Access to Inpatient Rehabilitation Therapy Act of 2015

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. Short title This Act may be cited as the Access to Inpatient Rehabilitation Therapy Act of 2015 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 intensity of therapy Three Hour Rule (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 on a priority basis (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. 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) (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, 2016.

Summary: Access to Inpatient Rehabilitation Therapy Act of 2015 Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services 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.