I 
110TH CONGRESS 
1ST SESSION H. R. 4248 
To ensure access to recreational therapy in inpatient rehabilitation facilities, 
inpatient psychiatric facilities, and skilled nursing facilities under the 
Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 15, 2007 
Mrs. TAUSCHER (for herself and Mr. ENGLISH of Pennsylvania) introduced 
the following bill; which was referred to the Committee on Ways and 
Means, and in addition to the Committee on Energy and Commerce, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To ensure access to recreational therapy in inpatient rehabili-
tation facilities, inpatient psychiatric facilities, and 
skilled nursing facilities under the Medicare Program. 
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 ‘‘Ensuring Medicare Ac-
cess to Recreational Therapy Act of 2007’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Recreational therapy is a critical health care 
service that— 
(A) restores, remediates, and rehabilitates 
functional capacity for persons with injuries, 
chronic illnesses, and disabilities; 
(B) is provided by a qualified recreational 
therapist and is prescribed and supervised by a 
physician as part of a treatment plan; and 
(C) has been demonstrated by evidence- 
based research to improve the physical, cog-
nitive, social, and emotional functioning of indi-
viduals who receive the service. 
(2) The Centers for Medicare & Medicaid Serv-
ices (in this Act referred to as ‘‘CMS’’) has explicitly 
stated in preamble language to Federal regulations 
and in correspondence with Members of Congress 
that recreational therapy provided in inpatient reha-
bilitation facilities (each in this Act referred to as an 
‘‘IRF’’), inpatient psychiatric facilities (each in this 
Act referred to as an ‘‘IPF’’), and skilled nursing 
facilities (each in this Act referred to as a 
‘‘SNF’’)— 
(A) is a covered service under title XVIII 
of the Social Security Act; 
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(B) is an important service in supporting 
improved outcomes for Medicare beneficiaries; 
and 
(C) is a skilled rehabilitative modality in-
cluded in the bundle of services as part of the 
payment rate for IRFs, IPFs, and SNFs under 
the respective Medicare prospective payment 
systems for these settings. 
(3) Out of concern for potential liability for 
fraud and abuse, many IRF, IPF, and SNF facility 
administrators are declining to offer recreational 
therapy services because they lack clear regulatory 
guidance on the inclusion of recreational therapy 
services in the mix of services built into the prospec-
tive payment systems for these settings. 
(4) In order to ensure that Medicare bene-
ficiaries have access to this critical service, there is 
a compelling need for CMS to inform IRF, IPF, and 
SNF administrators, as well as the fiscal inter-
mediaries who process claims for payment, through 
the issuance of regulations or through publication in 
the Medicare Benefits Policy Manual, that rec-
reational therapy provided in IRFs, IPFs, and SNFs 
is covered by the respective Medicare part A pro-
spective payment system when required by the pa-
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tient’s condition and prescribed by a physician as a 
part of the facility’s plan of care for the patient. 
(5) Policy clarifications issued by CMS will not 
impose an additional burden on the Medicare Hos-
pital Insurance (HI) Trust Fund, as the costs of 
providing recreational therapy services to patients 
are already built into the prospective payment sys-
tems for the respective settings. 
SEC. 
3. 
ENSURING 
ACCESS 
TO 
PRESCRIBED 
REC-
REATIONAL THERAPY IN CERTAIN SETTINGS. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services, acting through the Administrator of 
CMS, shall issue a notice of proposed rulemaking, or issue 
a transmittal amending the Medicare Benefits Policy Man-
ual, or both, specifying that— 
(1) recreational therapy is a covered service 
under title XVIII of the Social Security Act in IRFs, 
IPFs, and SNFs; 
(2) recreational therapy is a skilled rehabilita-
tive modality included in the bundle of services as 
part of the payment rates for IRFs, IPFs, and 
SNFs under Medicare’s respective prospective pay-
ment systems for these inpatient settings; and 
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(3) any recreational therapy that is provided to 
a Medicare beneficiary in an IRF, IPF, or SNF pre-
scribed by a physician as part of the facility’s plan 
care for the patient must be provided by a qualified 
recreational therapist. 
(b) CONSTRUCTION.—Nothing in subsection (a) shall 
be construed as affecting the payment rates otherwise es-
tablished for IRFs, IPFs, or SNFs under the Medicare 
program. 
Æ 
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