,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #dgee  ,,in ,,the ,,house ,,of  
,,representatives  ,may #bi1 #bjad ,mr4 
,thompson of ,pennsylvania 7for himself 
and ,mr4 ,butterfield7 introduced the   
following bill2 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    
unit4  #a4 ,short title ,this ,act may  
be cited as the ,access to ,inpatient   
,rehabilitation ,therapy ,act of #bjad4 
#b4 ,findings and purpose  7a7 ,findings
 ,congress finds the following3  7#a7   
,intensive1 coordinated medical         
rehabilitation provided in inpatient    
rehabilitation hospitals and units is   
critical to ,medicare beneficiaries with
 injuries1 illnesses1 disabilities1 and 
chronic conditions in order to return to
 health1 full function1 independent     

living1 and a high quality of life4     
7#b7 ,the ,centers for ,medicare        
,medicaid ,services 7in this section    
referred to as ,,cms7 uses an intensity 
of therapy requirement to help determine
 which ,medicare beneficiaries are      
appropriate for treatment in an         
inpatient rehabilitation hospital or    
unit4 ,,cms has interpreted the         
intensity of therapy requirement through
 application of the so-called ,three    
,hour ,rule 7#db ,c4,f4,r4              
#dab4fbb7;a77#c77;ii77 which requires   
the patient to be able to participate in
 three hours of rehabilitation therapy  
per day1 five days per week1 or #ae     
hours of rehabilitation therapy over a  
one-week period4  7#c7 ,before #bjaj1   
,,cms regulations explicitly stated that
 physical therapy1 occupational therapy1
 speech therapy1 and_/or orthotics and  
prosthetics were counted toward the     
,three ,hour ,rule on an as-needed      
basis4 ,in addition1 ,,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 7,,hcfa ,ruling #he-b74  7#d7     
,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 setting4
  7#e7 ,,cms by regulation 7#gd ,fed4   
,reg4 #cihaa 7,august #g1 #bjji77       
revised these prior regulations1        
effective ,january #a1 #bjaj1 by        
limiting the ,three ,hour ,rule to      
recognize only four services 7namely1   
physical1 occupational1 and speech      
therapy as well as orthotics and        
prosthetics7 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 ,rule4 
,as a result1 recreational therapy      

services are often not available to     
patients who require medically necessary
 recreational therapy as part of their  
plan of care4  7#f7 ,recreational       
therapy is a treatment service designed 
to restore1 remediate1 and rehabilitate 
a patient's level of functioning and    
independence in life activities1 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 condition4   
,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
 care4  7b7 ,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 setting1 including physical        
therapy1 occupational therapy1 and1 as  
needed1 speech therapy1 orthotics and   
prosthetics1 and recreational therapy4  
#c4 ,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       
7,,irf7  7a7 ,in general ,section       
#ahhf7;j7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acieww7j77 is amended by
 adding at the end the following new    
paragraph3  7#i7 ,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 7pursuant to applicable     
regulations7 whether inpatient services 
in a rehabilitation facility are        
reasonable and necessary under section  
#ahfb7;a77#a77;,a74  4  7b7 ,effective  
date ,the amendment made by section 7a7 
shall apply to services furnished on or 
after ,january #a1 #bjae4