Administrative and professional issues for the occupational therapist working in home health care include contractual relationships, referral systems, third-party reimbursement, documentation, equipment, and ethics. In this paper, the regulations for third-party reimbursement by Medicare, Medicaid, and Blue Cross for occupational therapy in home health care are explained, including the Medicare definition of homebound status and the requirement that treatment be restorative. The effect of such regulations on occupational therapy treatment planning and documentation of services is discussed. Coverage of frequently ordered equipment by Medicare and Medicaid is explained. Both the issues related to standards of practice, including the length and frequency of occupational therapy treatment sessions, and the expected duration of treatment are discussed. The effect on the professional relationship of treating patients in their own environments is examined. Changes in third-party reimbursement for inpatient care have presented occupational therapists with the challenge of working with acutely ill patients in their homes.

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