Access to Inpatient Rehabilitation Therapy Act of 2014

Summary: Access to Inpatient Rehabilitation Therapy Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to include recreational therapy services among the therapeutic modalities that constitute an intensive rehabilitation therapy program in determining whether inpatient services in an inpatient rehabilitation facility are reasonable and necessary. 

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.