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As a new Medicare Part A payment model for home health agencies (HHAs) gets set to launch January 1, APTA and two other provider organizations are urging HHAs to keep patient access to needed care front-and-center, and not react to the new system with "unnecessary staffing changes."

In a joint statement by APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA), the organizations state:

"APTA, AOTA, and ASHA are aware of the potential for clinicians and assistants to be negatively impacted by the reactions of some home health agencies when implementing Medicare’s Patient-Driven Groupings Model (PDGM) on January 1, 2020. Unnecessary staffing changes could affect the clinicians’ practice patterns and their ability to exercise clinical judgment, as well as patients’ access to care — ultimately damaging the quality of therapy provided by home health agencies. Our organizations continue ongoing dialogue with CMS and home health agencies to ensure that Medicare beneficiaries continue receiving the skilled therapy they need. APTA, AOTA, and ASHA are committed to advocating on behalf of our professions and the people they treat."

The statement summarizes one of the central points APTA, AOTA, and ASHA have been driving home since PDGM was finalized for implementation on January 1, 2020: that PDGM changes nothing in terms of CMS' requirements that HHAs provide high-quality reasonable and necessary rehabilitation services and that clinicians use clinical judgment in determining appropriate frequency, duration, and modality of services.

As the new system is implemented, the association will be gathering on-the-ground information from physical therapists and physical therapist assistants on how HHAs are responding, and will share those reports with CMS. CMS will also be tracking utilization and patient outcomes under PDGM to ensure appropriate provision of therapy. If you have experiences to share related to implementation of PDGM (or the SNF PDPM), reach out to advocacy@apta.org.

Learn the basics of how you can manage the PDGM in this "Compliance Matters" column published in PT in Motion magazine. Need more information? APTA has created an entire PDGM webpage with multiple resources to help you understand and make the case for your value in the system.


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