I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to Inpatient 

5 Rehabilitation Therapy Act of 2014’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 


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1 (1) Intensive, coordinated medical rehabilitation 

2 provided in inpatient rehabilitation hospitals and 

3 units is critical to Medicare beneficiaries with inju4 ries, illnesses, disabilities, and chronic conditions in 

5 order to return to health, full function, independent 

6 living, and a high quality of life. 

7 (2) The Centers for Medicare & Medicaid Serv8 ices (in this section referred to as ‘‘CMS’’) uses an 

9 ‘‘intensity of therapy’’ requirement to help determine 

10 which Medicare beneficiaries are appropriate for 

11 treatment in an inpatient rehabilitation hospital or 

12 unit. CMS has interpreted the intensity of therapy 

13 requirement through application of the so-called 

14 ‘‘Three Hour Rule’’ (42 C.F.R. 412.622(a)(3)(ii)) 

15 which requires the patient to be able to participate 

16 in three hours of rehabilitation therapy per day, five 

17 days per week, or 15 hours of rehabilitation therapy 

18 over a one-week period. 

19 (3) Before 2010, CMS regulations explicitly 

20 stated that physical therapy, occupational therapy, 

21 speech therapy, and/or orthotics and prosthetics 

22 were counted toward the Three Hour Rule on an as23 needed basis. In addition, CMS regulations stated 

24 that ‘‘other therapeutic modalities’’ that were deter25 mined by the physician and the rehabilitation team 


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1 to be needed by the patient ‘‘on a priority basis’’ 

2 would qualify toward satisfaction of the rule (HCFA 

3 Ruling 85–2). 

4 (4) This language allowed recreational therapy 

5 to count toward satisfaction of the Three Hour Rule 

6 for patients who required this mix of therapies on a 

7 priority basis in the inpatient rehabilitation hospital 

8 or unit setting. 

9 (5) CMS by regulation (74 Fed. Reg. 39811 

10 (August 7, 2009)) revised these prior regulations, ef11 fective January 1, 2010, by limiting the Three Hour 

12 Rule to recognize only four services (namely, phys13 ical, occupational, and speech therapy as well as 

14 orthotics and prosthetics) and removing the discre15 tion of the physician and the rehabilitation team to 

16 count other therapeutic services needed by the pa17 tient toward satisfaction of the Three Hour Rule. As 

18 a result, recreational therapy services are often not 

19 available to patients who require medically necessary 

20 recreational therapy as part of their plan of care. 

21 (6) Recreational therapy is a treatment service 

22 designed to restore, remediate, and rehabilitate a pa23 tient’s level of functioning and independence in life 

24 activities, to promote health and wellness as well as 

25 to reduce or eliminate the activity limitations and reVerDate Mar 15 2010 22:09 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4755.IH H4755

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1 strictions to participation in life situations caused by 

2 an illness or disabling condition. Recreational ther3 apy in the inpatient rehabilitation hospital and unit 

4 setting is provided by qualified recreational thera5 pists when required by the patient’s condition and 

6 prescribed by a physician as part of a patient’s plan 

7 of care. 

8 (b) PURPOSE.—It is the purpose of this Act to re9 store reliance on the professional judgment of the treating 

10 physician and the rehabilitation team when determining 

11 whether a Medicare patient meets the intensity of therapy 

12 requirement of an inpatient rehabilitation hospital or unit 

13 in order for that patient to gain access to the appropriate 

14 mix of medically necessary therapeutic rehabilitation serv15 ices in that setting, including physical therapy, occupa16 tional therapy, and, as needed, speech therapy, orthotics 

17 and prosthetics, and recreational therapy. 


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1 SEC. 3. INCLUDING RECREATIONAL THERAPY AMONG THE 

2 THERAPY MODALITIES THAT CONSTITUTE AN 

3 INTENSIVE REHABILITATION THERAPY PRO4 GRAM IN DETERMINING THE MEDICAL NE5 CESSITY OF SERVICES IN AN INPATIENT RE6 HABILITATION FACILITY (IRF). 

7 (a) IN GENERAL.—Section 1886(j) of the Social Se8 curity Act (42 U.S.C. 1395ww(j)) is amended by adding 

9 at the end the following new paragraph: 

10 ‘‘(9) INCLUDING RECREATIONAL THERAPY

11 AMONG THERAPY MODALITIES THAT CONSTITUTE AN

12 INTENSIVE REHABILITATION THERAPY PROGRAM IN

13 A REHABILITATION FACILITY.—The Secretary shall 

14 include recreational therapy services among the 

15 therapeutic modalities that constitute an intensive 

16 rehabilitation program in determining (pursuant to 

17 applicable regulations) whether inpatient services in 

18 a rehabilitation facility are reasonable and necessary 

19 under section 1862(a)(1)(A).’’. 

20 (b) EFFECTIVE DATE.—The amendment made by 

21 section (a) shall apply to services furnished on or after 

22 January 1, 2015. 

Æ 


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