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 reha-
bilitation 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) intro-
duced 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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: 
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(1) Intensive, coordinated medical rehabilitation 
provided in inpatient rehabilitation hospitals and 
units is critical to Medicare beneficiaries with inju-
ries, 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 Serv-
ices (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 deter-
mined by the physician and the rehabilitation team 
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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, ef-
fective January 1, 2010, by limiting the Three Hour 
Rule to recognize only four services (namely, phys-
ical, occupational, and speech therapy as well as 
orthotics and prosthetics) and removing the discre-
tion of the physician and the rehabilitation team to 
count other therapeutic services needed by the pa-
tient 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 pa-
tient’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 re-
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strictions to participation in life situations caused by 
an illness or disabling condition. Recreational ther-
apy in the inpatient rehabilitation hospital and unit 
setting is provided by qualified recreational thera-
pists 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 re-
store 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 serv-
ices in that setting, including physical therapy, occupa-
tional therapy, and, as needed, speech therapy, orthotics 
and prosthetics, and recreational therapy. 
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