,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #hgdf  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,augu/ #bf1 #bjbb,mr4 
,c\rtney 7= himself1 ,mr4 ,?ompson (    
,p5nsylvania1 & ,mr4 ,butt]field7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means  ,a     
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to re/ore        
physician judgm5t to prescribe !        
appropriate mix ( skill$ modalities t   
con/itute an int5sive rehabilitation    
!rapy program 9 an inpati5t             
rehabilitation hospital or unit4  #a4   
,%ort title ,?is ,act may be cit$ z !   
,access to ,inpati5t ,rehabilitation    
,!rapy ,act ( #bjbb4  #b4 ,f9d+s &      
purpose  7a7 ,f9d+s ,congress f9ds !    
foll[+3 7#a7 ,int5sive1 coord9at$ m$ical
 rehabilitation provid$ 9 inpati5t      
rehabilitation hospitals & units is     
critical to ,m$ic>e b5efici>ies )       
injuries1 illnesses1 disabilities1 &    
*ronic conditions 9 ord] to return to   
heal?1 full function1 indep5d5t liv+1 & 

a high quality ( life4  7#b7 ,! ,c5t]s =
 ,m$ic>e  ,m$icaid ,s]vices 79 ?is      
section ref]r$ to z ,,cms7 uses an      
int5sity ( !rapy requirem5t to help     
det]m9e :i* ,m$ic>e b5efici>ies are     
appropriate = treatm5t 9 an inpati5t    
rehabilitation hospital or unit4 ,,cms  
has int]pret$ ! int5sity ( !rapy        
requirem5t ?r\gh application ( ! s-call$
 ,?ree ,h\r ,rule 7#db ,c4,f4,r4        
#dab4fbb7;a77#c77;ii77 :i* requires !   
pati5t to be able to p>ticipate 9 ?ree  
h\rs ( rehabilitation !rapy p] day1 five
 days p] week1 or #ae h\rs (            
rehabilitation !rapy ov] a "o-week      
p]iod4  7#c7 ,9 #aihi1 a ,f$]al di/rict 
c\rt held t ,m$ic>e det]m9ations =      
hospital rehabilitation c>e are to be   
bas$ ^u an assessm5t ( ea* individual   
pati5t's ne$ = c>e & d5ials (           
admissions1 s]vices1 &_/or ,m$ic>e      
cov]age bas$ ^u num]ical utilization    
scre5s1 diagno/ic scre5s1 diagnosis1    
specific treatm5t norms1 ! ,?ree ,h\r   
,rule1 or o!r rules ( ?umb are n        

appropriate4 ,hoop] v4 ,sullivan1 ,no4  
,h-#hj-ii 7,d4 ,conn4 #aihi74  7#d7     
,be=e #bjaj1 a ,,cms rul+ explicitly    
/at$ t physical !rapy1 occupational     
!rapy1 spee* !rapy1 & or?otics &        
pro/hetics 7 c\nt$ t[>d ! ,?ree ,h\r    
,rule on an z-ne$$ basis4 ,9 addition1 !
 ,,cms rul+ /at$ t o!r !rapeutic        
modalities t 7 det]m9$ by ! physician & 
! rehabilitation team to be ne$$ by !   
pati5t 8on a priority basis0 w\ld       
quality t[>d satisfaction ( ! rule      
7,,hcfa ,rul+ #he-b74  7#e7 ,?is        
language all[$ physicians ) specializ$  
tra9+ & exp]i5ce 9 inpati5t hospital    
rehabilitation to prescribe ! mix (     
skill$ !rapies & s]vices appropriate to 
meet ! ne$s ( ea* individual pati5t 9   
ord] to satisfy ! ,?ree ,h\r ,rule 9 !  
inpati5t rehabilitation hospital or unit
 sett+4  7#f7 ,,cms by regulation 7#gd  
,f$4 ,reg4 #cihaa 7,augu/ #g1 #bjji77   
revis$ ^! prior requirem5ts1 effective  
,janu>y #a1 #bjaj4 ,! ,secret>y ( ,heal?
 & ,human ,s]vices ackn[l$g$ t he is    

b\nd by ! c\rt's decision 9 ,hoop] v4   
,sullivan t rules ( ?umb1 includ+ !     
,?ree ,h\r ,rule1 may n be impos$ to d5y
 ,,irf cov]age4 ,! ,secret>y /at$ t he  
w\ld 8monitor ! appropriat5ess (        
in/ances :]e ,i,r,fs demon/rate !       
requir$ level ( int5sity0 )\t meet+ !   
,?ree ,h\r ,rule4  7#g7 ,! ,secret>y's  
#bjaj regulation limit$ ! ,?ree ,h\r    
,rule to recognize only f\r skill$      
s]vices 7namely1 physical !rapy1        
occupational !rapy1 & spee* language    
pa?ology s]vices z well z or?otics &    
pro/hetics7 & requir$ t ! pati5t's      
physician mu/ c]tify t ! pati5t         
requires1 at admission1 at lea/ two ( ! 
f\r !rapy modalities1 "o ( :i* mu/ be   
ei!r physical !rapy or occupational     
!rapy4 ,! ,secret>y's #bjaj regulation  
remov$ ! discretion ( ! physician1 9    
consultation ) ! rehabilitation team1 to
 prescribe o!r skill$ modalities &      
!rapeutic s]vices ne$$ by ! pati5t t    
w\ld c\nt t[>d satisfaction ( ! ,?ree   
,h\r ,rule4 ,z a result1 ! full         

complem5t ( m$ically necess>y1 skill$   
!rapy s]vices may n be available to     
inpati5t rehabilitation hospital pati5ts
 z "p ( _! plan ( c>e4  7#h7 ,skill$1   
!rapeutic modalities 9 addition to      
physical !rapy1 occupational !rapy1     
spee* language pa?ology s]vices1 &      
or?otic & pro/hetic s]vices t %\ld be   
c\nt$ t[>d ! ,?ree ,h\r ,rule include   
recreational !rapy s]vices1 respiratory 
!rapy1 & o!r skill$ modalities z det]m9$
 by ! ,secret>y :5 su* skill$ s]vices   
are m$ically necess>y & prescrib$ by a  
physician z "p ( ! pati5t's plan ( c>e4 
7b7 ,purpose ,! purpose ( ?is ,act is to
 re/ore reliance on ! pr(essional       
judgm5t ( ! treat+ physician1 9         
consultation ) ! rehabilitation team1 :5
 det]m9+ :e!r a ,m$ic>e pati5t meets !  
int5sity ( !rapy requirem5t ( an        
inpati5t rehabilitation hospital or unit
 9 ord] = t pati5t to ga9 access to !   
appropriate mix ( m$ically necess>y1    
rehabilitation s]vices 9 t sett+4 ,?is  
,act reta9s ! curr5t requirem5t t !     

pati5t mu/ ne$ at admission physical    
!rapy1 occupational !rapy1 spee*        
language pa?ology s]vices1 or or?otic & 
pro/hetic s]vices b p]mits ! pati5t's   
physician to modify ! int5sive          
rehabilitation !rapy program aft]       
admission to include additional necess>y
 !rapy modalities4  #c4 ,physician      
judgem5t to det]m9e ! !rapy modalities t
 con/itute an int5sive rehabilitation   
!rapy program 9 det]m9+ ! m$ical        
necessity ( s]vices 9 an inpati5t       
rehabilitation facility  7a7 ,9 g5]al   
,section #ahhf7;j7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7j77 is     
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#i7 ,physician judgem5t to  
det]m9e ! !rapy modalities t con/itute  
an int5sive rehabilitation !rapy program
 9 a rehabilitation facility ,9 ! case (
 a claim = paym5t "u ! prospective      
paym5t sy/em "u ?is subsection ) respect
 to a dis*>ge ( an individual1 9        
implem5t+ section #dab4fbb ( title #db1 
,code ( ,f$]al ,regulations 7or any     

successor to su* regulation7 = purposes 
( det]m9+ if items & s]vices ) respect  
to su* dis*>ge are to be consid]$       
reasonable & necess>y "u section        
#ahfb7;a77#a71 ! ,secret>y %all provide 
t an int5sive rehabilitation !rapy      
program describ$ 9 p>agraph 7a77#c77;ii7
 ( su* section #dab4fbb-- 7,a7 %all1 at 
! "t ( ! admission associat$ ) su*      
dis*>ge1 consi/ ( physical !rapy1       
occupational !rapy1 spee* language      
pa?ology s]vices1 or or?otic & pro/hetic
 s]vices 7or any comb9ation !re(72 &    
7,b7 may1 aft] su* admission1 be modifi$
 by ! rehabilitation physician treat+   
su* individual to include o!r skill$    
!rapeutic modalities1 includ+           
recreational !rapy1 respiratory !rapy1 &
 o!r skill$ s]vices specifi$ by !       
,secret>y4  4  7b7 ,effective date ,!   
am5dm5t made by subsection 7a7 %all     
apply to admissions occurr+ aft]        
,decemb] #ca1 #bjbb1 or ! la/ day ( !   
em]g5cy p]iod describ$ 9 section        
#aace7;g77#a77;,b7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4                    
#acbj;b-#e7;g77#a77;,b771 :i*ev] is     
soon]4