Text: H.R.4248 — 110th Congress (2007-2008)All Information (Except Text)

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Introduced in House (11/15/2007)


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 committee concerned


A BILL

To ensure access to recreational therapy in inpatient rehabilitation facilities, inpatient psychiatric facilities, and skilled nursing facilities under the Medicare Program.

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

SECTION 1. Short title.

This Act may be cited as the “Ensuring Medicare Access to Recreational Therapy Act of 2007”.

SEC. 2. Findings.

Congress finds the following:

(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, cognitive, social, and emotional functioning of individuals who receive the service.

(2) The Centers for Medicare & Medicaid Services (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 rehabilitation 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;

(B) is an important service in supporting improved outcomes for Medicare beneficiaries; and

(C) is a skilled rehabilitative modality included 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 prospective payment systems for these settings.

(4) In order to ensure that Medicare beneficiaries 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 intermediaries who process claims for payment, through the issuance of regulations or through publication in the Medicare Benefits Policy Manual, that recreational therapy provided in IRFs, IPFs, and SNFs is covered by the respective Medicare part A prospective payment system when required by the patient’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 Hospital Insurance (HI) Trust Fund, as the costs of providing recreational therapy services to patients are already built into the prospective payment systems for the respective settings.

SEC. 3. Ensuring access to prescribed recreational 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 Manual, 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 rehabilitative modality included in the bundle of services as part of the payment rates for IRFs, IPFs, and SNFs under Medicare’s respective prospective payment systems for these inpatient settings; and

(3) any recreational therapy that is provided to a Medicare beneficiary in an IRF, IPF, or SNF prescribed 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 established for IRFs, IPFs, or SNFs under the Medicare program.