[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4755 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4755
To amend title XVIII of the Social Security Act to include recreational
therapy among the therapy modalities that constitute an intensive
rehabilitation therapy program in an inpatient rehabilitation hospital
or unit.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 29, 2014
Mr. Thompson of Pennsylvania (for himself and Mr. Butterfield)
introduced the following bill; which was referred to the Committee on
Ways and Means
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to include recreational
therapy among the therapy modalities that constitute an intensive
rehabilitation therapy program in an inpatient rehabilitation hospital
or unit.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Access to Inpatient Rehabilitation
Therapy Act of 2014''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress finds the following:
(1) Intensive, coordinated medical rehabilitation provided
in inpatient rehabilitation hospitals and units is critical to
Medicare beneficiaries with injuries, illnesses, disabilities,
and chronic conditions in order to return to health, full
function, independent living, and a high quality of life.
(2) The Centers for Medicare & Medicaid Services (in this
section referred to as ``CMS'') uses an ``intensity of
therapy'' requirement to help determine which Medicare
beneficiaries are appropriate for treatment in an inpatient
rehabilitation hospital or unit. CMS has interpreted the
intensity of therapy requirement through application of the so-
called ``Three Hour Rule'' (42 C.F.R. 412.622(a)(3)(ii)) which
requires the patient to be able to participate in three hours
of rehabilitation therapy per day, five days per week, or 15
hours of rehabilitation therapy over a one-week period.
(3) Before 2010, CMS regulations explicitly stated that
physical therapy, occupational therapy, speech therapy, and/or
orthotics and prosthetics were counted toward the Three Hour
Rule on an as-needed basis. In addition, CMS regulations stated
that ``other therapeutic modalities'' that were determined by
the physician and the rehabilitation team to be needed by the
patient ``on a priority basis'' would qualify toward
satisfaction of the rule (HCFA Ruling 85-2).
(4) This language allowed recreational therapy to count
toward satisfaction of the Three Hour Rule for patients who
required this mix of therapies on a priority basis in the
inpatient rehabilitation hospital or unit setting.
(5) CMS by regulation (74 Fed. Reg. 39811 (August 7, 2009))
revised these prior regulations, effective January 1, 2010, by
limiting the Three Hour Rule to recognize only four services
(namely, physical, occupational, and speech therapy as well as
orthotics and prosthetics) and removing the discretion of the
physician and the rehabilitation team to count other
therapeutic services needed by the patient toward satisfaction
of the Three Hour Rule. As a result, recreational therapy
services are often not available to patients who require
medically necessary recreational therapy as part of their plan
of care.
(6) Recreational therapy is a treatment service designed to
restore, remediate, and rehabilitate a patient's level of
functioning and independence in life activities, to promote
health and wellness as well as to reduce or eliminate the
activity limitations and restrictions to participation in life
situations caused by an illness or disabling condition.
Recreational therapy in the inpatient rehabilitation hospital
and unit setting is provided by qualified recreational
therapists when required by the patient's condition and
prescribed by a physician as part of a patient's plan of care.
(b) Purpose.--It is the purpose of this Act to restore reliance on
the professional judgment of the treating physician and the
rehabilitation team when determining whether a Medicare patient meets
the intensity of therapy requirement of an inpatient rehabilitation
hospital or unit in order for that patient to gain access to the
appropriate mix of medically necessary therapeutic rehabilitation
services in that setting, including physical therapy, occupational
therapy, and, as needed, speech therapy, orthotics and prosthetics, and
recreational therapy.
SEC. 3. INCLUDING RECREATIONAL THERAPY AMONG THE THERAPY MODALITIES
THAT CONSTITUTE AN INTENSIVE REHABILITATION THERAPY
PROGRAM IN DETERMINING THE MEDICAL NECESSITY OF SERVICES
IN AN INPATIENT REHABILITATION FACILITY (IRF).
(a) In General.--Section 1886(j) of the Social Security Act (42
U.S.C. 1395ww(j)) is amended by adding at the end the following new
paragraph:
``(9) Including recreational therapy among therapy
modalities that constitute an intensive rehabilitation therapy
program in a rehabilitation facility.--The Secretary shall
include recreational therapy services among the therapeutic
modalities that constitute an intensive rehabilitation program
in determining (pursuant to applicable regulations) whether
inpatient services in a rehabilitation facility are reasonable
and necessary under section 1862(a)(1)(A).''.
(b) Effective Date.--The amendment made by section (a) shall apply
to services furnished on or after January 1, 2015.
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