapy service and functionally reassess the patient …”

This could be interpreted 2 different ways:

• The more reasonable way would be to read it as indicating that a Qualified Therapist must perform the assessment visits (whenever they are), but that a Therapy Assistant could perform any other visit during the episode for which he/she has the qualifications to perform. Meaning that PTAs and COTAs are eligible to perform most all other non-assessment visits.

• The more draconian interpretation could be taken to mean that Therapy Assistants were no-longer eligible to perform visits in the home health setting; and we’d just like to get a clean, clear explanation of this before some over-zealous reviewer/auditor starts miss-applying this proposed change. Maybe we are a little defensive here, but after the issues that we have been dealing with with F2F, I think you might be able to see our concerns.

We respectfully request that you clarify, with no uncertainty, how this is to be interpreted.