I 
118TH CONGRESS 
1ST SESSION H. R. 6110 
To amend title XVIII of the Social Security Act to restore physician judgment 
to prescribe the appropriate mix of skilled modalities that constitute 
an intensive rehabilitation therapy program in an inpatient rehabilitation 
hospital or unit. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 26, 2023 
Mr. THOMPSON of Pennsylvania (for himself and Mr. COURTNEY) 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 restore 
physician judgment to prescribe the appropriate mix of 
skilled modalities that constitute an intensive rehabilita-
tion therapy program in an inpatient rehabilitation hos-
pital 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 2023’’. 
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 3 hours of rehabilitation therapy per day, 5 days 
per week, or 15 hours of rehabilitation therapy over 
a 1-week period. 
(3) In 1989, a Federal district court held that 
‘‘Medicare determinations for hospital rehabilitation 
care are to be based upon an assessment of each in-
dividual patient’s need for care’’ and ‘‘denials of ad-
missions, services, and/or Medicare coverage based 
upon 
numerical 
utilization 
screens, 
diagnostic 
screens, diagnosis, specific treatment norms, the 
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‘Three Hour Rule’, or other ‘rules of thumb’ are not 
appropriate.’’ Hooper v. Sullivan, No. H–80–99 (D. 
Conn. 1989). 
(4) Before 2010, a CMS ruling explicitly stated 
that physical therapy, occupational therapy, speech 
therapy, and orthotics and prosthetics were counted 
toward the Three Hour Rule on an as-needed basis. 
In addition, the CMS ruling 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 quality to-
ward satisfaction of the rule (HCFA Ruling 85–2). 
(5) This language allowed physicians with spe-
cialized training and experience in inpatient hospital 
rehabilitation to prescribe the mix of skilled thera-
pies and services appropriate to meet the needs of 
each individual patient in order to satisfy the Three 
Hour Rule in the inpatient rehabilitation hospital or 
unit setting. 
(6) CMS by regulation (74 Fed. Reg. 39811 
(August 7, 2009)) revised these prior requirements, 
effective January 1, 2010. The Secretary of Health 
and Human Services acknowledged that he is bound 
by the court’s decision in Hooper v. Sullivan that 
‘‘rules of thumb’’, including the Three Hour Rule, 
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